Psychodynamic Therapy (PDT), perhaps the oldest form of therapy used today, has its roots in Freudian psychology (as in Sigmund Freud), circa 1900, and essentially works by helping you become more aware of your subconscious in order to gain insight into behaviors that may be self-destructive.

Experts say few of today’s mental health professionals practice an exclusive form of psychodynamic therapy but rather incorporate components of it along with other forms of therapy such as cognitive behavior therapy (CBT). “What matters THE MOST for good outcomes is the therapeutic alliance between the therapist and the client, regardless of what type of therapy is being administered,” says psychiatrist Michael McGee, MD, chief medical officer at the Haven Treatment Center in California and author of The Joy of Recovery. “It is the alliance that heals.”

Victor Fornari, MD, director of child and adolescent psychiatry at Zucker Hillside Hospital in Glen Oaks, New York and Cohen Children’s Medical Center in New Hyde Park, New York agrees. “Psychodynamic therapy is very helpful for recognizing, understanding, expressing, and overcoming various conflicts,” says Dr. Fornari.  “It helps a person to deal with repressed emotions in order to improve her relationships and can be very effective for a variety of emotional struggles.”

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If you are having relationship issues, for example, it may be helpful to consider trauma or neglect in your past—PDT can be a way to explore possible connections. “If your father always put you down, and find yourself getting into romantic relationships with critical men, that is a repetition compulsion,” explains Dr. McGee. “Getting back to painful early childhood experiences and then seeing how we enact those painful relational dynamics in our everyday life can be insightful.”

Regardless of the therapeutic approach, Dr. McGee says the work of therapy is to watch the workings of the mind. In CBT the emphasis is on the way a person’s thoughts shape their feelings and actions—a way to learn new patterns instead of trying to figure out why dysfunctional patterns are there in the first place. CBT is a more here-and-now, problem-solving approach to behavioral change. In PDT, the idea is that insight will be enough to see the patterns. By making the unconscious conscious, we are no longer as controlled by it,” he says.

How Does Psychodynamic Therapy Work?

The terms “psychoanalysis” and “psychodynamic therapy” are often used interchangeably, says Bryan Bruno, MD, a psychiatrist at Lenox Hill Hospital in New York City. “But psychoanalysis is actually a subset of psychodynamic therapy, which grew out of the theories practiced by Freud at the turn of the last century,” he explains.

“[PDT] is really for people who want to find greater meaning in their lives, improve self-awareness, and explore and understand the influence of the past on present behavior and emotions,” Dr. Bruno says. The aim is to explore distressing thoughts and feelings and consider how the past can inform the present. PDT can tap into dreams, fears, and desires as a source of information about how you view yourself and others and to help you make sense of problematic experiences.

It focuses on recognizing and then addressing defense mechanisms. “These defense mechanisms are the reactions and behaviors that a patient uses to avoid distressing thoughts and feelings,” Dr. Bruno says.

When targeted on specific problems, PDT can sometimes be a faster approach to working through them but this approach needs to be mutually agreed to at the start by you and your therapist.  Traditional psychoanalysis tends to go on for longer periods and be quite intensive typically involving one or more hour-long sessions per week.

In addition to depression and anxiety, PDT can be used to treat attention deficit hyperactivity disorder (ADHD) and phobias such as agoraphobia, explains Adella Nikitiades, PhD, a clinical psychologist for the Montefiore Health System, a healthcare network of healthcare providers and a system of 11 hospitals based in New York state. “PTD for children with ADHD can be focused on the child’s ability to self-regulate, recognize his own feelings, thoughts, and emotions, and gain a coherent sense of self, Dr. Nikitiades explains. “A session with Thomas, 6-year-old boy with ADHD, for example, would include, but not be limited to, the therapist joining the child’s play and providing external structure: ‘When Thomas moved from object to object without any ability to focus or persist on any single toy, the therapist joins the play and asks questions such as: What does the bunny want to do? What is he carrying in his bag?’ ”

Having a central focus (the inability to self regulate or having a fear of elevators, for example) can help tease out the most important issues which inform the structure of each session and helps identify treatment goals.1,2 “Psychodynamic therapy is known for its focus on the patient-therapist relationship and also on the patient’s relationship to the external world and to her life,” Dr. Fornari says.

Is Psychodynamic Therapy Effective?

In a 2015 review of outcome and effectiveness studies of PDT for the major categories of mental disorders published in the journal World Psychiatry, researchers found that PDT is an effective treatment for depression, some forms of anxiety, eating disorders and somatic problems (i.e. irritable bowel syndrome, abdominal pain, and bowel dysfunction)3 but there is little evidence to support it for treating post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), bulimia nervosa, cocaine dependence or psychosis.

Dr. Nikitiades emphasizes that PDT is very good at increasing insight into how you function in different contexts of your life. “PDT can help you learn to understand yourself better,” she says, “and when you understand yourself better, you can start to make changes in your life that bring you closer to the life you wish to live.”

To illustrate how PTD works in real life, Dr. McGee shares an anecdote about a friend raised by a mother who suffered from bouts of depression and later married a mentally-ill woman. “My friend learned to see the world through depressive lenses because of his mother’s mental illness. Dynamically, his desire to love his wife was a way to act out of his desire to heal his mother.”

If you are interested in using PDT as a path to personal growth and behavior changes, Dr. McGee suggests interviewing therapists on their approach. “Ask them if they explore past early relationships and do dream work,” Dr. McGee says but cautions against relying solely on a PDT practitioner.  “Good therapy is almost always eclectic. A combination. A synthesis of approaches. I would avoid personally a therapist who was only psychodynamically-oriented. Insight can only take us so far. Then there is the hard work of changing lifelong habits and developing new relational and other life skills.”



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Last Updated: Aug 12, 2020