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  • Writer's pictureMonique Hiskens

What even is psychodynamic psychotherapy?



Psychodynamic psychotherapy is a broad umbrella term which is notoriously difficult to describe. A concise general summary can be found here: https://www.medicalnewstoday.com/articles/psychodynamic-therapy#definition

Psychodynamic psychotherapy could be considered a modern form of psychoanalytic psychotherapy - you may find these words are used interchangeably at times.

 

Psychodynamic psychotherapy can include a number of different methods of working, both short and long term, with adults and children. This can include different treatment modalities such as Mentalisation Based Treatment (MBT), play therapy, sand tray, art therapy, EMDR, dyadic therapy for parents and children, family therapy, wider systemic interventions, Parent Child Interaction Therapy and many others. Each therapist will utilise different skills when working with different families.

 

In this article, however, I hope to describe some of the core tenets of psychodynamic psychotherapy with children and adolescents. In another blog, I have written more about the ways that working with a psychotherapist might be similar and different to working with a psychologist or psychiatrist.

 

Core ideas:

-       The therapeutic relationship

The therapeutic relationship is a unique experience distinct from other kinds of relationships. It is a connection built together over time by both the therapist and the client, and as a result, each is distinctly unique. Within the therapeutic relationship, both the therapist and the client can work to built further understandings and insights into the clients experience. There is an invitation in psychodynamic psychotherapy to bring your authentic self, and think together with the therapist about what makes it difficult to do so.

 

-       Finding words for the difficult parts.

Many parents share the experience of asking their children questions which are met with the famously frustrating answer “I don’t know”. Questions like; why are you feeling so sad or angry? What can I do to help? What do you need? What’s going on?

Psychodynamic psychotherapy aims to form a broader, fuller, deeper understanding about parts which may be typically concealed. In psychotherapy, the therapist works with the child and their family to bring attention to and articulate their emotional life in ways that they have not yet felt able to.

For many young children, this process of understanding does not involve sitting and talking things through together. The therapist utilises play, art and the therapeutic relationship to support the child to communicate their experience and work through inner conflicts.

 

-       Discovering together.

Psychodynamic psychotherapy takes the position that people are highly complex and unique. As a result the therapist can never truly be an authority or expert on the way others should live, decisions they should make, what skills they need to practice or what is best for them. There is faith in the concept that somewhere within, people hold important knowledge about themselves, and with support they can identify what is best for themselves. At times, there seem to be invisible blocks (which therapists might call defenses) which prevent people from accessing this information or utilising it.

The therapist takes the position that in the process of building a therapeutic relationship,  deeper insight can be accessed which opens doorways to lasting psychological change. By taking this individualised route, however, the process of change can be slow, meandering and difficult. The therapist aims to walk alongside clients as a guide, rather than leading or directing from in front. It is a process of doing, rather than being done to.

 

-       Impact of the past and the unconscious

Often people feel that there are patterns which continue to happen in their lives, despite the fact that they don’t feel good. The “rinse and repeat” effect. Psychotherapy aims to investigate these patterns in depth, to discover what is unconsciously keeping them going. This could be thought of as a process of uncovering what templates or scripts are automatically employed in a family, which contribute to the repeating of unhelpful patterns. At times people talk about wanting to get to the root or the core of the problem. Often this involves delving into the ways that the past continues to inform our present lives.

 

-       Defences

As mentioned above, people unwittingly employ a number of different defences in order to cope with the challenges of everyday life. Some defences are easy enough to live with, others can get in the way at different times. Psychodynamic psychotherapy aims to identify and understand some of the defences that people use, thinking together with the client about whether or not these ways of approaching the world are still effective.

 

-       Attention to inner conflicts

People often describe experiencing conflicting feelings in many different arenas of life; “I know I should comfort my child when they are upset, but I just find it so frustrating”, “I feel like I should make healthier meals, but I am just too tired to make it happen”.

Children often communicate their conflicting feelings, too. Think of the very upset child trailing at her mothers ankles, who angrily rejects mum’s offer of a hug. Or the child who may be aggressive and demanding towards their friends despite complaining they feel upset and lonely.

 

The therapy process, therefore, is a qualitative experience. It is often talked about as being more of an art, rather than a hard science, which can bring with it an unfortunate associations that this is not an evidence based method of practice. The research outlining the effectiveness of psychodynamic psychotherapy, suggests otherwise. For further reading on the evidence base of psychodynamic psychotherapy, see this PDF article written by Dr Jonathan Shedler: https://www.apa.org/pubs/journals/releases/amp-65-2-98.pdf.


Instead, I would suggest it is more like creating a portrait series rather than working through a paint by numbers set. It can be many things including creative, arduous, frustrating, revealing and ultimately rewarding. In my experience, it is a very human need to be listened to. Most, if not all people benefit from access to a safe, understanding space where they can express themselves fully, including the parts which are typically kept hidden from view.

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