When I was in graduate school, I was lucky to have a wonderful mentor, a talented psychoanalyst from whom I learned both psychodiagnostics and psychotherapy. Dr. Sidney Smith will always have a special place in my heart. Like him, many of my other teachers at the California School of Professional Psychology also hailed from the San Diego Psychoanalytic Institute. Since then, I have sought additional training in other methods, more geared to the treatment of trauma. But most of all, I continue learning from my patients.
Psychodynamic therapy is a “talk therapy” intended to provide a safe setting where one can voice one’s innermost thoughts and feelings, wishes, hopes and desires, and attempt to identify the obstacles to their fulfillment, such as self-doubts, negative beliefs about oneself, anxiety, depression and fear.
As the therapist listens attentively and in empathic attunement to the patient’s various communications, he or she may point out certain areas worthy of their joint attention, meanwhile guiding the patient to observe him/herself from a neutral, non-judgemental and increasingly compassionate place. This provides an opportunity for the patient to better understand himself, his behavior and his interpersonal relations with others.
During the initial sessions, both patient and therapist draw up a work plan in accordance with the patient’s goals. Periodically, they will re-assess where they are along this road map, and may redefine the patient’s priorities, as needed.
Some forms of psychodynamic therapy are more goal-oriented and short term than others. This may be a worthwhile topic to bring up with your therapist, especially at the beginning, when you are establishing what it is that you wish to achieve from the therapy. Financial considerations may also have bearing on the duration of therapy.
Psychodynamic, and especially a psychoanalytically-informed psychotherapy based on psychoanalytic principles —many of which may be traced back to Freud’s seminal contributions in the 19th century— focuses on the patient’s unconscious or hidden narratives and conflicts, in an attempt to shed light on these processes (e.g., via interpretation). In other words, the patient is guided to reach certain insights, as the therapeutic process adds developmental context and thus new meaning to previously enigmatic behavioral responses, ostensibly triggered by various situations.
Another way to describe this form of therapy is to say that it attempts to elucidate the dynamics of the instinctual forces operating within the patient’s psyche i.e., the struggle between creative life-affirming forces and destructive forces steering toward a return to an inorganic state. Attention is also paid to how the patient invests instinctual energy in his or her significant others (“objects.”)
In psychoanalysis, and to a lesser extent in psychodynamic therapy, the spontaneous, budding patient-therapist relationship may be utilized as a kind of live laboratory, as it were, one providing a window into the patient’s preferred, conscious and unconscious modes of interpersonal relations with others. For example, a patient may idealize his therapist, perhaps raising him to the level of perfection, meanwhile devaluing himself and his own abilities.
Via the therapeutic process, which may include an interpretation of these patterns and feelings, presumably transferred from a previous relationship with an earlier object (e.g., a parent) and subsequently placed upon the person of the therapist, these feelings can be gradually re-owned.
As the patient feels more understood and contained, and less alone with it all, the therapeutic process may lead to symptomatic relief e.g., the lifting of a reactive depression. As more conflict-free energy becomes available to the patient, the therapeutic work (both within and outside the session) may pave the way for actual behavioral and functional changes in one’s life, changes which may point to a greater degree of self-actualization.
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As alluded to earlier, this kind of therapy focuses on inner conflicts, manifested by mixed feelings, contradictory belief systems, inner voices or parts, and their expression in behavior. We may thus state that, “Part of me would like to do X, but another part (of me) wants to do Y.” For example, one may wish to do something for oneself e.g., go on a trip with a friend, but find it incompatible with the conflicting wish to “be there” for one’s partner at an important work-related event. A working-through of this conflict may lead to a satisfactory resolution.
It is possible to learn about oneself and one’s own inner conflicts from one’s dreams. According to Freud, the dream represents an unconscious compromise, that protects sleep. In therapy, dreams may be utilized in various ways, depending on the training and orientation of the therapist.
In conclusion, the therapist’s role is to allow the patient to make life choices from an informed, conscious place, not while under the influence of unconscious needs or wishes. Normally, the therapist does not take sides with a specific voice or part, but aligns him/herself with and supports, life-affirming, healing forces within the patient.
