The Basics of Psychodynamic Psychotherapy

Psychodynamic psychotherapy is aimed at improving the quality of an individual’s life by understanding the meaning and function of the thoughts, feelings, and behaviors which are causing them difficulty or discomfort (symptoms).

Psychodynamic psychotherapy views symptoms as channels of expression for elements of experience (desires, needs, & emotions) which can not be thought about (they are kept unconscious and therefore not available for thought). These elements of experience are unthinkable because, on an intrapsychic level, they conflict with the requirements of the environment (parents, care givers, society, etc.). The basic goal of psychodynamic psychotherapy is to make what is unconscious (and therefore not available for thought) conscious (and thereby useful in selecting activities which will bring about the highest levels of life satisfaction). This is accomplished by understanding the meaning of a symptom and explaining its development.

Change begins with understanding what has made it necessary for a desire, need, or emotion to become unconscious (unthinkable). Such understanding is accomplished by collaborative exploration of the associations (thoughts & memories) connected to the unwanted behavior (symptoms) and clarifying the underlying desire, need, or emotion. This can also be facilitated by working with associations to dream material.

Explaining the development of the symptom is accomplished by clarifying the elements of the early environment which made it impossible for the individual to think about his or her needs, desires, and emotions. This usually involves the psychotherapist deductively reconstructing the circumstances under which care givers failed to understand and manage the needs, desires, and emotions of the person in therapy.

Understanding one's needs, desires, and emotions makes it possible for them to be thought about in a way that makes their appropriate gratification or management possible. The goal of the therapeutic process is for the individual to be able to think rather than just act. The outcome of psychodynamic psychotherapy is an individual whose needs, desires, and emotions can be identified, understood, and tolerated long enough to enable them to find the best way of dealing with them.

When we are not helped (by our care givers) to deal effectively with our needs, desires, and emotions they become sources of shame that we seek to avoid by keeping them out of consciousness. Shame can be thought of as the opposite of mastery. When we feel shame it is because we feel unable to deal with something effectively. The state of mind that accompanies feelings of shame is traumatic. When we sense that we are getting close to a situation associated with shame anxiety develops signaling the danger of re-traumatization. For example someone who was humiliated as a child for being angry may react with anxiety when faced with a possibly anger provoking situation. If, as children, we are helped to manage our needs, desires, and emotions by an understanding and soothing care giver, these elements of our experience can be thought about in ways that can make our life more satisfying. Psychoanalytic psychotherapy helps by providing an environment in which an individual can develop the capacity to experience, identify, understand, and communicate their needs, desires, and emotions.

The simplest way to look at psychodynamic psychotherapy is as a kind of “re-parenting” in which the therapist functions like a parent to the undeveloped parts of the self which need to be identified, understood, and managed. Through their interactions with a psychodynamic psychotherapist the patient develops the ability to perform these functions on their own.