Psychodynamic Therapies | Psychology for UPSC Optional (Notes) PDF Download

Introduction

Psychodynamic therapy, often associated with the famous question "How does that make you feel?" is a type of therapy that focuses on the client's deep-seated needs, urges, and desires. While it may not be as popular as cognitive-behavioral therapy or interpersonal therapy, it remains a recognizable and valuable approach to understanding and resolving psychological issues. In this article, we will delve into the theory, goals, techniques, and tools of psychodynamic therapy, shedding light on its importance in the field of mental health.

What is Psychodynamic Therapy?

• Psychodynamic therapy is a therapeutic approach that takes a holistic view of the client's perspective, making it a "global therapy." Unlike problem-based therapies such as cognitive-behavioral therapy, which primarily focus on symptom reduction, psychodynamic therapy delves into the client's deep-seated needs, urges, and desires. This leads to significant differences between these therapies in terms of their goals, techniques, and overall approach (McLeod, 2014).
• The contrast between global and problem-based therapy is not the only factor that distinguishes psychodynamic therapy from other more common forms of therapy. Rather than concentrating on behavior, psychodynamic therapy involves the interpretation of mental and emotional processes (Strupp, Butler, & Rosser, 1988).
• Psychodynamic therapists aim to help clients recognize patterns in their emotions, thoughts, and beliefs to gain insight into their current selves. These patterns often trace back to the client's childhood since psychodynamic theory asserts that early life experiences have a profound impact on adult psychological development and functioning (Matthews & Chu, 1997).
• The objective of psychodynamic therapy is to assist the client in identifying crucial elements that contribute to their identity and reorganize them in ways that foster a more functional and positive sense of self. Sessions are intense and open-ended, following the client's free association rather than adhering to a fixed schedule or agenda. Typically, they occur once a week and last about an hour. Unlike Freud's psychoanalytic therapy, which demanded a greater time commitment, modern psychodynamic therapy is generally less intensive (WebMD, 2014).
• In contemporary psychodynamic therapy, the traditional couch is often replaced by a pair of chairs, and the therapist and client engage in face-to-face interactions rather than maintaining the therapist's hidden position.
• During these sessions, the therapist encourages the client to freely discuss whatever is on their conscious mind. The thoughts and feelings shared are examined for recurring patterns in the client's unconscious mind.
• Psychodynamic therapy is frequently employed in the treatment of individuals diagnosed with depression or anxiety. Some evidence suggests that it may be as effective in treating depression as other therapeutic approaches (WebMD, 2014).

Goals of Psychodynamic Therapy

• Psychodynamic therapy aims to achieve two main objectives: (1) promoting self-awareness in the client and (2) facilitating an understanding of their thoughts, emotions, and beliefs in relation to their past experiences, particularly those from childhood (Haggerty, 2016).
• To accomplish this, the therapist guides the client in exploring unresolved conflicts and significant events from their past.
• Psychodynamic therapy operates on the assumption that chronic issues originate in the unconscious mind and need to be brought into consciousness for catharsis to take place. Therefore, it is essential for the client to possess self-awareness in order to identify these unconscious patterns of thinking and comprehend their origins, allowing for effective resolution (Haggerty, 2016).

Psychodynamic Theory, Perspective, and Key Concepts

To gain a comprehensive understanding of psychodynamic therapy, it is crucial to delve into its historical roots. Despite undergoing changes over the past century, this therapeutic approach remains rooted in the foundational work of early contributors to modern psychology.

During the late 19th century, Sigmund Freud was engrossed in developing his groundbreaking ideas concerning the human mind and the theory of human development. Although some of Freud's theories have been contradicted by empirical evidence obtained through scientific research, they served as the building blocks for psychodynamic theory and sparked a revolutionary school of thought that persists today, albeit in an adapted and refined manner.

Freud introduced a conceptual framework in which he proposed that the human mind comprises three distinct components:

• The id, representing primal instincts and residing in the unconscious mind.
• The superego, encompassing moral beliefs and principles.
• The ego, serving as a mediator between the instinctual id and the moral superego (Haggerty, 2016).