Psychodynamic therapy can be used to treat various conditions. However, it requires the patient to be curious about him or herself and his or her inner world, and to be able to tolerate affects (feelings) without necessarily acting upon them, impulsively or otherwise. A certain level of introspection and psychological mindedness is needed and may be cultivated and refined during therapy.
It is customary to leave the termination date open-ended at first (unless the therapeutic contract is for a short-term therapy), and eventually to set a date several months or even a year in advance. Obviously, this is not set in stone, and is negotiable.
The duration of treatment is influenced by many factors. Ideally, it should allow for significant gains to be made—not only in terms of new insights achieved, but with respect to their application in everyday life: symptomatic relief, advances in one’s relationships, in one’s attitude towards oneself (i.e., celebrating one’s strengths and accepting one’s shortcomings) and towards others (e.g., being able to accept and love them as they are), refining one’s goals and ambitions, with respect to family, work, creativity.
In a nutshell, the therapy should last long enough for the patient to develop new resources and strengthen those already available to him or her. These resources, which include beneficial experiences and memories with meaningful figures, should be enough to allow for adaptive behavior in the face of new challenges, change adversity and ambiguity.
Obviously, one’s life circumstances, life style and need to travel, health, and available resources such as finances and time—all these may affect the duration of treatment.
If, for whatever reason, a patient wishes to terminate the relationship before the bulk of the work is done, this should be discussed ahead of time with the therapist.
Sometimes, despite the wish to discontinue the therapy (and temptation to inform the therapist via a text message or email), the opportunity for mutual exploration of the patient’s motives within the session may be quite informative. For example, patients sense they are getting emotionally closer to the therapist, and this may feel uncomfortable to them, or even anxiety-producing. Perhaps they don’t want to become dependent on the therapist, or are afraid the therapist will reject them or leave them once he or she gets to know them better (as may have happened in the past with significant others.) Perhaps they have an unconsicous need to test the therapist, and see how she or he reacts when they bring up their leave-taking.
When patients can learn to tolerate the urge to leave, and find within themselves the courage to bring it up in the session and discuss their reluctance to continue, perhaps they can learn something useful about themselves-in-relationship. This something may prove valuable when applied to their relationships outside the session. In fact, the working through of these issues, grist for the therapeutic mill, so to speak, may prove invaluable.
It is possible to summarize characteristic aspects of dynamic psychotherapy in the following way:
In psychodynamic therapy, we value dreams and tend to give them priority when they come up during a session, because dreams may be viewed as a telegram from the unconscious.
There are many different approaches to dreams and their interpretation. For example, some therapists (usually Jungians) will be attuned to the resonance with collective archetypes that may have been constellated in the patient’s psyche at that time. Others will focus on developmental issues, including psychosexual development. At times, they may focus on the links between the dream and how the patient feels about the therapist. All approaches are valid and informative, and may have something valuable to offer the dreamer.
Dreams can be understood as a conscious form of a repressed wish, a disguised expression of some inner conflict or struggle that we (our brain) is trying to work through, even as we sleep. Freud suggested that the dream is a compromise formation between the demands of the ego’s defenses to protect us from anxiety, and the unconscious wish, which if conscious, would presumably evoke much anxiety, and that this compromise allows us to sleep. Thus, even “anxiety dreams” are understood to reflect a compromise.
The manifest story of the dream (the action plot) is one level of understanding, but the underlying subtext can be quite elusive, and requires some collaborative work between the dreamer and the therapist, in order to be further understood. I find that it is important to attend to the feeling tone of the dream e.g., how one feels in the actual dream, as well as upon its recounting. Not only how the dream is told, but to whom and when, all these are important. It is also necessary to retain an open mind and allow for an associative process to come about, as it will have important clues that may help elucidate the meaning of the dream, including why the dreamer brought it up.
Generally speaking, I assume that all the figures and conflicts in the dream represent aspects or parts of the dreamer. The dream is to be taken symbolically, and not literally. Among other things, it may point to attachment styles and relationships with significant others, including the therapist.
