Psychodynamic and Psychoanalytic Therapy

Psychodynamic therapies draw on psychoanalysis, the theory developed by Sigmund Freud. This theory aims to explain the unconscious influences behind human behaviour, and it holds that personality is shaped by thoughts and drives located in the unconscious. The psychodynamic approach is a therapy method that focuses on helping people cope with their problems by exploring their own inner world.

In therapy, the client shares emotional difficulties and behaviours with the therapist in order to clarify, face and heal inner conflicts. The therapist focuses on the client’s past experiences, especially childhood, to help the client gain insight. In this way the client develops awareness of their own attitudes and behaviours and adopts a healthier approach to solving problems.

In psychodynamic therapy, problems such as anxiety and depression are thought to stem from emotional difficulties experienced in the past. Therapy therefore examines the coping mechanisms, defence mechanisms and other patterns the client has used. This brings to light, and allows work on, the inner conflicts and defences that cause the client’s problems. Many techniques can be used to bring emotional and mental relief, including mirroring, interpretation through mirroring, analysis of transference and countertransference, interpretation and clarification.

How is a psychodynamic assessment done?

A psychodynamic assessment evaluates the events a person has lived through and the unconscious factors at work. The therapist takes the person’s life history in chronological order, which helps in forming a formulation of their psychological state. The psychodynamic approach is based on unconscious drive conflicts, psychosexual level, object relations, self-representations and libido that underlie a person’s behaviour and psychological state. It considers how childhood experiences are reflected in adult behaviour.

According to the psychodynamic approach, negative experiences affect people in adulthood even if they do not remember them. Therapy therefore aims to understand and work through the person’s past experiences and unconscious factors. The goal is to help the person understand themselves better, recognise their unconscious drives and conflicts and resolve them in a healthy way. In this way the person can free themselves from the effects of negative past experiences and lead a healthier life. Because it addresses the deep psychological factors behind behaviour and mental state, the psychodynamic approach helps people understand themselves better and live more healthily. It is used especially in long-term therapy and helps people face themselves and explore their inner world.

How long does psychodynamic therapy take?

Psychodynamic therapy is a psychotherapy method that focuses on unconscious processes to understand how past experiences are reflected in present behaviour and to help the person gain insight. It aims to restore psychological well-being, and its length can vary. The process is closely linked to the client’s belief that therapy will help and to their trust in the therapist. The number and severity of traumas experienced can also affect its length. Brief psychodynamic therapy can last up to 25 sessions and is goal-oriented. Long-term psychodynamic therapy can last two years or more and works more deeply with the person’s past experiences. This method is suitable for individual psychotherapy and helps clients face the past and take steps towards a healthier future.

Who is psychodynamic psychotherapy for?

Psychodynamic psychotherapy is recommended particularly for people who:

• have had problems or difficult relationships they have been unable to resolve for a long time
• feel close to depression
• have psychosomatic complaints
• suffer from neurotic conflicts or have a sensitive personality structure
• have phobias or obsessions, or sexual problems in relationships
• have borderline, narcissistic or schizoid personality problems or disorders
• have anxiety disorders or panic attacks
• struggle with avoidance of attachment, obsessive attachment or infidelity in relationships

Psychodynamic therapy is an effective way of addressing these problems. When it is carried out by an experienced mental health professional, improvement can spread across all of the client’s problems in a chain reaction. For therapy to succeed, however, it is important that the client trusts the therapist and believes the therapy will have positive results. The method focuses on unconscious processes in the mind and on past experiences. The therapist analyses the client’s feelings, thoughts and behaviours to understand how negative past experiences are reflected in present life and where the problems come from. Throughout therapy, the aim is for the client to gain more awareness of themselves and to face their past experiences.

The difference between psychodynamic and psychoanalytic therapy

Psychodynamic therapy aims to help clients understand their life experiences better and gain strength by exploring recurring patterns and their causes and consequences. To establish a clear link between events in the outside world and experiences in the inner world, the client needs to remember during the psychodynamic process. This method is based on psychoanalytic theories and accepts the existence of the unconscious. However, psychodynamic therapy does not have as strict a frame as psychoanalysis and is more flexible in practice.

Psychoanalytic therapy goes deeper through a stricter way of working. In this method the therapist must have undergone, or be undergoing, their own analysis. Psychodynamic therapy is more flexible in terms of duration, the therapist’s activity and the frame. The causes and consequences of vicious circles in the client’s life are explored, and by becoming aware of their own choices and strength, the client can open up new possibilities in life. The effect of therapy is directly linked to the client’s own experiences and is subjective.

How psychodynamic therapy helps clients

Free association is very important in psychodynamic therapy. To find the key point of a problem, free association is encouraged and the client speaks freely. Relational therapists, for their part, contribute to solving problems by talking about the relationship between patient and therapist. The patient’s history and the parts that have remained hidden are also central to the treatment. In the opening phase, the patient is expected to tell their story in their own words. Information is gathered about why the patient is seeking treatment, what triggers the problems and their mental health in general. Psychological tests and personality assessments may also be used to identify cognitive and psychological difficulties.

Psychodynamic therapy places the unconscious at the centre. A person’s current life and experiences in the outside world are approached, along the axis of inner experience (the inner world), as a kind of excavation, discovery and reconstruction. Links between past and present experiences are made through the material and dynamics that emerge in therapy.

Psychodynamic therapy

Unlike directive, structured, suggestion-based therapies that work at the conscious level (such as cognitive behavioural therapies), psychodynamic therapy does not intervene directly in symptoms. It aims at lasting change and transformation by trying to reach the roots of the symptoms. For this reason psychodynamic therapy requires long-term work, often spread over years.

Psychoanalytic therapy

The frame of therapy is the most fundamental element of the work. In psychoanalytic therapy it is important that sessions continue face to face, at the agreed frequency, day and time, within an established constancy. Exploring and working on the links between the feelings and thoughts the client develops towards the therapist and their past relationships makes change and transformation possible within the transference relationship.

The work is face to face and can be individual, or it can take place in an analytic group setting within the framework of psychoanalytic group therapy (group analysis) (Istanbul Group Analysis Association – IstGA).

Istanbul Psychoanalytic Association

Psychoanalysis on the couch (Istanbul Psychoanalytic Association, PsikeIstanbul), held at least three times a week, takes place in an analytic setting in which the person lies on the couch with the analyst sitting behind, and can give themselves over entirely to free association. Here too, the frame is essential.

To learn more about cognitive behavioural therapy, follow the link.