According to Freud, these components develop during specific stages of childhood. He posited that humans are born with the id, acquire the ego during the toddler stage, and incorporate the superego around the age of five. Based on his theory, Freud concluded that an individual's personality is deeply rooted in their childhood experiences.

While Freud believed that each individual possessed these three components, their development could be significantly influenced by environmental factors and familial relationships. These influences could contribute to the formation of a healthy sense of self and effective functioning, or they could lead to the development of neuroses and dysfunctional patterns of thought.

Freud proposed that the driving force behind human behavior lies buried in the unconscious mind. He theorized three levels of the mind:

• The Unconscious:
  This level houses our instincts, deeply held beliefs, and numerous patterns of thought and behavior. Although we are not consciously aware of its contents, Freud believed that the unconscious mind constitutes a substantial part of our identity, desires, and actions aimed at fulfilling our desires.
• The Subconscious or Preconscious:
  This level exists between the conscious and unconscious mind and can be accessed with deliberate effort. Its contents lie just beneath the surface of consciousness.
• The Conscious:
  This is the level of awareness in which we operate. According to Freud, the conscious mind has the least defining content and represents only a small portion of our overall being.

Based on this theoretical framework, Freud emphasized the importance of delving into the unconscious level to address and resolve issues. It is within the unconscious mind that unspoken values, implicit beliefs, and patterns of thought and behavior developed during childhood are stored.

While psychodynamic theory has evolved beyond many of Freud's simplistic notions about human nature, several underlying assumptions in the psychodynamic approach still bear resemblance to Freud's work:

• The unconscious mind plays a substantial role in driving human behavior and emotions.
• All behavior is rooted in causality; there are reasons behind every action.
• Childhood experiences exert a significant influence on thoughts, emotions, and behavior in adulthood.
• Critical conflicts encountered during childhood development shape our overall personality as adults (Freud, 1899).

Freud's theories directly support the practices of psychoanalysis, but they also contribute to the foundation of psychodynamic theory and inform the methods and techniques employed in contemporary psychodynamic therapy.

Psychoanalysis: The Freudian Approach

Psychoanalysis and modern psychodynamic therapy, while originating from the same source, exhibit notable differences in their approaches.

• The time commitment and duration of psychoanalysis are much more intensive compared to modern psychodynamic therapy. Psychoanalysis typically involves two to five sessions per week, spanning multiple years (McLeod, 2014).
• The physical arrangement of the therapy room holds significance. In psychoanalysis, the client, often referred to as a patient, reclines on a couch while the therapist sits behind them, remaining out of their line of sight. In modern psychodynamic therapy, it is more common for the therapist and client to face each other or maintain visual contact.
• The therapeutic relationship between the therapist and client/patient demonstrates greater imbalance in psychoanalysis than in modern psychodynamic therapies. The positioning of the therapist and client implies a substantial power differential, with the therapist assuming the role of a distant and detached expert who holds specialized techniques and knowledge that are not readily shared with the client. Conversely, the client adopts a vulnerable position, relying on the therapist's expertise to unravel their dysfunctional thoughts and beliefs (McLeod, 2014).

While certain psychoanalytical practices have endured or been adapted in modern psychodynamic therapy, the pronounced power disparity between therapist and client is less prominent in the current approach. Over the past century, the therapist's role has been modified to promote equality and establish a more balanced treatment environment.

Role of the Psychodynamic Therapist

• In psychodynamic therapy today, the therapist assumes the crucial role of collaborating with the client to uncover the underlying causes of their symptoms.
• To fulfill this role, the therapist encourages the client to openly express their emotions and assists them in identifying recurring patterns in their thoughts, emotions, and behaviors.
• By exploring these patterns, the therapist helps the client grasp their significance and understand how they impact their well-being.
• An important aspect of the therapist's role is delving into the client's past. Discussions about childhood and early life experiences occupy a significant portion of psychodynamic sessions, as this therapy acknowledges the profound influence of these experiences on the client's present difficulties.
• The therapist also observes the client's interactions within the therapeutic relationship and contributes their own insights into the client's relational patterns.
• Psychodynamic theory suggests that the client's behavior in the therapist-client relationship often mirrors their behavior in other relationships, such as those with parents or significant figures from their childhood (WebMD, 2014).
• In essence, the therapist's objective is to help the client establish connections between past experiences and current challenges, while empowering them to draw upon their internal resources to address these difficulties.

