Understanding Psychodynamic Therapy: Theory, Mechanisms, and Therapeutic Scope
Psychodynamic therapy is a psychotherapeutic approach that aims to understand the unconscious processes that shape an individual’s emotions, thoughts, and behaviors. Psychodynamic therapy, which seeks to take a deep journey into the individual’s inner world, is concerned not only with the visible symptoms but also with the underlying causes of these symptoms. In line with this goal, the therapy focuses on the effects of the individual’s past experiences, particularly relationships formed during childhood and events experienced, on their current psychological functioning (Cabaniss et al., 2011; Cabaniss et al., 2013).
This approach, based on Freud’s psychoanalytic theory, has evolved over time and expanded through modern psychodynamic theories. Psychodynamic therapy, after multiple stages of development, now focuses not only on understanding the individual’s psychological conflicts but also on developing self-esteem, relationship-building capacity, and coping mechanisms for stress. Thus, it can be said that another goal of psychodynamic therapy is to offer the individual not only symptomatic relief but also structural internal change (Cabaniss et al., 2011; Cabaniss et al., 2013).
In the psychodynamic approach, which offers a dynamic understanding of the individual’s mental structure, just as a geologist investigates the forces at work beneath the earth’s surface, a therapist working with the psychodynamic school also seeks to understand the unconscious forces underlying the client’s visible behaviors. This therapeutic process is based on understanding the individual’s life story, recognizing unconscious conflicts, and helping them develop new coping strategies with this awareness. In the current therapy sketch, psychodynamic therapy theory will be comprehensively addressed, its areas of application will be examined, and the positive and profound effects it has in the therapy room will be highlighted.
What is Psychodynamic Therapy?
Psychodynamic therapy is a form of talk therapy that aims to understand how thoughts, feelings, desires, and conflicts in the individual’s unconscious mind affect their behavior, emotional responses, and thought patterns in daily life. This therapeutic approach aims to eliminate symptoms that negatively affect the individual’s functioning and to discover and transform the unconscious dynamics underlying these symptoms. In this respect, psychodynamic therapy offers a holistic view of the individual’s mental structure (Cabaniss et al., 2011; Cabaniss et al., 2013).
The concept of ‘’psychodynamic’’ refers to the idea that mental processes are in a state of constant movement, change, and interaction. Based on Freud’s theory, this approach asserts that the mind is not a static structure, but rather a dynamic force at work at both the conscious and unconscious levels. In psychodynamic therapy, an individual’s emotional states, thoughts, internal conflicts, and behavioral patterns are addressed in connection with internal representations shaped by past experiences, particularly those formed during childhood relationships. The fundamental characteristics of psychodynamic therapy, which has a multifaceted and complex structure, are as follows (Cabaniss et al., 2011; Cabaniss et al., 2013):
- Focuses on unconscious processes:
The fundamental premise of psychodynamic therapy is the assumption that unconscious sources primarily feed the psychological distress experienced by individuals. Individuals often struggle to understand why they behave in the same patterns, why they get caught up in the same types of relationships, or why they repeat the same mistakes. Understanding, identifying, and transforming the processes underlying these thoughts is an important goal of psychodynamic therapy. In the therapeutic process, the conflicts, repressed emotions, unwanted behavior patterns, defense mechanisms, and internal representations that the individual carries unconsciously are brought to light and given meaning. The psychodynamic therapy process helps the individual gain a deeper understanding of their inner world, build stronger relationships with others, and develop healthy coping mechanisms (Cabaniss et al., 2011).
- Offers a developmental approach:
Psychodynamic therapy establishes a connection between an individual’s past and present. In particular, relationships with caregivers during early childhood directly influence an individual’s self-perception, ways of relating to others, and coping mechanisms for stress. Within the psychodynamic framework, the therapist analyzes the individual’s life story and attempts to assess how developmental factors such as attachment styles, traumas, neglect, and parental attitudes are reflected in current psychological functioning (Cabaniss et al., 2011).
