Unpacking the principles of psychodynamic therapy

Like most psychologists, the first treatment modality I was introduced to when starting my internship was cognitive behaviour therapy. I loved it! It provided me with a framework for identifying the link between thoughts, emotions, and behaviour, and I found that many of my clients responded positively to cognitive interventions. However, as I began to work with more complex presentations, I wanted a framework to help me make sense of some of my client’s deeper and unconscious processes. After researching several different therapies, I decided to train in psychodynamic psychotherapy.

This was a long process. Initially, I completed an intensive training course which entailed full-day workshops on alternate Saturdays for six months, where I learnt about the theory and practice of psychodynamic therapy. I was then required to see two clients each week, for a minimum of two years, and present these same cases at a supervision group every fortnight. This entailed taking verbatim notes after each session (in psychodynamic therapy no notes are taken during the session) so I could present a detailed overview of each session at supervision, where I was given extensive feedback. I ended up doing this for three years. At the same time, I also attended my own personal therapy in addition to ongoing weekly supervision focussing on my own private practice clients.

When I started this training, back in 2006, I embraced a whole new way of working. I began to work longer-term and found clients would stay in treatment even after they exhausted their Medicare rebated sessions. Clients were reporting increased insight, improved relationships, stronger boundaries, and a deeper connection to themselves. Even as I have expanded my skillset in recent years to include EMDR (I am an Accredited EMDR Practitioner) and Sensorimotor Psychotherapy, I always draw on the principles of psychodynamic therapy as I relate to my clients.

So, what are the principles of psychodynamic therapy?

1. There is an emphasis on unconscious processes and how these influence an individual’s thoughts, emotions, and behaviours. The therapist helps the client explore, uncover, and gain access to these “hidden” aspects of themselves

2. Childhood experiences are believed to shape a person’s personality and psychological functioning.The therapist explores past experiences, particularly those from childhood and adolescence, to identify any unresolved conflicts and understand how these might continue to impact the client in the present.

3. The therapist is looking for themes and patterns in the client’s history and patterns of relating, and will makes interpretations about their thoughts, feelings, and behaviours to help them gain insight into their unconscious processes. This not only facilitates meaningful therapeutic work towards growth and healing, but also gives the clients more agency in their choices and actions.

4. The therapeutic relationship is a key aspect of psychodynamic therapy and often becomes an important focus of exploration. This includes a focus on transference and countertransference.

5.Transference refers to the client’s tendency to project feelings, emotions and attitudes from past relationships to present interactions. The therapist uses this to help the client gain insight into their patterns of relating to others, including and themes that may emerge as part of the therapeutic relationship.

5. Countertransference refers to feelings and/or unconscious reactions that the therapist feels towards the client, which can also be a therapeutic tool when the meaning is explored and brought to awareness.

5. Psychodynamic therapy explores the defense mechanisms that people employ to protect themselves from painful emotions or thoughts. By understanding and addressing these defenses, clients can work through underlying issues more effectively.

6. Clients may exhibit resistance to therapy as they encounter painful or uncomfortable feelings. This can occur regardless of the modality. In psychodynamic therapy the therapist works with the client to explore and understand these resistances, as they often provide valuable insights into underlying issues.

7. The primary goal of psychodynamic therapy is to increase the client's insight and self-awareness. By understanding the unconscious factors that drive their thoughts and behaviors, clients can gain greater control over their lives and make healthier choices.

As scientist-practitioners, psychologists are trained to use evidence-based therapies, and typically the literature will point us to CBT as a “gold-standard” treatment for many presentations. There is evidence to suggest that psychodynamic therapy is not only effective but that psychodynamic therapy not only improves symptoms, but follow up more than 9 months later showed further improvement, suggesting ongoing changes, even after therapy ended (Abass, Hancock,Henderson and Kisely, 2006). This was based on a meta-analysis of 23 randomised controlled trials with over 1400 clients.

The Australian Psychological Society (2018) also lists short-term psychodynamic therapy as having Level 1 evidence for the treatment of Depression and Borderline Personality, and Level 2 evidence for the treatment of a range of disorders including Adjustment Disorder, Generalised Anxiety Disorder, Social Anxiety Disorder, Binge Eating Disorder and Substance Use Disorders.

If you would like to learn more about psychodynamic therapy, I offer regular supervision groups on this topic. All groups have a maximum of five participants and count as group supervision hours towards the internship. You can book online here.