Types of Psychodynamic Therapy

In order to facilitate the discussion of psychodynamic therapies, I have consistently referred to it as a singular entity. However, it is important to note that psychodynamic therapy is better understood as a category encompassing various therapeutic approaches rather than a singular type.

While all the therapies mentioned below are rooted in the overarching model of psychodynamic theory, they each apply the principles of this theory in distinct ways.

1. Brief Psychodynamic Therapy

• The distinguishing characteristic of brief psychodynamic therapy, as implied by its name, is its brevity compared to other forms of psychodynamic therapies.
• This type of therapy typically takes place over a few sessions or even just one session in certain cases. In some instances, individuals grappling with a specific problem may only need to establish a few significant connections to overcome that problem.
• For example, if a client is experiencing acute anxiety without a known cause, it may be possible to identify a triggering event or circumstance and develop coping strategies within a single session.
• While it is not realistic to expect the resolution of all problems within one session for every individual seeking treatment, there are situations where the identification and management of a specific issue can be achieved with a relatively brief investment.
• Brief psychodynamic therapy has been applied in scenarios such as:
  • Cases of rape;
  • Accidents (e.g., traffic accidents, physical injuries);
  • Acts of terrorism;
  • Acute psychological disturbances (e.g., anxiety, depression);
  • Traumatic family events (e.g., discovery of a secret, divorce).

2. Psychodynamic Family Therapy

• Psychodynamic family therapy is a therapeutic approach that is conducted within the context of a family system. This family system can consist of various configurations, including couples in a romantic relationship, parent-child relationships, siblings, grandparents and grandchildren, or any combination of these family members.
• Compared to shorter-term family therapies based on cognitive-behavioral therapy (CBT) or interpersonal therapy (IPT), psychodynamic family therapy is typically long-term in nature. It is often initiated in response to chronic issues within the family rather than a specific problem or event that has emerged.
• Similar to other forms of psychodynamic therapy, this approach places emphasis on exploring unconscious processes and unresolved conflicts. However, it specifically examines these dynamics within the framework of family relationships. The therapist guides the family members in exploring their family history, with particular attention to any traumatic events that may have occurred.
• A key aspect of this therapy is the recognition of the significance of resolving conflicts between adult family members and their own parents. By addressing these unresolved conflicts, individuals gain a better understanding of the conflicts that arise within their partnerships and parent-child relationships.
• Psychodynamic family therapy serves to uncover and address deep-seated issues that contribute to family problems, ultimately fostering a healthier and more harmonious family dynamic.

3. Psychodynamic Art / Music Therapy

• Expressive arts therapy is an unconventional form of psychodynamic therapy that involves the use of art or music as a means of expressing feelings and emotions.
• Similar to other approaches within psychodynamic therapy, this form of therapy is non-directive and non-structured, allowing the client to take the lead during the session. It does not require any specific artistic or musical talent or ability. Instead, clients are encouraged to use art or music as vehicles for self-expression.
• Clients may choose to share specific art pieces or music and discuss the emotions they evoke, connect them to childhood events, or explore the personal meaning they find in these creative expressions. Alternatively, clients may bring in a particular song or album that resonates with them on a deep level.
• In some instances, clients may engage in active creation of art or music during the therapy session. The focus is not on producing "good" art or music, but rather on using these mediums to convey thoughts and feelings in a way that makes sense to the individual.
• Through the use of art and/or music, a therapeutic bond is formed between the therapist and the client, fostering understanding and connection. Some individuals may find that art and music offer a more profound mode of communication than traditional verbal dialogue.
• This type of therapy can be particularly beneficial for individuals who are shy or have difficulty expressing themselves verbally. It can also be helpful for clients experiencing severe anxiety or fear, as engaging with art and music can provide a soothing and calming effect.

