When we think about therapy, most of us envision the classic scenario of a client laying out on a couch expressing their feelings and the therapist listening intently. This picture of therapy was established by Sigmund Freud and his findings. Freud, often revered as the “Father of Psychoanalysis” believed that treating mental disorders should not rely on hospitals and medication but rather tapping into our unconscious. Later on, some of Freud's findings were discredited and his disciples went on to develop Psychodynamic theory - the foundation of Psychodynamic Psychotherapy. Psychodynamic psychotherapy is an in-depth form of talk therapy that focuses on resolving psychic tension that stems from unresolved conflicts from our past. It is based on the past work of Freud along with the integration of Ego Psychology, Self Psychology, and Object Relation Psychology.
What does Psychodynamic Psychotherapy treat?
- Adjustment Disorder
- Post-Traumatic Stress Disorder (PTSD)
- Panic Disorder
- Eating Disorders
Unlike symptom-based treatments such as Cognitive Behavioural Therapy (CBT), Psychodynamic Psychotherapy works underneath the surface to reveal unconscious issues. While CBT works by treating issues in the here and now through problem-solving and skills-based learning, Psychodynamic Psychotherapy encourages us to look into our past to gain any insight to help us in the present. When we are facing an issue in the present we may not know that it is a resolved conflict of our past that is driving this behaviour. Psychodynamic Psychotherapy brings that conflict to our present so we can deal with it.
Most Psychodynamic Psychotherapy works under the assumption that most of our thoughts and behaviours are driven by our past experiences. These experiences are buried deep within our unconscious and so often we are unaware of why we truly act in a certain way. Freud often used an analogy of an iceberg to describe the different levels of the mind.
The very tip of the iceberg is our consciousness, the part of our cognition that we are aware of. Our thoughts, feelings and emotions that we can explain at any given moment lie within our consciousness.
Then just below the surface of the water is our pre-conscious or subconscious; these are aspects of our minds that we could be aware of if we tried to. These thoughts can often manifest in our dreams. Another way to think of our preconscious is like our breathing or our heartbeats; we are not aware of these processes all the time however we can be if we focus on them
Lastly there is the unconscious mind, the majority of the iceberg. These are thoughts, feelings and urges that are completely out of our awareness and inaccessible to us on our own. According to Psychodynamic theory, oftentimes this part of our brains hides our most unpleasant thoughts to keep us from experiencing pain or anxiety.
We are masters at blocking our painful memories and burying them deep within our unconsciousness through defense mechanisms. While effective in blocking out unwanted thoughts, these defense mechanisms take a toll on our daily functioning.
Examples of Defense Mechanisms
One of the most important processes in Psychodynamic Psychotherapy is the therapeutic relationship between the client and the therapist. Any issue a client may have with a past relation - often with a primary caregiver - can manifest itself within the client/therapist relationship. This process is called transference and it is pivotal in understanding the unconscious workings of the mind. For example, if someone's unhealthy attachment to their mothers is impeding their ability to properly function in their daily lives they might try Psychodynamic Psychotherapy. During the process, while the client is freely speaking they place their hostility for their mother on their therapist.