Psychodynamic Psychotherapy

Psychodynamic psychotherapy is an in depth therapy, highly effective for those with complex, deep-rooted and often unconsciously based emotional and relationship problems or anyone who wants to work in depth.

What is Psychodynamic Psychotherapy?

Psychodynamic psychotherapy theory, based on clinical practice, believes that we develop defence mechanisms as a way of protecting ourselves from having to deal with painful or difficult aspects of ourselves. These defence mechanisms can often be unhelpful, causing and maintaining emotional problems, relationship difficulties and even adding to mental health conditions such as depression and anxiety.

Psychodynamic psychotherapy seeks to help the client to bring these internal conflicts into their consciousness, to safely experience the feelings which are causing the emotional suffering and to begin to resolve those conflicts by working with the therapist.

This work is done through the therapeutic relationship.

What should I expect from Psychodynamic psychotherapy?

1. The therapeutic relationship – a key trait of working in a psychodynamic way is that the relationship between you and the therapist will be important to your therapy.
2. Transference - Psychodynamic psychotherapy believes that unconscious patterns of your inner world will be reflected in your relationship with the therapist - (this is called ‘transference’). These patterns of relating develop very early on through our relationships with others.
3. Understanding patterns in your life - by identifying and understanding patterns of relating that keep repeating in your life you can become more conscious of them, developing the capacity to understand and change them.
4. Your therapist may remain reserved - A psychodynamic psychotherapist may be less socially responsive and immediately reassuring than other therapists, who may take on a more involved role in your therapy, because a psychodynamic therapist is trying to evoke and support the transference.
5. Speaking your mind - a psychodynamic psychotherapist will ask you to try to say whatever is going through your mind and, whilst remaining closely tuned in and empathic, will also be more neutral, keeping their own personal feelings and reactions private. The therapist will listen deeply to all you tell them and think carefully about it.
6. Understanding through the therapeutic relationship - as well as trying to pick up hidden patterns and meanings in what you are saying, the therapist will also be interested in the way you are relating to him or her, and how this links with other, perhaps problematic, relationships in your life.
7. Longer term therapy – psychodynamic therapy aims to influence deeper layers of personality, at the source of the troubling thought or behaviour so courses of therapy can typically last longer than a therapy like CBT.
8. Long term effects - emerging research evidence is finding lasting benefits of this approach and a sleeper effect that endures long after treatment has ended. There have been a number of recent studies highlighting this in both adolescent and adult depression.

What is Psychodynamic Psychotherapy used to treat?

Psychodynamic psychotherapy is used effectively for many different issues, with both adults and children.

Psychodynamic psychotherapy can offer valuable insights and significantly help reduce emotional distress for people who have the following issues:

• Depression
• Anxiety
• Eating disorders
• Body image issues
• Low self esteem
• Relationship problems
• Phobias
• OCD
• Grief and bereavement
• Trauma

Many people who experience a loss of meaning in their lives or who are seeking a greater sense of fulfilment may be helped by psychodynamic psychotherapy.

Is Psychodynamic psychotherapy right for me?

Psychodynamic psychotherapy provides an effective treatment for a range of psychological disorders, both as a treatment in its own right and as a way of supporting other forms of treatment, such as medication.

The key indicators that psychodynamic psychotherapy might be a good choice for you include:

• Wanting to work in depth: Being able to really understand why you feel the way you feel and learn more about your personality is a big attraction to many of those who choose to start psychodynamic psychotherapy.
• You want to really know yourself: You will work to understand both your conscious and unconscious thoughts and this can be both fascinating, but also highly effective at helping understand the way you feel about certain things.
• You want to ‘let go’ of the past: For many of us, our early experiences are hugely formative – it can take time to unpick and understand them all, but many who attend psychodynamic psychotherapy say they feel huge relief at understanding and being able to ‘let go’ of the past.
• You are happy to work longer term: Some people find that they are much happier and secure knowing that can keep seeing their therapist for as long as they like – it allows you to work at your natural pace and will mean you can go into greater depth. It is also likely you will build a very special relationship with your therapist.

It is often helpful to have an initial meeting with a possible therapist – you can use this to ask any questions you have, to make sure you are happy to work with the therapist and to understand a bit more about how the therapist works.

Why might Psychodynamic Psychotherapy be the wrong therapy for me?

If the immediate, surface problem is a disabling or dangerous behaviour, such as constantly needing to check things, compulsive hand washing, bingeing or purging behaviour or self-harm, a behavioural approach may be the best starting point.

This is because behavioural therapeutic approaches can help you to learn new ways of dealing with these behaviours and can help give you a steadier base on which to explore more deep-rooted issues.

For some people, psychodynamic psychotherapy may not be the right choice for them because they would rather work in a more practical, time limited approach – such as CBT.

So, the choice of approach depends both on what is wrong and on what the person wants. Sometimes it takes time to work this out but getting it right is really important to getting the outcomes you are looking for from your therapy.

The therapeutic relationship is the key mechanism for change in psychodynamic psychotherapy. Motivation to change can help things move faster and I have seen significant progress made in a short space of time when people know that something is a problem that they really want to change. Elements of the process are like taking a long look in the mirror. It can be uncomfortable but very worth while.

Stuart Hannah

MSW, MPsychPsych

Child & Adolescent Psychotherapist

Birmingham

Stuart Hannah is a highly experienced Child & Adolescent Psychotherapist. Until 2014 he was Looked After & Adopted Children Lead for Leeds & York NHS Foundation Trust, which he left to become Therapy Lead North for Five Rivers Child Care....