5 Psychodynamic Tools and Techniques

Psychodynamic therapy places less emphasis on structured exercises and activities compared to other therapeutic approaches. However, there are several essential tools and techniques used in psychodynamic therapy that enable therapists to explore the depths of the unconscious mind with their clients. The following five tools and techniques are commonly employed in various forms of psychodynamic therapy.

1. Psychodynamic Diagnostic Manual (PDM)

• The Diagnostic and Statistical Manual (DSM) is commonly regarded as a fundamental resource for clinical psychologists, providing a framework for comprehending and assessing behavior in therapeutic settings.
• However, psychodynamic therapists and theorists often raise concerns regarding the DSM's emphasis on observable symptoms and its omission of more subjective experiences as diagnostic criteria.
• To address this issue and alleviate disagreements over diagnostic criteria, an alternative or complementary tool called the Psychodynamic Diagnostic Manual (PDM) was introduced in 2006. Psychodynamic practitioners may find the PDM more beneficial in diagnosing and treating their clients compared to the conventional DSM.

2. Rorschach Inkblots

• While these amorphous and abstract inkblots are closely associated with Freudian psychoanalysis, they are also employed in certain forms of psychodynamic therapy today.
  
• The Rorschach Inkblot test is a tool that tends to be widely misunderstood by the general public. It has been portrayed in popular culture as either a definitive assessment of an individual's personality, providing unique insights into their psychology and predicting various mental health conditions, or as a frivolous exercise in naming indescribable shapes.
• In reality, the Rorschach test is neither of these extremes. It cannot unveil one's entire childhood experiences, but it is also not a trivial relic of a bygone era in psychology.
• Psychologist Hermann Rorschach developed the original inkblots in the early 1900s (Framingham, 2016). During that time, a popular game called Blotto involved a set of inkblots that could be used to create poems, stories, or charades.
• Rorschach noticed that individuals diagnosed with schizophrenia reacted differently to these inkblots, which led him to study their use as a diagnostic tool and a means of discussing symptoms.
• His work resulted in a set of 10 inkblot images that could be presented to a client with the intention of observing and analyzing their reactions.
• During the Rorschach test, the therapist presents each inkblot to the client individually and asks them to describe what they see. The client is free to interpret the image as a whole, focus on specific elements, or even consider the blank spaces surrounding the image.
• The therapist takes notes on the client's descriptions and interpretations of the images, and may ask additional questions to encourage further elaboration.
• While there is ongoing debate regarding the validity and reliability of the results obtained from this test, many therapists find that it offers valuable qualitative information about the client's emotions and thought processes (Cherry, 2017). It has also shown some effectiveness in diagnosing thinking disorders like schizophrenia and bipolar disorder.
• Individuals with these types of disorders tend to perceive and interpret the images differently from those without such diagnoses.
• The significance of this test lies in the process of interpretation and description undertaken by the client, rather than any specific content within the inkblots. Consequently, administering, scoring, and interpreting the test requires a highly trained professional.

3. Freudian Slip

• This informal and somewhat underutilized technique in psychodynamic therapy remains relevant and worthy of consideration.
• A "Freudian slip," also known as a slip of the tongue or parapraxes in more formal terms, refers to those instances when we intend to express one thing but inadvertently reveal another, often with deeper meaning attached to the slip.
• For instance, a Freudian slip might occur when someone intends to say "That is your best idea yet!" but unintentionally says "That is your breast idea yet!" In such cases, it is possible to infer that the individual may have a particular anatomical feature in mind or associates the person they are addressing with that feature.
• Freud and certain subsequent psychodynamic theorists proposed that these seemingly accidental slips of the tongue hold deeper meaning. According to Freudian theory, no behavior is truly accidental or arbitrary. Instead, every action and spoken word are influenced by the mind, whether it be the conscious, subconscious, or unconscious, as well as the individual's circumstances.
• A psychodynamic therapist may place particular significance on such slips, whether they occur during therapy sessions or are shared by the client. They may interpret these slips as glimpses of the unconscious mind, indicating unfulfilled desires or hidden associations between concepts.
• While many contemporary psychologists consider Freudian slips to be primarily unintentional mistakes, it is difficult to deny that at times, a slip of the tongue can unveil intriguing connections within the speaker's mind.

