Psychodynamic Therapy

Psychodynamic therapy originated from the classical psychoanalytical theory of Sigmund Freud. His psychological hypotheses are i) the economic hypotheses state that psychological pressures were in conflict with one another or being repressed. The internal tension had to be discharged to relieve symptoms. ii) The typological hypothesis states that the mind is divided into regions of conscious (inner awareness), unconscious (out of our awareness) and pre-conscious (outside but that could be brought into awareness). iii) The dynamic hypothesis means intrapsychic forces oppose one another. iv) The genetic hypothesis focuses on individual development. The above four hypotheses are combined as the drive theory.

The fifth hypothesis, structural theory differentiated the id (instinctual drive, pleasure seeking), the ego (our realistic self and mediated between the id and the superego), and the superego (moral development).

Freud’s human development theory focuses on psychosexual stages. They are oral stage from birth to approximately 18 months (pleasure from feeding and sucking), anal stage up to 3 years old (toilet training), phallic stage from about 3 to 6 years old (more aware of their bodies), latency stage from 6 years of age until puberty (integrating sexual identity), genital stage is from puberty to adulthood (becomes independent and detached from parents).

Ogden states that object relations theory was “a theory of unconscious internal object relations in dynamic interplay with current interpersonal experience.” Freud’s concept of the object refers to an instinctual impulse in which tension needs to be discharged. Klien stated that people were seeking connection. He changed the emphasis from Freud’s libidinal drive to the internalization of object relations. That means the children’s needs are unmet because of inadequate parenting. Winnicott suggests that a holding environment prevents the problem of false self-disorder. The mother is there for her child and recedes when she is not needed. Psychodynamic therapy is a movement from the perfectionistic, defensive position, causing grandiosity and depression, towards a more stable self.

Self-psychology theory refers to empathy, the key observational method. Selfobject experiences are the key to healthy growth. Client needs powerful validation. This is attentive listening while keeping non-judgmental, with the therapist aware of their contribution to the client’s mental state. Empathy is curative. “Feeling understood is the adult equivalent of being held.” If a client feels understood, it helps to promote growth and healing. Joint construction of meaning emerges when the therapist uses quality empathy to nourish the unique client’s perspective and their life plan. With self-disorder, the client may not “feel to himself like a person.”

Sullivan introduces relational theory that empathic linkage is a “contagious spread of mood from caregivers to babies”. Babies learned anxiety from their caregiver. “Good” meant not anxious. “Bad” was anxious. Mitchell identified the three strategies to understand the experience of human relationships by design (biologically born to be drawn together), intent (seek pleasure and avoid pain), and implications (sense of self is a complex process deeply dependent on other people). To achieve authenticity and self-awareness, Bromberg emphasises an ongoing dialectic between separateness and unity of the self-state. (Jochum, 2016)

Shedler identifies seven distinctive features of psychodynamic therapy. Together, they form a process that is an unstructured and open-ended dialogue session. i) Focus on affect and expression of emotion. Emotional insight will help change. ii) focus on defense and resistance. iii) identify repeated themes and patterns where clients are unaware or unable to change. iv) discuss experience with a developmental focus, and find the link between the past and current repeated pattern. v) focus on interpersonal relationships and how personality affects them. vi) work through the therapeutic relationship by using transference and counter-transference. vii) emphasize exploration of fantasy life. (Lara Gross, 2018)

Reference:

Jochum, B. (2016). Exploring the Integration of Mindfulness in Psychodynamic Therapy Institute for Clinical Social Work. Chicago, Illinois.

Lara Gross, M. S. (2018). EXPLORING THE RELATIONSHIP BETWEEN MINDFULNESS AND PSYCHODYNAMIC THEORY: DEFENSIVE FUNCTIONING AND REFLECTIVE FUNCTIONING Chestnut Hill College.