Why we practice Psychodynamic Psychotherapy

Hartley Psychotherapy is a practice that specializes in psychodynamic psychotherapy, but what does that mean? In this blog, we’ll unpack the core differences between psychodynamic therapy and other common therapeutic modalities, and how to know when you might want to make the switch.

Psychodynamic therapy is borne out of the psychoanalytic tradition founded by Sigmund Freud. You may have heard of Freud and psychoanalysis before, but you’ve definitely seen the classic depiction of the patient lying on a daybed in an all leather and wood room while a cigar-smoking psychiatrist asks them about their childhood.

This caricature can make people hesitate when they’re considering psychodynamic therapy. Your mental health problems are serious, and you want to be confident that the therapist you choose is taking it seriously.

The good news is that psychodynamic therapy is evidence-based and proven to be effective. Freud is credited as the founder of talk therapy, and his influence on how both clinicians and the public think about mental health is still apparent today. The meaning we give to dreams, the importance of subconscious thoughts and feelings, and the therapeutic goal of working through the underlying cause of conscious emotional distress can all be traced back to Freudian theories.

Moreover, there are lots of reasons that psychoanalysis fell out of fashion that have nothing to do with its ability to treat mental illness: psychoanalysts were often very expensive, only operated in big cities, and took a backseat to the cognitive behavioural trend of the late 20th century.

In the late 20th century, therapy was still hard to come by and could be quite costly and time-consuming. Other forms of therapy that were focused on reframing thoughts or training new behaviours were a way to drive down costs and open therapy up to more people. These other therapies could be practiced with an instruction book with simpler steps to follow compared to analysis.

“Psychodynamic therapy is about uncovering and treating root causes rather than focusing on symptoms.”

 Compared to the early days, therapy is more affordable now, covered by many health insurance providers, more widely available, and there is a greater diversity in psychological opinion. The result is a resurgence in forms of therapy like psychodynamic that are practiced outside of the leather and wood office with a therapist who only smokes outside between sessions.

So, if psychodynamic therapy isn’t about leather armchairs and cigars, what is it about? Psychodynamic therapy is about uncovering and treating root causes rather than focusing on symptoms.

When you get physically sick, say with a cold, your attention is often on the symptoms of the cold. You might notice the fever, the sore throat, the congestion, etc. The first move is usually to try and treat those symptoms. An over-the-counter medication could reduce your fever or clear up congestion.

When you take a medication like this, you might feel better, but it doesn’t mean you’re not still sick. You know that the cold meds will make it so you can live a little more normally, but you still need to take it easy to give your body time to recover.

That’s because what’s causing your illness isn’t the fever or congestion, it’s a virus that has invaded your body. Until your immune system has dealt with that virus, you can’t ever be truly well.

Now, when we get a viral infection, we have an immune system that goes to work to help us heal. We treat symptoms because they affect our day-to-day lives but assume that our immune system will work behind the scenes to deal with the virus.

This is sometimes true of mental health too. Some psychologists have posited a psychological “immune system” that helps us deal with stress and trauma. Stressful life events are unavoidable, and typically our minds are pretty good at handling them.

The reason this is important to talk about is because the most common form of therapy, cognitive behavioural therapy (CBT), is based on treating symptoms rather than the underlying illness or issues. In the same way we often don’t know how we got a virus, we also might not know why we’re experiencing mental health issues. Sometimes we can point to a specific life event, but most of the time lives are complex and it’s hard to pinpoint when things changed.

For CBT practitioners the belief is that, by treating the symptoms of a mental disorder, we give our psychological immune systems a chance to correct the underlying issue. For psychodynamic therapy, however, the goal is to uncover root causes of the symptom.

The difference is not slight. It could be compared to taking a Tylenol for a sore throat versus taking an antibiotic to treat the infection. Like taking Tylenol, CBT often brings (temporary) symptom relief. But research has shown that psychodynamic psychotherapy leads to longer lasting relief and more significant changes in the patient’s life because it treats the underlying causes.

Let’s take a fictional example. Suppose a patient, John, finds himself inexplicably angry at his friends after every dinner party. He knows they haven’t done anything wrong, and after a night’s rest he finds himself ashamed and embarrassed to have thought of his friends the way he did. Each time they get together, he vows not to end the night like last time, but each time as they come to the end of their time together, he becomes reserved, rude, and sometimes even hostile.

A cognitive behavioural therapist might look at this case and divide it into the thoughts and the actions to try and remedy both. The therapist would give John “homework” where every time he had a rude or angry thought about his friends, he reframes the thought or challenges it. He decides if it is a case of catastrophizing, negative self-talk, etc.

The therapist would also give John a game plan for if he ever expressed his anger again. A script to use to tell his friends he was sorry, and a way to reframe the situation so he did not perpetuate a cycle of negative self-talk.

This might help John feel better. Over time, he might find he can attend dinner parties and leave the event without getting angry at his friends. But by never addressing why he got angry at his friends after parties, there’s little guarantee he won’t relapse or have a similar issue appear in a different aspect of his life. He has come up with a rational game plan without ever treating the cause of the emotional issue.

In psychodynamic therapy, John would be encouraged to unpack his anger. CBT often encourages patients to question their beliefs by engaging in a rational dialogue with themselves, but psychodynamic therapy is non-judgemental in this way. Rather than trying to figure out what irrational belief has caused the anger, John is encouraged to explore the associations his friends have for him. Psychodynamic therapy would help John work through the emotional triggers that led to him exploding at his friends. Through this process, John gains insight into himself and the symptom is treated by addressing the root causes.

Over time, John may begin to recognize that he is afraid of losing his friends, or that he’s angry at himself for not being as interesting as he feels they are. It might also be connected to painful memories from his childhood, such as when his parents got into an argument after dinner which ultimately led to their divorce. He might begin to notice that these experiences manifest as anger after dinner parties, but they are also why he has not taken a vacation from work in several years, or has trouble putting away the dishes, often feels lonely or unable to connect with romantic partners.

By addressing the root cause through psychodynamic psychotherapy, John is now able to see how these deep seeded beliefs about himself and his place in the world might be based in a few key events that occurred years earlier. By bringing all of this into his conscious mind, he is able to move towards being the person he would like to be and leading the life that he would like to have. He feels better about himself.

Psychodynamic psychotherapy then, is a process. The therapist works with the patient to help them gain better understanding and insight into themselves. This occurs through a particular form of talk which involves the patient describing their thoughts, emotions and experiences. By working through and treating root causes, the patient moves toward relief of their symptoms, a sense of greater control of their life, and feeling more content.

It might sound based on this example that there is no value to CBT, but that’s not entirely true either. Therapy is a long process, and at different stages in your journey you might find different things helpful. Sometimes a headache is just a headache, but sometimes it’s a sign to get on antibiotics. Similarly, sometimes the things troubling our psychology can be solved with an acute form of therapy like CBT, and sometimes they need something else.

We hope blogs like this serve as a reminder that there are options out there. Maybe you’re new to therapy, maybe you’ve tried a few different therapists before. In any case, if you’re ready to dive into the root causes of your mental health problems, then it’s time to give psychodynamic therapy a try.