What is Psychodynamic Therapy?
In the 1870s, thermodynamics were a hot topic. No pun intended. It explained energy and heat in a way that made sense and it drastically advanced the field of physics. Everybody was talking about it and everybody wanted a piece of it. And one particular scientist at the University of Vienna named Ernst Wilhelm Von Brücke thought to himself, “Well wait a second, if these laws dictate our entire world, then aren’t all living beings, including humans, just bodies of energy that would also abide by these laws?” Ernst published his theory in 1874, which was a significant year because it was the same year that he began advising a bright, young, first-year medical student.
Albert Einstein. I’m just kidding, it’s Sigmund Freud. Freud really liked Von Brucke’s theory, so he stole it and took it a step further. He surmised that not only do the laws of thermodynamics apply to the human body, but they also apply to the human psyche. Voila! Psychodynamic theory was born. A lot of early psychologists became founders and devotees to this theory, including Freud himself and Carl Jung. And it became the basis for the first talk therapy techniques, including Psychoanalysis. If you’re interested in learning more about psychoanalysis, then check out my video for more on that. Around the same time, a boy named Alfred Adler was born to a Jewish grain merchant and his wife. Alfred developed rickets at a young age and was not able to walk until he was four years old. His healthy older brother was showered with attention, while his mother had very little patience for Alfred’s needs. At one point he developed pneumonia and the doctor told his father, “Your boy is lost.” But Alfred beat the odds.
He recovered from his afflictions, grew strong, and became fiercely competitive with his older brother. Little did Alfred know, his illness and sibling rivalry would lead him to develop an entirely new form of mental health treatment… Psychodynamic Therapy. Before we dive in, let’s answer a very important question. What do we mean when we say “Psychodynamic Therapy”? Often Psychoanalysis and Psychodynamic Therapy are used as interchangeable terms, but they’re quite different. And a lot of people – like Anna Freud and Melanie Klein – developed different flavors of this technique, based on different interpretations of the human psyche. But Alfred Adler stands out as the first and most prominent psychodynamic theorist whose impact continues to this day. As such, today I’ll be focusing on Adlerian techniques to describe Psychodynamic Therapy. To better understand Psychodynamic Therapy, let’s talk about what it believes. Psychodynamic Therapy believes that striving for superiority is the core motivation for all human beings.
Which…kinda sounds dark. But superiority doesn’t necessarily refer to trying to dominate other people or wanting a leadership role or having other people admire you. Instead, superiority means rising above what you currently are and striving to live a more perfect and complete life. That sounds…pretty nice! Adler proposed that human beings truly believe that the perfect and complete life is attainable and so we create our own fictional goals for our lives and believe that those personal goals are the entire purpose of life. If you realize these goals, you realize your “ideal self”. So logically, a person’s life will be greatly influenced by these goals that they perceive to be the purpose of life. However, Adler proposed that striving towards our ideal self will bring up inescapable feelings of inferiority, or not being good enough. He termed this common human experience the “inferiority complex”. As we know from his story, Adler had a lot of personal experience with inferiority.
But he didn’t think that that was a bad thing. Adler believed that those feelings of inferiority have driven every improvement humanity has developed to better deal with our world. Like computers or indoor plumbing. See, the belief is that areas where you feel inferior influence where you choose to become superior. And wherever you choose to become superior becomes your “lifestyle”. For example, let’s say that you felt less intelligent than others at a young age. You might strive to become intellectually superior. Your routine, habits, and interactions will then change to achieve that goal of intellectual superiority. Essentially, your lifestyle becomes one of an intellectual and other people will start to describe you as introverted, bookish, or smart. So take a moment and think about your own lifestyle. You live your life the way that you do because you find it important. The reason you are not in the gym for hours every day is probably because being extremely physically fit isn’t your ideal self.
Or maybe you do go to the gym every day, in which case…good for you. Psychodynamic Therapy also heavily focuses on childhood experiences and family environment as the root of many mental health issues and disorders. Adler developed the idea of birth order, which is the theory that your position in your family will influence your inferiorities and also your lifestyle choices. You know, the whole “eldest child is type-A, middle child is the rebel, youngest child is the baby” thing. When I first heard about birth order, I was super into the idea because it seemed to fit so well with my own family. But the evidence for a birth order effect on personality is actually pretty weak. It may seem accurate within a family, but when scientists look at whole populations, they don’t really see an effect. Psychodynamic Therapy also examines a person’s level of social interest. Social interest is the desire and capacity to coordinate and work with other people for the greater good. “The greater good.” “Shut it!” See, unlike, psychoanalysis, which focuses on internal conflicts, Psychodynamic Therapy is more concerned with interpersonal conflicts. Adler understood that humans are inherently social beings and so, to be healthy, a person must have real involvement and investment in society.
