Defining the Psychodynamic Approach

"Psychotherapy" is an general term that encompasses a wide variety of approaches to treatment. One such approach is psychodynamic therapy, which studies the psychological forces underlying human behavior, feelings, and emotions, as well as how they may relate to early childhood experience. This theory is especially interested in the dynamic relations between conscious and unconscious motivation; it asserts that behavior is the product of underlying conflicts of which people often have little awareness. The primary focus of psychodynamic therapy is to uncover the unconscious content of a client's psyche in order to alleviate psychic tension. 

Comparing Psychodynamic and Psychoanalytic Therapies

Psychodynamic therapy is similar to psychoanalytic therapy, or psychoanalysis, in that it works to uncover repressed childhood experiences that are thought to explain an individual's current difficulties. Psychoanalytic therapy is based on the ideas that a person's development is often determined by forgotten events in early childhood, and that human behavior and dysfunction are largely influenced by irrational drives that are rooted in the unconscious.

In terms of approach, psychodynamic therapy tends to be briefer and less intensive than traditional psychoanalysis; it adapts some of the basic principles of psychoanalysis to a less intensive style of working, usually at a frequency of once or twice per week. Compared to other forms of therapy, psychodynamic therapy emphasizes the relationship between client and therapist as an agent of change. 

Core Characteristics of the Psychodynamic Approach

Psychodynamic theory emphasizes the systematic study of the psychological forces that underlie human behavior. It is especially interested in the dynamic relations between conscious motivation and unconscious motivation. In the treatment of psychological distress, psychodynamic therapies target the client's inner conflict, from where repressed behaviors and emotions surface into the patient's consciousness. All psychodynamic therapies have a core set of characteristics:

• An emphasis on unconscious conflicts and their relation to development, dysregulation, and dysfunction.
• The belief that defense mechanisms are responses that develop in order to avoid unpleasant consequences of conflict.
• The belief that psychopathology develops from early childhood experiences.
• The idea that representations of experiences are founded upon interpersonal relations.
• A conviction that life issues and dynamics will re-emerge in the context of the client-therapist relationship as transference and countertransference.
• The use of free association as a core method to explore internal conflicts. During free association, patients are invited to relate whatever comes to mind during the therapeutic session, without censoring their thoughts.
• The focus on interpretations of defense mechanisms (often unconscious coping techniques that reduce anxiety arising from unacceptable or potentially harmful impulses), transference (a phenomenon in which a patient unconsciously redirects their feelings onto the therapist or another person), and current symptoms.

Types of Psychodynamic Therapy

There are several forms of psychodynamic psychotherapy, such as interpersonal therapy (IPT) and person-centered therapy. 

IPT is a structured, supportive approach that strives to connect the external, such as interpersonal struggles, with the internal, such as an individual's mood. IPT is particularly attentive to relationships and social roles. It is usually a time-limited treatment, typically lasting 12–16 weeks, that encourages the patient to regain control of mood and functioning.

Person-centered therapy is less structured and non-directive. Developed by Carl Rogers, this method of therapy proposes that the function of the therapist is to extend empathy, warmth, and "unconditional positive regard" toward their clients. By listening to and echoing back the clients' own concerns, the therapist helps the client see themselves as another might see them. This can help them perceive inconsistencies or biases in their perceptions of the world and other people.

Person-centered therapy

Person-centered therapy (PCT) is a type of psychodynamic therapy in which the client guides each session and the therapist provides unconditional positive regard. The goal of PCT is to provide clients with an opportunity to develop a sense of self wherein they can realize how their attitudes, feelings, and behaviors are being negatively affected.

History of Psychodynamic Therapy

Psychodynamic theory was born in 1874 with the works of German scientist Ernst von Brucke, who supposed that all living organisms are energy systems governed by the principle of the conservation of energy. During the same year, medical student Sigmund Freud adopted this new "dynamic" physiology and expanded it to create the original concept of "psychodynamics," in which he suggested that psychological processes are flows of psychological energy (which he termed the "libido") in a complex brain. Freud coined the term "psychoanalysis," and related  theories were developed further by Carl Jung, Alfred Adler, Melanie Klein, Anna Freud, Erik Erikson, and others. By the mid-1940s and into the 1950s, the general application of the "psychodynamic theory" had been well established.

Efficacy of Psychodynamic Therapy

The effectiveness of strict psychoanalysis is difficult to gauge; therapy as Freud intended it relies heavily on the interpretation of the therapist and is therefore difficult to prove. The effectiveness of more modern, developed techniques of psychodynamic therapy can be more accurately gauged, however. Meta-analyses in 2012 and 2013 found evidence for the efficacy of psychoanalytic therapy; other meta-analyses published in recent years showed psychoanalysis and psychodynamic therapy to be effective, with outcomes comparable to or greater than other kinds of psychotherapy or antidepressant drugs. 

In 2011, the American Psychological Association made 103 comparisons between psychodynamic treatments and non-dynamic competitors and found that 6 were superior, 5 were inferior, 28 showed no difference, and 63 were adequate. The study found that this could be used as a basis to make psychodynamic psychotherapy an "empirically validated" treatment. In 2013, the world's largest randomized controlled trial on therapy with anorexia outpatients, the ANTOP study, proved modified psychodynamic therapy to be more effective than cognitive behavioral therapy in the long term.

In contrast, a 2001 systematic review of the medical literature by the Cochrane Collaboration concluded that no data exist demonstrating that psychodynamic therapy is effective in treating schizophrenia and severe mental illness, and cautioned that medication should always be used alongside any type of talk therapy in schizophrenia cases. The Schizophrenia Patient Outcomes Research Team in particular cautions against following a psychodynamic approach in treating cases of schizophrenia due to its lack of empirical support.

Criticisms of Psychodynamic Therapy

Psychoanalysis continues to be practiced by psychiatrists, social workers, and other mental health professionals; however, its practice is less common today than in years past. Psychodynamic therapy, in contrast, is still commonly used today. 

A common critique of psychoanalysis is its lack of basis in empirical research and too much reliance on anecdotal evidence by way of case studies. Both psychoanalysis and psychodynamic therapies have been criticized for a lack of scientific rigor, sometimes even referred to as "pseudoscience." A French 2004 report from INSERM said that psychodynamic therapy is less effective than other psychotherapies (including cognitive behavioral therapy) for certain diseases. It used a meta-analysis of numerous other studies to find whether the method was "proven" or "presumed" to be effective in the treatment of different diseases. Numerous studies have suggested that its efficacy is related to the quality of the therapist, rather than the particular school, technique, or training.