- It is based on hypothesis development:
In the psychodynamic approach, the therapist develops specific psychodynamic assumptions (formulations) regarding the problems experienced by the individual. These hypotheses are based on the individual’s past experiences, personality structure, defense mechanisms, and internal conflicts. However, these formulations are not fixed; as the therapeutic process progresses and new information about the client is obtained, the formulations are revised, deepened, and become more complex. The therapist uses these hypotheses throughout the therapy process as a ‘’guide map’’ to promote a holistic understanding of the individual’s psychological structure (Cabaniss et al., 2011; Cabaniss et al., 2013).
- It is relationship-based:
The therapeutic relationship is at the heart of psychodynamic therapy. The relationship that the client establishes with the therapist is not only a safe space for bonding, but also a reflective space where past relationship patterns are repeated. The feelings, expectations, and reactions that the individual develops toward the therapist -that is, transference- are treated as therapeutic material. The therapist acts as both an observer and a regulating element in this process. Through the therapeutic processing of transference, the individual is able to reinterpret past relationship experiences and transform current relationship patterns (Cabaniss et al., 2011; Cabaniss et al., 2013).
Although psychodynamic therapy is defined as an approach that aims to develop a deep understanding of the individual’s inner world and focuses on unconscious processes, this definition alone is not sufficient to fully explain how therapy works. At this point, it is of great importance to understand the dynamic structure of the therapeutic process, the techniques used, and how therapeutic change occurs. In line with the fundamental principles of psychodynamic therapy, multi-layered processes such as gaining insight, supporting self-functions, and reactivating development come into play. For this reason, this section of the sketch provides a more detailed examination of how psychodynamic therapy works.
How Does Psychodynamic Therapy Work?
Psychodynamic therapy is a broad concept that encompasses a range of theories and perspectives from various clinicians. Although Freud is the most famous clinician, clinicians such as Jung, Adler, Melanie Klein, Winnicott, and Otto Kernberg have made significant contributions to Freud’s original theory and have offered opposing views to existing information within Freud’s theory. This leads to other schools of thought emerging, even though they are all considered part of the psychodynamic theory, which serves as an umbrella term at this time. Psychodynamic therapy approaches individuals longitudinally, meaning that we employ coping mechanisms through our developmental stages. These coping mechanisms help us overcome the frustrations we encounter along the way, whether it is healthy or not. Even though psychodynamic approaches evaluate the “person” or personality according to different theorists, for example, if we approach personality from Erik Erikson’s framework, we can say that a series of psychosocial crises across the lifespan shape personality (Erikson, 1959). Unresolved conflicts at certain stages may lead to the development of maladaptive coping mechanisms. Similarly, suppose we approach personality from Nancy McWilliams’s perspective (McWilliams, 2011). In that case, personality structures reflect one’s internal experiences, defense mechanisms, and relational patterns, which are rooted in early emotional experiences. If we examine Otto Kernberg’s idea that individuals may become fixated at particular developmental levels, it influences their personality organization and ways of relating to others (Kernberg, 1984). As we mentioned earlier, psychodynamic therapies may employ different schools of thought in describing personality.
Considering this, there is no uniform working mechanism for psychodynamic approaches in terms of theoretical background. However, the common denominators of all psychodynamic therapy mechanisms are built on describing, reviewing, and linking (Cabaniss et al., 2013).
Describing:
As every individual is unique, so are the challenges they face. Describing part of the therapy starts with how the individual explains their problem, challenges, or issues they faced. However, we can say that this explanation is more than answering the question of “What brings you to therapy?” because the individual might have been experiencing multiple challenges, or they could not identify the “problem” right away. Like other talk therapies, psychodynamic approaches aim to address current problems and gather details of an individual’s functioning areas and patterns, including self, relationships, cognition, and work and play (Cabaniss et al., 2013).
Reviewing:
The reviewing part involves gathering the individual’s developmental history to understand how past experiences may have shaped their current functioning. Past experiences not only include near-time events, but also encompass significant life events across all life stages, including infancy. Especially those involving caregivers and significant loved ones are specifically considered as we start to form defense mechanisms and personality traits from infancy. The reason behind this process is to be able to understand their emotional and cognitive significance and lasting impact on individuals. Psychodynamic therapy aims to understand not only what happened but also how the individual perceived it and carried it forward into current patterns of thinking, feeling, and relating with others (Cabaniss et al., 2013).
