Psychodynamic Therapy: Exploring the Unconscious Mind
Psychodynamic therapy (sometimes called psychoanalytic psychotherapy) is a type of talk therapy that help patients bring their unconscious (hidden) feelings to the surface. This form of therapy can help patients understand and eventually manage the unconscious feelings that can influence their daily lives.
This type of therapy is based on the assumption that feelings held in the unconscious mind are often too painful or uncomfortable to be realized. For that reason, people develop defense mechanisms to protect themselves from actually knowing about, dealing with, or confronting these feelings.
Defense mechanisms are patterns of feelings, thoughts, or behaviors that are unconscious. These mechanisms can be either healthy or unhealthy, depending on what they are are and how they are used. They are meant to reduce stress, anxiety, and internal conflict—a way to cope with the world.
Common defense mechanisms include:
- Denial—refusing to face or perceive an unpleasant reality
- Projection—attributing one's unacceptable characteristics or motives to others
- Displacement—changing the target of built-up emotions or feelings, often anger, onto those (usually people or animals) who are less threatening
- Rationalization—making up "logical explanations" to conceal the real motives of one's thoughts or behavior
- Reaction formation—transferring an unacceptable impulse or emotion into a socially acceptable or positive one
In psychodynamic therapy, it is thought that many of these and other unhealthy defenses are causing more harm than good, and that is why the patient is seeking help.
Psychodynamic therapy is an offshoot of psychoanalysis. Psychoanalysis is a more intense and conservative approach that traces adult problems back to conflicts left unresolved from childhood. In both kinds of therapy, the patient's upbringing and conflicts with parents are examined. These conflicts play themselves out with other people in adult life, often causing the same problems to happen again.
How the Therapy Works
The therapist should have an attitude of unconditional acceptance toward the patient. This means that the patient is respected as an individual and not judged or criticized, regardless of the problem. As a trusting relationship develops, the therapist uses her knowledge, experience, and self-knowledge to help the patient understand what's going on in the unconscious mind. This process may include:
The patient transfers aspects of an earlier important relationship onto the therapist. This includes the feelings, thoughts, and defenses that the patient experienced in the early relationship.
Transference is believed to help the patient work through conflicts so that permanent change can take place. Through this process, the patient develops self-awareness and insight into current and childhood relationships. Then the patient can respond in terms of what is really happening instead of what happened in the past.
Countertransference refers to the therapist's unconscious and conscious emotional feelings toward the patient. It is the therapist’s thoughts and feelings directed towards the patient. The therapist uses how she feels to understand how the patient feels.
In each session, the therapist tries to gain insight into the patient's problem by looking at:
- How much the patient is in touch with feelings
- What feelings the patient is not aware of
- How close the patient is to knowing unconscious feelings
- How painful the feelings are for the patient
- How well the patient can tolerate the pain of feelings that emerge into consciousness
The therapist uses her interpretations to help the patient make sense of what is going on and to become more aware.
Benefits and Limitations
Many people have reported significant improvement after treatment. However, like all other therapies, psychodynamic therapy does not work for everyone.
If you choose this form of therapy, be open and honest. Also be patient with the process, which may be difficult, especially in the beginning. This type of therapy requires commitment and requires you to actively participate. Check with your insurance company to make sure these services will be paid for.
The American Psychological Association
National Mental Health Information Center
Mental Health America
Canadian Mental Health Association
Mental Health Canada
Canadian Psychiatric Association
Canadian Psychological Association
The effectiveness of psychodynamic therapy and cognitive behavior therapy in the treatment of personality disorders: a meta-analysis. Focus Psychiatry Online website. Available at: http://focus.psychiatryonline.org/cgi/content/abstract/3/3/417. Published Summer 2005. Accessed June 16, 2008.
Pain-focused psychodynamic psychotherapy. Psychiatric Times website. Available at: http://www.psychiatrictimes.com/psychotherapy/article/10168/1147526. Published February 1, 2008. Accessed June 16, 2008.
The psychodynamic approach. Ryerson University website. Available at: http://www.ryerson.ca/~glassman/psychdyn.html?new_sess=1. Accessed June 16, 2008.
Last reviewed May 2008 by Ryan Estévez, MD, PhD, MPH
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