In childhood, social interest can be nourished in a family environment of respect, trust, support, and understanding. Or it can be squashed in an atmosphere of competition, mistrust, neglect, domination, or abuse. Children from the latter kinds of families are more likely to strive for their ideal self at the expense of others through selfish means. Okay, so now that we know what Psychodynamic Therapy believes, let’s look at how it’s done. Unlike psychoanalysis where the client lays down on a couch and the therapist is just out of view, Psychodynamic Therapy happens face to face.
It’s also the first form of therapy to implement the empathetic therapist, which is now standard practice in modern counseling. See, the therapist is not a detached, emotionless blank slate like in psychoanalysis. Instead, the therapeutic relationship becomes an integral part of treatment. The therapist has positive regard for the client and shows genuine interest in their well-being. The first few sessions will typically just focus on gathering info on the client’s concerns and building that therapeutic relationship.
The primary goal of Psychodynamic Therapy is to make the unconscious…conscious. The therapeutic relationship with the therapist can reveal how the person interacts with their friends or family. The therapist then engages in consciousness raising by sharing their observations with the client. Suddenly, unconscious emotions, desires, and relationship patterns become visible. And when the client examines themselves, they’re more able to make changes in problematic areas. Consider this client who received divorce papers from his wife a few weeks ago. After discussing the issue over a few sessions, the therapist begins to challenge him and engage in consciousness raising.
Counselor: It sounds like you’re saying your wife hasn’t been emotionally present for you in the way you would like her to be. Robert: Yeah, I mean. She’s there, but…I don’t know. We’ve both made a lot of mistakes. Counselor: I notice that whenever we talk about Rachel’s responsibility in the divorce, you seem to have difficulty criticizing her behavior. Have you noticed that yourself? Robert: No, I’d never thought of it like that before. But I think you’re right. I mean, that makes a lot of sense.
Counselor: And what do you think makes you stop short of being critical? By making the client conscious of his reluctance to criticize his wife, it opens up a new conversation and may spur the client to further examine the dynamics of his relationship with his soon-to-be ex-wife. Another tool used in session is contingency control. This is a way of reframing a selfish goal in a humorous way so that the client can mock it rather than feel condemned by the therapist. For example, if you are a perfectionist, the therapist might have you imagine yourself as a mad scientist with frizzy hair, bent on taking over the world by building a giant lego robot.
But the scientist can’t achieve this goal because they’re too focused on the color and type of lego to begin with. Not only is it funny, but the client can understand how silly it is to allow something so small dictate such an elaborate plan. Another technique used by Psychodynamic Therapy is choosing. This technique allows clients to step outside of their comfortable lifestyles so they can pursue new lifestyles. One tool that’s commonly used is the “as if”. Let’s say a client says that she would really like to ask out her next-door neighbor on a date. But she says that she’s shy and says, “I’m not really the kind of person to start a conversation”. The therapist may task the client with acting “as if” they are that assertive person who does make the first move. She doesn’t have to become that person, she just has to act like it. If the client follows through, she’ll probably find out that it works – even if she doesn’t get the date – and that by acting in this way, she transforms fiction into reality.
With all of these techniques, the therapist can help the client understand their unconscious desires, inferiorities, and lifestyle, develop a healthy social interest, improve interpersonal relationships, and achieve realistic goals. And treatment doesn’t go on indefinitely, either. Psychodynamic Therapy is relatively short-term. While there is no set limit to sessions, it typically involves one session a week for anywhere from three months to a couple of years. All right, so now we know what Psychodynamic Therapy believes and how it’s done.
But, does it work? Unfortunately, not much research has been conducted on the actual effectiveness of Psychodynamic Therapy. And it depends on which study you look at. It’s definitely more effective than no treatment. And it’s been found to be about as effective as psychoanalytic therapy in a few studies. Newer treatments like behavioral and cognitive methods appear to consistently outperform Psychodynamic Therapy. But, some recent research shows that, when you control for therapist loyalty, the effectiveness is about the same as most other modern therapies.
However, Psychodynamic Therapy has not gone through the rigorous process of becoming an “evidence-based practice” like Cognitive Behavioral Therapy or Acceptance and Commitment Therapy. This means that its techniques haven’t been studied enough to show their effectiveness. So it’s kind of hard to give it a strong endorsement. Regardless of whether Psychodynamic Therapy is the right choice for treatment, it has undoubtedly changed the therapeutic landscape. It introduced new concepts like the empathetic therapist and short-term care, while also building the foundation for newer treatments. So that’s nothing for little Alfred to feel inferior about.
As found on Youtube