The Psychodynamic Approach - Background​

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Psychodynamic psychological theory has been historically developed by clinicians, people who see patients in the real world. This sets it apart from some other theories of psychotherapy, like Cognitive Behavioral Therapy or Solution Focused Therapy, which have roots in university research and animal studies.

 

Psychodynamic psychotherapy has undergone many double-blind scientific efficacy studies which compare it to other styles of psychotherapy and the results have been fascinating and mirror my own experience as a therapist, Shedler (2010), Leichsenring & Rabung (2008, 2011), Bateman & Fonagy (2008), Knekt et al. (2008), Steinert et al. (2017). In a nutshell, psychodynamic psychotherapy is just as effective as other styles at reducing symptoms in the short term. But, in the long term, psychodynamic psychotherapy seems to stand out. Once people have stopped psychodynamic psychotherapy the evidence shows continued improvement into the future not only in symptom reduction but also in terms of psychological growth and strength. These results indicate that psychodynamic psychotherapy produces deep and long-lasting change. In my professional opinion, this is because psychodynamic psychotherapy treats the roots of the problem, not just the symptoms. 

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The Tenets of Psychodynamic Psychotherapy

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Focus On Emotional Expression - There's a huge difference between private feelings and expressed feelings. Expressing emotions allows them to be properly digested and the emotional nutrition extracted can then be absorbed. This reduces their intensity and helps patients think about their feelings in more flexible, properly contextualized ways. As an emotion runs its course it performs important psychological and physical functions for us. 

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Investigating Attempts to Avoid Unpleasant Thoughts and Feelings - It's very understandable to avoid distressing thoughts and feelings on purpose. But, the mind does this avoidance in all sorts of ways. Many of these patterns of avoidance happen in ways that we are not aware of. Bringing these unconscious mental avoidance patterns into our awareness helps patients understand how they are, inadvertently and with good intentions, blocking their own healing. This knowledge helps them to unblock and overcome long-standing mental difficulties. 

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Pointing Out Repetitive  Patterns and Themes - We've all engaged in self-destructive patterns of behavior, thought, emotion, and relationship. Sometimes its difficult to notice them until someone points them out. When this happens we find ourselves in a new position. And we have a chance to understand them enough to move from unconscious pattern to purposeful decision. 

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Talking About Personal History - Past experiences have enormous influences on us. Being a whole human being means understanding how our particular past has shaped the lens through which we see and understand our present. This understanding helps to free us from the grip of the past and enables us to make decisions using our own conscious judgment. 

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Emphasis on Social Relationships - We are and always have been fundamentally social creatures. Understanding how we think and feel in our relationships helps us to develop new, healthier, and more joyous ways of relating to other people. When our relationships are good we are enhanced and come into our full bloom. 

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Exploration of the Therapeutic Relationship - The relationships that I form with the people who come to see me are themselves grist for the mill. By taking a good close look at how we're getting along and why it's like that we can get interesting insights into a person's pattern of relating to other people. I also use my psychological sensitivity to give people feedback on what its like to be with them in a way they can find illuminating. 

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Discussion of Fantasy Life - People's fantasy lives are fascinating and full of useful information about how they see themselves and the world. Exploring a person's fantasy life can shed light on their dreams and deep wishes. It can help us understand their yearning and unacknowledged needs. 

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Psychodynamic Psychotherapy is an insight-based, experiential, and deep style of psychotherapy that goes beyond superficial symptoms to heal and grow from the inside out. I have found using it in psychotherapy enormously useful. 

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The Person-Centered Approach - Background

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This style of psychotherapy also has roots in clinical practice. It has also been demonstrated to be effective by double-blind research studies; Elliott et al. (2013), King et al. (2000), Greenberg et al. (1994), Sachse & Elliott (2002), Zuroff et al. (2007). The founder of Person-Centered Psychotherapy is Carl Rogers, an American Psychologist. It emphasizes people's innate ability to heal and grow as long as the proper conditions are met. These conditions have to do with a special focus on the therapeutic relationship and empathetic understanding. Person-centered psychotherapy is also traditionally used not just for symptom reduction but for personal growth. It's the theory of psychotherapy that coined the term' Self-Actualization" and where the famous phrase "The curious paradox is that when I accept myself, just as I am, then I can change." comes from. For me, this is the psychotherapy style that has the most heart. 

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Tenets of Person-Centered Psychotherapy

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​Unconditional Positive Regard - This describes the attitude that the psychotherapist purposefully takes when relating to patients. It means that I see my patients as inherently good no matter what. They may be acting in self-destructive ways but their intention is to feel better, be at peace, and be happy. Knowing this in my bones allows me to accept them as they are, and provide non-judgemental understanding. For a patient to be able to change, they must first experience that the way they are now is accepted. 

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Focus on Empathetic Understanding - The experience of being understood by a psychotherapist should go beyond an intellectual understanding. A good psychotherapist uses their ability to understand at the emotional level and convey this empathetic understanding to the patient. Feeling understood at both the intellectual and emotional levels helps a person accept and work through their feelings. 

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​Authenticity - This style of psychotherapy places a lot of emphasis on being authentic with the people you work with. This is considered superior to taking the stance of an authority figure. In psychotherapy with teenagers in particular this has a disarming effect that allows teens to drop their guard and feel free to relate to me as a person.

 

 Non-Directive Approach - Person-centered psychotherapy theory acknowledges that patients themselves are the experts on their lives. My patients know better than me what they need to talk about and feel through. They guide me and then I can help them. With teenagers, this approach helps to develop a sense of authority over themselves which leads to taking on more appropriate personal responsibility. It also helps to prevent the emergence of defiance or rebelliousness in the therapeutic relationship.

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Self-Actualization - This is the idea that people have an innate drive toward healing, growth, personal development, authenticity, and fulfillment. Under the appropriate conditions, anyone will choose to move in this direction. Psychotherapy is intended to provide the conditions for this natural healing and growth-promoting process to take place. 

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Teenagers do not usually experience a relationship with an adult that has these qualities. When they experience it they gain access to an adult mind without the pitfalls of power hierarchies or the threat of punishment or being exposed. This therapeutic situation opens up new possibilities for healing and growing. 

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