For consumers contemplating seeing a therapist, there are many types of therapy to choose from. One of the most widely practiced forms of therapy, is psychodynamic therapy. But what does psychodynamic therapy really mean?
What is Psychodynamic Therapy?
Psychodynamic therapy starts from the assumption that people are caught in multiple struggles between opposing demands, impulses, fears, and wishes.
A simple and humorous example of this can be found in the following cartoon, which illustrates the vicissitudes of the human psyche:
The person here is damned if he does – and damned if he doesn’t: A typical dilemma, in which we humans find ourselves…
- He likes the freedom that comes with being an adult, and abhors the alternative, which would mean being a dependent child without autonomy and choice.
- However with the pleasant realization that he is an adult, comes the unpleasant realization that freedom comes with responsibility. He is now parenting himself and has to set boundaries on his own desires. The price he pays if he transgresses is: guilt.
- And yet, he fights back against his internal doubt and asserts his free will to do as he pleases…
- But when he now chooses to eat his ice cream, he can no longer enjoy it without an intense feeling of shame for having done something wrong.
A Lesson in Psychodynamics:
This simple storyline, humorous as it may be, conveys very well what psychodynamic therapy is really about.
According to a psychodynamic viewpoint, we are often in internal battles with ourselves, having feelings, thoughts, and wishes that pull us in opposite directions all at once.
The result of being such a house divided against ourselves is a sense of anxiety and inner unrest, which only human beings can feel. Since this anxiety is such an aversive feeling to us, we will subsequently go to great extent to avoid it or to find some kind of solution that will silence the conflict that produces it.
To solve our conflicts we will defend against one of the feelings so as to create psychological balance where there previously was none. The way we do this is by deploying psychological defenses that distort the facts of reality for the sake of keeping our inner peace.
Defenses against Internal Conflicts:
Our ice cream lover could attempt to defend against his anxiety in a number of different ways, each of which would reduce the conflict in some way:
- He could subject himself to his own rigorous parental authority and create rules for how virtuous he has to be to truly earn his ice cream: “I will allow myself an ice cream only on my birthday, and only if I have achieved my goals at work”
- He could take on the identity of a “rebel” and push away all respect for authority in an attempt to minimize his own “guilty boy” syndrome: “I am not going to follow any rules because authorities don’t know what they are talking about”
- He could rationalize his sinful enjoyment, by looking only at the evidence against the validity of current research: “Health fanatics always change their mind about what’s healthy and what’s not. They will probably discover that ice cream is healthy in just a few years.”
- He could also punish himself after enjoying his ice cream, so as to atone for his sin: “I am going to not eat for a week, in order to make up for my weight gain”
These are but some examples of how the human psyche works to help us resolve our internal conflicts.
The Price We Pay for our Defenses:
The bad thing about defense mechanisms is that they have to twist reality in order to make certain feelings, wishes, or thoughts go away. Hence, the more internal conflicts we experience, the more out-of-sync with reality we end up becoming. Gradually we come to live in a reality where certain feelings, wishes, or thoughts get dimmed, shunned, distorted, or repressed. We substitute a fictional reality for the real world in order to preserve our psychological safety.
Another bad thing about defense mechanisms is that if they are challenged in any way, the anxiety is looming right beneath them. This means that we often don’t really have a choice to act any differently than we do. Hence, we are forced to punish ourselves after eating an ice cream, because if we don’t, our anxiety, our guilt, or our shame will return. We are thus not really in control of our life, but are controlled by our desire to escape from unpleasant feelings which threaten to besiege us.
Our Conflicts Are Often Unconscious:
Most people who come to therapy don’t enter the consulting room with the understanding that they have unresolved internal conflicts. Nor do they know that the symptoms they are experiencing might be the result of defense mechanisms that serve to keep anxiety at bay. Instead they simply feel depressed, anxious, unable to enjoy certain things in life, or besieged by feelings of guilt, shame, or inhibitions.
The goal of psychodynamic therapy is to help people understand the dynamics underlying their most troublesome symptoms so they can begin to make sense of why they feel compelled to starve themselves for a week, why they can’t enjoy having sex with their partner, or why they have become depressed in their marriage.
Often at the first therapy session, symptoms such as these do not make sense, and seem entirely arbitrary.
This is good news for the medical profession, which is quick to jump on this to suggest that the cause is purely biological or brain-based, a conclusion which can seem quite legitimate to the person who suffers without reason.
It is also good news for cognitive-behavior therapists who can readily get buy-in for the idea that symptoms have no deeper meaning or logic, but should be treated as if they themselves were the problem.
Yet, when clients are helped to become curious about their life and begin the work of talking freely and openly about the full range of their experiences, more clues begin to appear that will eventually allow both client and therapist to discover an underlying logic of the distressing symptom.
An Example of Psychodynamics at Work:
A depressed immigrant from India initially entered psychodynamic therapy because his wife was not happy with him and was thinking about divorce. As his therapy progressed, it became clear that the client had defied his parents’ wish that he enter into an arranged marriage. Although the client initially experienced his choice for a love marriage as a victory for his own autonomy, it was as if another part of him continued to feel guilty about his choice and unconsciously acted in ways that sabotaged his love marriage.
From a psychodynamic perspective, the client was not simply being irrational or self-destructive. Instead he was trying to resolve an unconscious conflict between retaining autonomy and not upsetting his parents.
The solution he had found helped him equalize his guilt feelings, while at the same time preserving his conscious sense of autonomy. He was simultaneously choosing to be in a love marriage and choosing not to be in one, thus appeasing both himself and his parents.
To make this solution viable, of course, he had to deny that he was pleasing his parents in any way. However, he also had to turn a blind eye to the fact that he was acting in ways that were destined to make his marriage fail.
His depression was a defense mechanism in the sense that it protected him from looking at his own subjective agency in choosing whether or not to make his marriage work. His despondency and perceived powerlessness helped him avoid confronting an underlying conflict that would give him anxiety.
Psychodynamic Therapy Helps You Get to the Root of Your Problems:
Psychodynamic therapy helps people uncover the conflicts underneath their symptoms so they can reclaim control of their lives.
In the case of the Indian spouse, discovering the underlying conflict would make it possible for him to confront his guilt feelings so he wouldn’t have to unconsciously punish himself by making his marriage fail. By increasing insight into his psychodynamic conflicts, he would be able to address the real issue underlying his depression and his marital problems.
The Effectiveness of Psychodynamic Therapy:
Helping people get to the root of their problems, is precisely what makes psychodynamic therapy such a powerful treatment.
Research on psychodynamic therapy shows that not only is it effective in helping people resolve their problems, it even continues to increase its benefits after treatment ends. Because it does not only focus on immediate symptom relief, but allows people to confront what motivates their symptoms, psychodynamic therapy helps people gain control of what causes their distress.
By helping people gain insight into underlying causes that make it difficult for them to enjoy their life, psychodynamic therapy works much like the old proverb that says, “give a man a fish and you feed him for a day; teach a man to fish and you feed him for a lifetime”.
Rather than just feeding you a solution, psychodynamic therapy helps you get in touch with what produces the problem, so you can finally claim ownership of it rather than continue to pursue temporary “quick fixes” that only serve to cover the real problem up.
This is why I believe psychodynamic therapy.
About me: I am Rune Moelbak, Ph.D. a psychodynamic therapist in Houston, Texas. I help people get to the root of their issues. To book a therapy appointment, visit my website at: www.bettertherapy.com