Linking:
After the first two steps, the final step of the psychodynamic therapy is to link the two using key theoretical information such as attachment, conflict, trauma, or defense mechanisms. Linking involves forming hypotheses about how past experiences may have contributed to present patterns, especially unconscious ones. For example, a person who grew up feeling emotionally invisible may develop a tendency to dismiss their own needs. Essentially, linking creates a bridge between the past and the present. This bridge helps individuals understand why they behave in certain ways or become stuck in the same situation over and over. By making sense of it, psychodynamic therapy aims to break this vicious cycle (Cabaniss et al., 2013).
What are the Working Areas of Psychodynamic Therapy?
Research on the effectiveness of psychodynamic therapy indicates that it has positive effects on a variety of psychological problems. These studies have shown that therapy is effective for mental health challenges such as depression, anxiety, personality disorders, and relationship problems. In particular, it is emphasized that therapy is a powerful tool for individuals to understand and cope with their inner conflicts. Research also shows positive results on the long-term effects and sustainability of psychodynamic therapy (Shedler, 2010).
Research on the long-term effects and sustainability of psychodynamic therapy shows that therapy can lead to lasting changes in individuals’ lives. By focusing on the process of resolving unconscious inner conflicts, psychodynamic therapy enables individuals to reach deeper understandings. These insights can persist even after the therapy has ended, positively impacting long-term psychological health. Sustainable effects play an important role in enhancing individuals’ emotional well-being, strengthening relationships, and improving quality of life ( Leichsenring, F., & Rabung, 2008). These findings contribute to the evaluation of psychodynamic therapy as a comprehensive therapeutic approach.
Takeaways:
- Psychodynamic therapy is a psychotherapeutic approach that aims to understand the unconscious processes that shape an individual’s emotions, thoughts, and behaviors.
- Psychodynamic therapy focuses not only on understanding the individual’s psychological conflicts but also on developing self-esteem, relationship-building capacity, and coping mechanisms for stress.
- The therapeutic relationship is at the heart of psychodynamic therapy.
- By using describing, reviewing, and linking, psychodynamic therapy helps individuals understand why they behave in certain ways or become stuck in the same situation over and over.
- Research on the long-term effects and sustainability of psychodynamic therapy shows that therapy can lead to lasting changes in individuals’ lives
References
- Cabaniss, D. L., Cherry, S., Douglas, C. J., & Schwartz, A. (2011). Psychodynamic Psychotherapy: A Clinical Manual. Wiley-Blackwell.
- Cabaniss, D. L., Cherry, S., Douglas, C. J., Graver, R. L., & Schwartz, A. R. (2013). Psychodynamic Formulation. Wiley-Blackwell.
- Erikson, E. H. (1959). Identity and the life cycle. International Universities Press.
- Kernberg, O. F. (1984). Severe personality disorders: Psychotherapeutic strategies. Yale University Press.
- McWilliams, N. (2011). Psychoanalytic diagnosis: Understanding personality structure in the clinical process (2nd ed.). The Guilford Press.
- Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2), 98–109. https://doi.org/10.1037/a0018378
- Leichsenring, F., & Rabung, S. (2008). Effectiveness of long-term psychodynamic psychotherapy: A meta-analysis. JAMA, 300(13), 1551–1565. https://doi.org/10.1001/jama.300.13.1551
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This page is also part of the Roamers Therapy Glossary; a collection of mental-health related definitions that are written by our therapists.
While our offices are currently located at the South Loop neighborhood of Downtown Chicago, Illinois, we also welcome and serve clients for online therapy from anywhere in Illinois and Washington, D.C. Clients from the Chicagoland area may choose in-office or online therapy and usually commute from surrounding areas such as River North, West Loop, Gold Coast, Old Town, Lincoln Park, Lake View, Rogers Park, Logan Square, Pilsen, Bridgeport, Little Village, Bronzeville, South Shore, Hyde Park, Back of the Yards, Wicker Park, Bucktown and many more. You can visit our contact page to access detailed information on our office location.