Psychodynamic psychotherapy

Psychodynamic psychotherapy

Definition

Psychodynamic psychotherapy is a method of verbal communication used to help a person find relief from emotional pain. It is based on the theories and techniques of psychoanalysis . Psychodynamic psychotherapy is similar to psychoanalysis in that it attributes emotional problems to the patient's unconscious motives and conflicts. It differs from classical psychoanalysis, however, in that psychodynamic psychotherapists do not necessarily accept Freud's view that these unconscious motives and conflicts are ultimately sexual in nature.

Purpose

The goals of psychodynamic psychotherapy vary depending on the method of treatment, which can be broadly described as either expressive or supportive. Expressive therapy seeks to relieve symptoms through the development of insight, or the slowly developing awareness of feelings and thoughts that were once outside of the person's awareness. Expressive therapy is based on the rationale that difficulties experienced in adult life originate in childhood; that children do not possess the maturity for making effective choices nor the independence to do so; and that methods of adapting that were developed in childhood may no longer be effective for adapting to the world as an adult. Through guidance from a therapist, the adult becomes aware of present ways of coping that are ineffective and how they served a purpose in childhood that is no longer relevant. The person learns that he or she now has a range of new options for solving problems, and for living in general that are now based on his or her maturity and independence.

In contrast to expressive therapy which is exploratory, supportive therapy remains closer to the surface of the patient's issues. Supportive therapy is an approach that is used to relieve immediate distress; to return the person to his or her previous level of functioning; and to strengthen adaptive ways of coping that the individual already possesses in order to prevent further discomfort. Expressive and supportive methods of treatment are not completely separate categories because elements of supportive therapy are used in expressive treatment and vice versa, depending on the therapeutic need. For instance, if a person in exploratory treatment is experiencing distress, a supportive approach may be used for a period of time in order to help the person feel more stable.

While many patients benefit from individual psychotherapy alone, some instances call for such additional therapies as family therapy , couples therapy , or group therapy in combination with individual treatment. A second treatment modality might be recommended when the patient's progress in individual treatment is highly dependent on relationships with significant others or with interpersonal relationships in general. Psychotropic (mood- or behavior-altering) medication may also be prescribed as an adjunct (help) to treatment in order to manage disturbances in anxiety level, mood or thinking. Whether additional treatments are recommended is based on the needs of the individual.

People seek psychodynamic psychotherapy for a variety of reasons that include but are not limited to the following: prolonged sadness, anxiety, sexual difficulties, physical symptoms without physical basis, persistent feelings of isolation and loneliness, and the desire to be more successful in work or love. People seek therapy because they have not been able to develop a stable resolution for their difficulties on their own or with the help of friends and family members.

Description

Sessions of psychodynamic psychotherapy may be scheduled from one to three days per week, with greater frequency allowing for more in-depth treatment. The duration of individual sessions varies, but typically lasts for 45–50 minutes. It is not usually possible at the outset of treatment to estimate the number of sessions that will be necessary in order to achieve the person's goals. It is possible, however, for the person to make arrangements for a specific number of sessions.

Psychodynamic psychotherapy begins with a period of evaluation during which the client discusses with the therapist the reasons for seeking treatment. This process gives the therapist the opportunity to learn about the person, to develop an understanding of his or her troubles, and to formulate ideas about how treatment should proceed. This phase of interviewing and learning may take place in one session or over a series of sessions; or it may be done in a less structured manner, depending on the therapist's style. During the initial sessions, such factors as the frequency and length of sessions and the policy for payment will also be discussed. At some point within the first few sessions, the therapist and the individual will come to a mutual understanding of the goals for treatment. After this point, the sessions will become less like an interview; the person is asked to say whatever is on his or her mind. It is the therapist's job to listen and to help identify patterns of thinking, feeling and interacting that may be contributing to the patient's current struggles. Consequently, the person becomes more aware of his or her thoughts and feelings; learns how some present ways of coping are no longer adaptive even though they may have been necessary in childhood; and discovers that he or she as an adult has a greatly expanded repertoire of resources and can use far more effective ways of dealing with problems. Deeper awareness and new insights stimulate psychological growth and change.

Psychodynamic psychotherapy places great importance on the therapeutic dyad, which is a medical term for the relationship between the therapist and the patient. It is within the context of the therapeutic dyad that positive changes in the patient's outlook and behaviors are able to unfold. This relationship is unique because the therapist maintains a uniform, neutral and accepting stance. Unlike other well-intentioned people in the person's life, the therapist has been trained to listen objectively and without criticism. This therapeutic attitude makes it easier for the person seeking treatment to speak freely and to therefore provide as much information for the therapist to work with as is possible.

Treatment continues until the troubling symptoms have been reduced or alleviated and the person is consistently making use of more adaptive methods of coping with greater insight. For some people, this positive experience inspires them to proceed with further treatment in order to bring about additional adaptive changes. For others, meeting the initial goals will be sufficient. If so, the focus of sessions turns to issues related to the end of treatment. This final phase of treatment is as important as the beginning and middle stages because it allows the individual to develop insight about his or her therapeutic experience. People need time to clarify how they feel about leaving the therapeutic relationship, and this termination involves identifying and understanding feelings about separation, maturation, loss and change. The length of time allotted to the termination phase varies with the type of treatment and with the needs of the individual.

Normal results

After a course of psychodynamic psychotherapy has ended, the person should, overall, continue to handle difficulties in a more adaptive manner; experience improved interpersonal relationships and productivity at work; and continue to develop new insights into his or her thoughts, feelings and behavior. In supportive treatment, insight and personality change are not the primary goals of treatment; the therapist and patient work toward a continuation of general stability in the person's life.

Resources

BOOKS

Balsam, Rosemary Marshall, M.D., and Alan Balsam, M.D. Becoming a Psychotherapist. Chicago: The University of Chicago Press, 1984.

Dewald, Paul, M.D. "The Psychoanalytic Psychotherapies." In Textbook of Psychoanalysis, edited by Edward Nersessian, M.D. and Richard G. Kopff, M.D. Washington, DC: American Psychiatric Press, 1996.

Prochaska, James O., and John C. Norcross. Systems of Psychotherapy: A Transtheoretical Analysis. 4th edition. Pacific Grove: Brooks/Cole Publishing Company, 1999.

ORGANIZATIONS

American Psychoanalytic Association. 309 East 49th Street, New York, NY 10017. (212) 752-0450. <http://www.apsa.org>.

American Psychological Association. 750 First Street, NE, Washington D.C. 20002. (800) 374-2721. <http://www.apa.org>.

Susan Fine, Psy.D.