What Is 'Psychodynamic' Therapy? What Gives it Depth?
Published on 4.1.24 at garyborjesson.substack.com
In the ever-expanding world of therapy, some therapists are psychodynamically oriented; others are not. As a practical matter, nearly all kinds of therapy have psychodynamic aspects. That said, a key way of distinguishing them is by the extent to which they are psychodynamic. Even if you’re not a therapist or a patient in therapy, reflecting on this distinction helps us consider about what it means to be human and to become our best selves.
Human beings are complex animals, obviously. Our difficulties, needs, and wants vary enormously from person to person. So of course there will be, and indeed are, many forms of therapy. Anyone who claims to possess the one right or best approach has too simple an idea of human nature to be taken seriously—except as an ideologue. Therapeutic approaches range along a spectrum from less psychodynamic, such as behaviorism and CBT, to more psychodynamic, such as Internal Family Systems (IFS), sensorimotor psychotherapy, Jungian psychology, and psychoanalysis.
Taking the unconscious seriously is the defining characteristic of psychodynamic therapy. Because it explores what lies below the surface of conscious awareness, it’s called “depth psychology.” Its other features largely stem from this one. Thus, a second key feature of psychodynamic therapy is attention to early childhood experience and attachment dynamics. This makes sense: early childhood is a time of rapid psychic development, most of which occurs before we have any conscious awareness of what’s happening to us.
A third feature of psychodynamic therapy is close attention to the therapeutic relationship. How we relate to others says a lot about who we are and how we view the world. Psychodynamic therapy recognizes that the therapeutic relationship acts in some ways as a microcosm of the patient’s more general experience in relating to others. Thus whether we’re avoidant or judgmental or confrontational or a people-pleaser, it won’t be long before this comes into our relationship with the therapist. Again, because we’re often unconscious of why we relate to others as we do, a therapist may draw attention to our way of relating to them as a way of inviting reflection on our way of relating generally—and where it comes from.
In this regard, one of Freud’s great contributions was his idea of transference, and how it can be used to help the patient get to know themselves better. Transference happens when a patient (or therapist) transfers ideas or feelings developed in the past onto another person in the present. For example, we may transfer the same irritable impatience onto our therapist (or partner or child) that our parent expressed toward us when we were young. Often these transfers or projections are unconscious—until someone points out to us that we’re acting just like our mom!
A final feature commonly attributed to psychodynamic therapy is that it takes longer than other kinds of therapy. This isn’t essential to it, but is instead a typical consequence of the other three features. Insurance companies and many patients are understandably put off by the fact that psychodynamic therapy tends to cost more money and time. It would be great if approaches with names like “solution-focused” and “short-term” could answer all our needs, but they cannot. For some of us, getting to know oneself is intrinsic to the value of therapy. And getting to know oneself is hard and inefficient. It’s one thing to rate your pain or anxiety or depression from 1 to 10, and notice how it changes after a session. It’s quite another to explore your thrownness in the world and get to know the forces (conscious and unconscious) that make you who you are, and show why you suffer as you do.
At their most ambitious, psychodynamic therapies aim for the root of presenting problems rather than focusing only on symptom relief. To summarize, this means working with unconscious material, exploring childhood experience, and attending to the therapeutic alliance. As I’ve noted elsewhere, it means addressing our felt experience and the younger parts of ourselves.
When I first heard the word psychodynamic, I thought of Plato, not Freud. The word is rooted in Greek soil. Psyche means breath, animating spirit of the body, soul, and mind. Dunamis means force, power, potential, capacity to change—in this case, to feel, think, or act in a variety of ways. Thus, psychodynamicsconcern the forces making us be who we are. Often we consciously experience these when we feel conflicted: Should I leave this job or this relationship? Part of me wants to stay, part wants to leave. Or, one part of me wants a second piece of pie or another drink, but another part knows better.
In Plato’s dialogue Phaedrus, Socrates likens our psyche and its forces to a charioteer drawn by two horses. The charioteer represents the rational force in the psyche, which is directing the other forces. (That’s the idea anyway!) The white horse is the social, spirited, loving and hating part of us. The black horse represents our animal needs, instincts, and appetites. This way of carving the psyche is paralleled by the modern triune model of the brain: The charioteer is the cerebral cortex and frontal lobes; the white horse is our social limbic brain (shared by horses and dogs, among other animals); and the black horse is our reptilian brain stem.
Psychodynamic therapy aligns with the Socratic view that the human psyche is complex and its core dynamics often unconscious. It’s no wonder, then, that we experience ourselves as confused, conflicted, or even in open revolt against ourselves (eg, self-harm and suicide). Socrates and psychodynamic therapy both proceed on the assumption that becoming our better selves involves examining ourselves and seeking to harmonize the forces making us who we are. No easy tuning!