steve graybar phd

Psychodynamic psychotherapy has its’ roots in the work of Sigmund Freud and psychoanalysis. Like many things since 1900, much has changed in this treatment approach. The changes that have occurred in psychodynamic therapy have received significant empirical support from psychotherapy researchers. Despite the fact that popular accounts of psychotherapy suggest, “only newer, symptom-focused treatments like cognitive-behavioral therapy or medication have scientific support,” there is ample evidence that psychodynamic therapy is as effective as these treatments and its’ effectiveness lasts over time (Shedler, 2010).

Consistent with Freud’s initial insights, psychodynamic therapy holds that our mental life is divided (though not neatly or cleanly), into conscious, pre-conscious and unconscious processes. Because of the ever-shifting boundary between these different levels of awareness, we tend to know more about ourselves than we fully understand or appreciate. Our unconscious contains the origins, hidden meanings and obscure motives of our inner life. Our preconscious offers clues, hunches and impressions about ourselves, about certain people or situations. Our conscious mind often attempts to make sense of it all by providing logical and linear, mood congruent, face-saving and historically consistent explanations of these private experiences. One-way psychodynamic therapy attempts to help clients is to provide a bridge of understanding between unconscious and conscious experiences. At its core, dynamic therapy offers a unique relationship through which there is communication that can relieve distress, promote learning, facilitate change and lead to personal growth.

Another important facet of psychodynamic therapy is the relationship between childhood development and adult personality. From infancy through adolescence our character is engraved through mutually influential processes of nature (our inherited characteristics) and nurture (our lived experiences). We enter the world extremely vulnerable, and completely dependent on our caretakers. As a result, a critically important attachment process takes place between parent and child. Adding a layer of complexity and drama to this developing bond are the unique characteristics of its’ participants. When there is a good, or “good enough” fit between child and caretaker, a secure bond occurs, self-esteem is promoted and overwhelming hurt or frustration is avoided. Problems arise when a child’s unique needs don’t fit well, (or at all), with the strengths and weaknesses of his/her caregivers, extended family or peers. Adjusting to good or poor environmental “fits” creates patterns of adaptation in how a child thinks, feels, behaves and interacts. These unconscious patterns help us cope, thrive and sometimes simply survive our childhoods as in the case of abuse or neglect. In concert with our genetic potentials, these patterns become indelible parts of our personality. When over-used, especially later in life, they can become inflexible, less adaptive and less successful and the source of much pain and confusion.

What Is Psychodynamic Therapy?

Describing psychodynamic therapy itself is not easy. Much like the difference between a biography and a resume, psychodynamic therapy assumes there is more to a person than basic facts and information. Unlike a resume, a good biography (and good therapy) looks beneath the surface. It examines both subtle and obvious forces influencing its’ subject. By exploring the intimate details, important relationships and significant events in a client’s life, psychodynamic treatment adds depth and texture to the story. Like a good biography, a course of psychodynamic psychotherapy attempts to provide order and meaning to the twists and turns in a client’s life, to his/her emotional distress, inner conflicts, confusing choices and courageous acts of love and self-sacrifice.

How Does It Work?

In therapy, my clients and I work together to clear a path between where they are and where they want to be. Through an emotionally honest conversation, the client’s initial concern is used as a catalyst for exploration, understanding and change. Together we follow threads of experience in order to uncover themes and make sense of painful patterns in their lives. Through this process insight occurs, feelings are softened, understanding is possible and a path becomes clear-though not necessarily easy. Small steps are taken. Additional hypotheses are developed. Explanations and ideas are shared, new feelings arise, even more steps are taken and meaningful change is made possible. Through this work, clients frequently come to appreciate emotional symptoms as understandable reactions to chronically endured pain- frequently experienced in low self-esteem, poor self-confidence and unfulfilling, if not blatantly unhappy relationships.