4. Free Association

• Free association is considered the cornerstone of psychodynamic therapy, playing a central role in the therapeutic process. This technique is straightforward yet often yields effective results.
• In psychodynamic therapy, "free association" carries two distinct meanings: the formal therapeutic technique of free association and the general method of client-driven discussion based on spontaneous associations between topics during sessions.
• The formal technique involves the therapist presenting a list of words, and the client responds immediately with the first word that comes to mind. This exercise can provide insight into the client's hidden associations and connections that lie beneath the conscious level.
• It is important to note that this technique may not be suitable for all clients, particularly those who are resistant to participating or sharing intimate details with the therapist. However, therapists should not automatically assume resistance if a client pauses before responding, as it may indicate that the client is nearing a repressed or highly significant connection.
• Engaging in free association may occasionally trigger intense or vivid recollections of traumatic events, known as abreactions. While such experiences can be distressing for the client, they can also lead to a transformative process of catharsis, allowing the client to work through significant issues (McLeod, 2014).
• Engaging in informal free association during therapy ensures that the therapist avoids steering the client in any specific direction and allows the client to naturally transition from one topic to another. This aspect is crucial in psychodynamic therapy, as it is essential to follow the client's lead in order to access the unconscious origins of psychological distress. By allowing the client's associations to guide the session, the therapist creates a space for authentic exploration and discovery.

5. Dream Analysis

• Dream analysis, although not scientifically proven as a treatment technique, can still be valuable for certain individuals. The efficacy of therapy cannot always be measured through rigorous scientific methods such as double-blind random control trials (RCTs), which are typically used as the gold standard of research.
  
• In the complex and multifaceted realm of therapy, it can be challenging to pinpoint the exact components or approaches that contribute to positive outcomes. In such cases, some less established techniques may play a role in facilitating real progress for the client. While it is not possible to formally recommend dream analysis as a reliable and effective tool, it is generally considered safe and can be included in the treatment process based on the discretion of the client and therapist.
• Dream analysis involves engaging in detailed discussions about the client's dreams. The therapist takes an active role in guiding the conversation, asking questions and prompting the client to recall and vividly describe the content of their dreams.
• While Freud often attributed repressed sexual desires or sexual symbolism to the latent content of dreams, contemporary interpreters of dreams have expanded the range of possible interpretations.
• Various therapists, coaches, counselors, and practitioners of mystical arts employ numerous approaches to analyze dreams, but no specific method has been identified as universally superior or more valuable than others.
• One widely recognized approach to dream analysis is proposed by psychologist and author Dr. Patrick McNamara. His theory of the dreaming process can be explored at an individual level, enabling clients to engage with their own dreams and search for personal meaning within them.

McNamara’s proposed process of dreaming is as follows:

• Step One: The initial step involves the dreamer dissociating from their usual sense of personal agency and allowing themselves to enter a "liminal state." This state creates a space where the dreamer can explore new facets of their identity by temporarily letting go of their usual self.
• Step Two: Transitioning into the liminal space, the dreamer embraces the realm of possibilities for their identity. It is akin to removing the familiar "mask" they usually wear and being receptive to discovering a new one.
• Step Three: This step encompasses the bulk of the dream, where the dreamer actively tries out different identities. The dreamer may experience fear or anxiety associated with shedding their existing identity and may seek to regain a sense of control by searching for alternative identities or a different sense of self.
• Step Four: Eventually, the dreamer either adopts a new, transformed identity or reverts to their original identity. According to McNamara, the aim is to find a more unified sense of self, although this often involves embracing aspects of our darker side (McNamara, 2017).

These steps are connected to four literary tropes that are believed to help us make sense of narratives: metonymy (breaking down narrative elements), synecdoche (rearranging those elements into a new whole), metaphor (comparing the elements or the whole to something familiar), and irony (reflecting the new whole).

By utilizing these tools to analyze narratives, McNamara suggests that we can apply this process and the literary tropes to decipher the meaning of any dream or sequence of dreams (2017). While this technique lacks scientific validation, it may still prove beneficial for personal understanding.