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Psychodynamic therapy (PDT) originates from the work of Sigmund Freud. It is a form of talk therapy that explores the connection between a patient's past experiences – often from childhood – and their current mindset.
But to truly understand PDT, we must break down the root of its name.
The word "dynamics" in psychodynamics is borrowed from thermodynamics, the branch of physics that describes how kinds of energy interact and transform. Psychodynamics describes the psychological and emotional forces that interact in a person's mind.
How Psychodynamic Therapy Works
PDT's basis states deriving insights from childhood can give patients insights about their current problems. THis insight can ultimately help them achieve a higher quality of life.
In any type of psychotherapy, the relationship between the patient and therapist is important, but especially in PDT. Psychodynamic therapy's success relies heavily on trust, since the topics discussed during sessions are often sensitive or traumatic.
PDT can be used to help individuals, couples, and families. Sometimes it is short-term, lasting only 10-20 sessions, but PDT can be conducted over a period of 1-2 years.
PDT can be compared to other popular forms of therapy, such as cognitive behavioral therapy (CBT). Both aim to help patients increase their self-awareness and gain more control over their own mental health.
PDT puts more emphasis on unpacking how past traumas affect current emotions, while CBT focuses more on how present thoughts and perceptions play into behaviors.
Does Psychodynamic Therapy Work?
Up until recently, there had been few studies measuring the success of PDT. This led to some skepticism about its effectiveness. But in recent years, researchers have observed its benefits.
A 2018 study found that psychoanalytic and PDT therapies were effective in improving general psychosocial well-being and reduced the number of patients who attempt suicide. Another study found that PDT can also help reduce symptoms of PTSD.
Researchers sought to determine whether or not PDT is as effective when conducted online. They found that the therapy was still successful when delivered via telehealth, especially for depression.
However, the outcome of PDT depends on many factors – one being the ability of the therapist to administer the therapy properly. Studies acknowledge that less "effective" therapists are less likely to see changes in patient outcomes from using PDT.
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Criticisms of Psychodynamic Therapy/Can Psychodynamic Therapy Cause Harm?
Each mental health professional has their own preferred therapy modalities, which is why therapists' opinions about the effectiveness and validity of PDT may differ.
Some psychologists do not use PDT because they believe it is not active enough. Many prefer pragmatic approaches like CBT, which tackles problems head-on by trying to reframe a patient's logic and perspective on a particular issue.
By comparison, PDT takes a more roundabout approach, examining the sources of problems. Certain therapists and patients may find this modality tedious and emotionally taxing. Some have even suggested that it could be damaging to patients by retraumatizing them.
Another criticism of PDT is its focus on the significance of formative experiences, which could lead patients to believe that their negative thought patterns and dysfunctional communication styles are set in stone. This could be disempowering and create the belief that seeking help is futile.
The success of PDT relies heavily on certain requirements being met. A 2019 study found that misguided client expectations, distrust between client and therapist, and the client's inability to relate to the therapist could hamper positive therapy outcomes.
Similarly to physical healthcare, accurately predicting which treatment will be most effective for a patient is difficult. It is the therapist's responsibility to recognize when to change therapeutic approaches.
Most therapists use a combination of therapy modalities with patients to optimize their therapy outcome. This could mean using a PDT-oriented approach during the initial stage of getting to know a patient and switching to another approach later on.
Frequently Asked Questions
What's the difference between psychodynamic therapy and psychoanalysis?
PDT and psychoanalysis are inherently related. Sometimes they are used interchangeably. Psychoanalysis refers specifically to Freud's theories, while PDT refers to his ideologies as well as his followers.
How long does PDT take to work?
The time investment needed to see results from PDT depends on each patient. Some see results in a matter of weeks, while others spend 6-12 months or longer in therapy before seeing initial results.
Do all therapists learn about PDT in school?
Psychodynamics is a foundational area of study within psychology. Most clinical psychology programs offer courses specific to psychodynamic theory or incorporate psychodynamic principles into various courses.
Is Psychodynamic Therapy a Good Fit?
The success of PDT comes down to three main factors: the therapist's ability and experience, the compatibility between the patient and therapist, and whether or not the patient is well-suited for PDT.
PDT is most effective on those with harmful "internalizing" coping mechanisms as opposed to harmful "externalizing" coping mechanisms. The former describes anxious and depressive symptoms, PTSD, obsessive compulsion, and social withdrawal. The latter mainly refers to outward manifestations of emotions, e.g. aggression, impulsivity, and anger management issues.
People who experience internalizing difficulties may experience substance abuse problems, panic disorders, and personality disorders – all of which can benefit from PDT.
Another good indicator of whether or not you are a good candidate for PDT is if your past experiences and traumas are central to your current negative mental health symptoms.
The best way to determine if PDT is right for you is by scheduling a consultation with a mental health professional.
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- Briggs, Stephen et al. (2019). The effectiveness of psychoanalytic/psychodynamic psychotherapy for reducing suicide attempts and self-harm: systematic review and meta-analysis.
- Castro Batic, Barbara et al. (2020). Exploring harm in psychotherapy: Perspectives of clinicians working with children and young people.
- Charis, Christos et al. (2021). Depression conceptualization and treatment.
- Curran, Joe et al. (2019). How does therapy harm?
- Kraybill, OG. (2018).Trauma processing: when and when not?
- Lindegaard, Tomas et al. (2020). Efficacy of Internet-Delivered Psychodynamic Therapy: Systematic Review and Meta-Analysis.
- Paintain, Emma et al. (2018). First-line therapy for post-traumatic stress disorder: A systematic review of cognitive behavioral therapy and psychodynamic approaches.
- Yonatan-Leus, Refael et al. (2019). Therapist effects in yearlong psychodynamic therapy: An exploratory study.