The Fit Between Therapist and Client

The psychodynamic treatment process starts in the very first session where the therapist and client begin developing a very personal yet completely professional relationship. The first session or two are used to see if there is a, “good fit” between the client and therapist. A good fit between myself, and my client, is anchored in safety, trust, curiosity and mutual respect. Without a safe, comfortable and respectful foundation there is little hope for a successful therapy experience.

An Interpersonal Approach to Psychodynamic Therapy

The majority of people who seek psychotherapy do so because they are in emotional pain. At the same time, much of their distress is due to their inability to find happiness or satisfaction in their relationships with others. Regardless of how confusing or self-defeating a client’s thoughts, feelings or behavior might appear, I have been convinced over many years of practice-every client presents for treatment trying to solve the problem of human relatedness- of being loved, wanted, accepted, appreciated and understood.

The therapeutic relationship is an invaluable resource in the client’s treatment. It can be used to support a client’s efforts to change. It can serve as a window into the hurtful or confusing aspects of a client’s relationships in the past and present. If used thoughtfully, the interactions between the therapist and client provide an appreciation for how the past can add to, or complicate, emotional distress in the present. The “here and now” of the therapeutic relationship can allow the therapist and client to understand how unconscious processes (automatic thoughts, feelings and reactions) protect us, yet can lead to problems in relationships and even more pain. The great strength of psychodynamic therapy is that it can help clients address relationship problems as well as specific symptoms (anxiety, depression, grief, anger).

In addition, there is no more important relationship than the relationship we have with ourselves- reflected in our self-concept, self-esteem and relationships with others. Psychodynamic treatment allows clients to review and reconsider how they think about, feel toward and treat themselves. As therapy concludes, clients function as their own therapist. They develop the capacities to manage stress, maintain self-esteem and reach out to others in healthy and satisfying ways. A positive treatment outcome allows a client to leave therapy with a more calm and clear inner voice, and an empathic and more accepting perspective about themselves and others.

An Existential Perspective in Psychodynamic Therapy

Beneath our difficulties and emotional distress are fundamental questions about life. These concerns are woven deeply into the fabric of what it means to be human. Philosopher Paul Tillich (1952) wrote of life’s ultimate concerns and psychiatrist Irvin Yalom (1980) distilled them into our conscious and unconscious struggles with death, isolation, meaning and freedom. These ultimate concerns encircle all of us. Nearly every psychotherapy client wrestles with questions about life and death and the nature of existence. About being connected to, yet undeniably, separate from, others in his/her life, about meaning and meaninglessness, about the responsibility we all have for our own happiness and pain. While these ultimate concerns are often neglected or pushed aside by the pressures of everyday living (or good fortune), they frequently take center stage when we are confronted with poor health or unhappiness.

Valuing Emotion in Treatment

An emotion-focused approach to psychotherapy simply acknowledges that if substantial change is to occur in treatment it must involve and include emotion. The Latin root of the word emotion means, “to move.” Without feeling emotion, deep and meaningful emotion, we are unlikely to move, or be moved, in ways that allow us to make changes in our selves or in our lives. Whenever anything of significance happens in our lives, whenever anything that truly matters begins or ends, there is emotion involved. During these times, emotion, either paralyzes us, and blocks our efforts to change, or catalyzes us, and fuels our efforts to respond and live with greater freedom and dignity.

Closing Thoughts

In addition to addressing the difficult and distressing side of life, psychodynamic therapy can contribute to and draw from a client’s positive inclinations. Every client brings strength, creativity and resilience to his/her therapy. Each client has within his/her grasp happy, healthy and adaptive attitudes (Akhtar, 2011). While I take psychotherapy very seriously, it is not an activity that must be done at all times and in all ways with grave seriousness. Any given hour can have the therapist and client exploring a painful setback or a heartfelt laugh about an experience one or the other has chosen to share. No aspect of a client’s experience is inappropriate or off limits- including but not limited to pain and sorrow, laughter and joy. I do not believe successful treatment can be any other way.


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