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What is the psychodynamic approach in therapy?

The psychodynamic approach in therapy focuses on the client’s unconscious thoughts and feelings, as they have an impact on the client’s current behaviour. Therefore, the main goals of this approach are to help the client become self-aware, explore how their past experiences can influence their present behaviour, and how their psychological problems from the past can be resolved. 

What to expect from psychodynamic therapy?

Psychodynamic therapy can either be short-term which typically lasts between a few months to a year with 25-30 sessions, or long-term lasting for a few years with 50 therapy sessions or more. The duration of psychodynamic therapy depends on the client’s needs and the severity of their problems. 

During psychodynamic therapy sessions, clients are usually encouraged to freely discuss anything that is on their mind, such as memories from the past, or how they are currently feeling. In psychodynamic therapy, the client would typically begin the session. The therapist will ensure they create a safe and non-judgmental space for their client, by listening actively and showing empathy. Furthermore, the therapist encourages self-reflection, which helps the client understand their unconscious thoughts and conflicts. 

What’s some of the theory behind psychodynamic?

The development of psychodynamic theory can be explained through four schools of thought: 

1. Drive theory: Freud suggested that an individual’s behaviour is influenced by different drives including the sex (eros), self-preservation, and destruction (death) drives. The id is the instinctual area of the brain that contains the basis of these drives. As an individual develops, external factors make it difficult to fulfil these drives. Gradually, the superego and ego trigger internal challenges. The superego is responsible for our morals and societal standards and acts as a conscience when we go against those values. The ego is the mediator between the external world and the id, which supports decision-making. 

2.  Ego psychology: Freud believed that the ego solely developed from the id. However, some theorists such as Rapaport & Hartmann further developed his work and believed that the ego developed autonomously, and did more than just control individuals' drives. They suggested that individuals have an additional drive to help explore their world. Overall, ego psychology helps to understand how the ego adjusts to the external world and social norms.

3. Object relations theory: This theory suggests that our early experiences and relationships with others, such as our parents and siblings, have an impact on our present interactions with other people. Object relations theory also emphasises the significance of our internalised representations (objects) of these relationships, which influences our feelings and behaviour. 

4. Self psychology: Self psychology was proposed by Kohut in 1959, who suggested that an individual’s perception of themself is influenced by their boundaries and differences from others. Those with a lack of self-esteem or an incomplete sense of self may experience mental health issues. However, individuals with a developed sense of self have better self-control, so they are more resilient. Some theorists believe that an underdeveloped sense of self stems from a lack of empathy from parents during childhood. 

What’s the difference between CBT and psychodynamic?

There are many differences between CBT and psychodynamic therapy. For example, psychodynamic therapy is usually long-term, typically lasting up to two years, whereas CBT sessions are short-term, and commonly last between 2-3 months. 

Another difference between psychodynamic and CBT is that psychodynamic therapy explores how an individual’s past experiences and unconscious behaviors can influence our current thoughts and behaviours. However, CBT focuses on identifying and adjusting current negative thought patterns and behaviours, which play a role in mental health issues, and finding practical solutions to overcome these difficulties. 

A further difference is that CBT is directed and led by the therapists asking their clients questions to help them reach their goals. On the other hand, in psychodynamic therapy, the client would begin the session and take the lead. The therapist would create a space for their client to talk freely and discuss whatever is on their minds, rather than asking questions. 

Who is psychodynamic therapy best suited for?

Psychodynamic therapy is suitable for several individuals. For instance, those who are suffering from mental health disorders such as depression, anxiety, eating disorders, and addictions. Furthermore, psychodynamic therapy may also be suitable for individuals who wish to explore their unconscious thoughts and feelings and gain insight into their early experiences, which mentally challenge their present behaviour. In addition, individuals who are passionate about gaining an in-depth understanding of themselves and their inner world may also benefit from psychodynamic therapy.

Why is the relationship between clients and therapists so important in psychodynamic therapy?

In psychodynamic therapy, it is important to ensure that the client and therapist build up a good relationship. When trust and a positive rapport are built between the client and therapist, it creates a supportive and safe space for clients which encourages them to freely discuss their thoughts, feelings, and childhood experiences. As a result, having a positive relationship helps the client to feel more comfortable to open up about their problems and inner world. This in turn will help the therapist gain an in-depth insight into their client’s unconscious thoughts. 

What are some techniques used in Psychodynamic?

Several techniques are implemented to help explore the client’s unconscious thoughts and emotions. For instance, free association is when the client is encouraged to freely discuss what is on their mind, such as their fears, dreams, significant events during the week, or any conflicts with others from the past. 

Another technique used is dream analysis, where the therapist helps the client explore the meaning and significance of their dreams. Exploring the client’s dreams enables the therapist to understand the client’s unconscious thoughts, feelings, and unresolved issues, which promotes self-discovery. 

A further technique implemented in psychodynamic therapy is clarification and interpretation. The therapist will either respond to their client through clarification by giving feedback or asking elucidating questions to gain a better understanding of their statement if something was unclear, or via interpretation which is how the therapist interprets their client’s thoughts and emotions. 

An additional technique used in psychodynamic therapy is catharsis, where clients will respond with a shift in their behaviour when the interpretations are accurate. Some of these actions include tears, anger, or laughter. The clients may also experience some shame or anxiety.