Psychodynamic approaches to therapy


Psychodynamic approaches to therapy

Sigmund Freud

Underpinning all talking therapy, this approach goes back to Freud who first proposed the idea of an unconscious mind. He demonstrated that the psyche is dynamic, ie that there can be different “urges” within the psyche. In a healthy person these are in a state of uneasy truce. In a “neurotic patient” these are out of balance, causing all kinds of distress including physical symptoms.

Freud’s solution to the ills of the mind was the treatment called “psychoanalysis”. This was based on the idea that a therapist could be a “blank screen”, ie say and do so little that the patient would begin (after months of several sessions per week) to “project” their dynamics onto the therapist. The patient was encouraged to “regress” and the fantasies become the stuff of the therapy. Many years later, having cycled again and again through weaker and weaker “neurosis”, the therapist declared the patient “analysed”. All this sounds a bit odd today. However, we owe a huge debt to Freud for opening up the territory. His idea of the unconscious is now commonly used in everyday life.

Psychoanalysis was the first therapy tradition and all others have built upon it. Staying within the tradition of psychodynamic approaches to therapy, many writers (Klein, Anna Freud, Fairburn) have updated Freud’s teaching, taking it in new directions. Hugely influential have been Object Relations Theory (Winnicott, Guntrip, Bion) and Attachment Theory (Bowlby). Many of these writers have greatly added to our understanding of child development, of emotional pain and of the mechanisms at play in therapeutic relationships. The field continues to develop to this day.

Transference

For example, “transference” is the term used by therapists to describe the way clients see a therapist in ways which echo their past relationships. So, a client who has been brought up by critical carers is likely to anticipate a critical response from a therapist. Since such a client will be struggling with a sense of being criticised by many people in their lives, therapy offers a place where they can examine the influence of this early learning. The concept of transference comes directly from Freud’s original teaching.

Modern psychoanalysts are divided about the benefits of the blank screen approach and psychoanalytic psychotherapy has been influenced by recent findings from neuroscience.

My experience with Psychodynamic Approaches to therapy

After I gained employment in counselling I joined a psychodynamic therapy supervision group which introduced me to psychodynamic theory and practice. Over many years this was my main approach. I remember one of my teachers saying, “I would argue that it isn’t me who is psychodynamic – its the world”.

Recommended reading

Introduction to the Practice of Psychoanalytic Psychotherapy. Alessandra Lemma. 2015 (2nd edition).