What is Psychodynamic Therapy?

By Holly Gordon, Psychologist/Doctor of Mental Health (DMH)

Psychodynamic psychotherapy is a method of treatment that promotes self-understanding, with the goal of feeling freer, more in control of one’s life and more fulfilled in relationships. The word “psychodynamic” refers to struggling forces within us, fears or convictions we hold, often unconscious and outside of our awareness, which push us to both behave and experience life and relationships in particular ways.

People use what dynamic therapists call “defenses” to protect themselves from bad feelings. For example, being clinging and guilt tripping may help a person feel that they have hooked the other, abating insecurity; bragging and adopting a superior attitude can cause one to feel important, not insignificant; being aloof may cause one to feel immune from relational hurts; exploding in anger when one feels slighted may dispel feelings of inadequacy. As these examples demonstrate, these ways of behaving may be self-destructive or cause unhappiness, but they feel immediately necessary to protect a sense of safety or self esteem. Defenses fool the client more than they fool anyone else, and that is the goal: to protect oneself from immediate psychic pain, no matter the consequences in reality of failed relationships, lost jobs, inhibited lives. In fact, people often seek therapy because their defenses no longer work for them. Either clients see the cost of their behaviors, or troubling emotional states persist. Psychodynamic therapy seeks to understand the unconscious anxieties and needs that press the client to use these life-limiting defenses, which can feel outside of individual control. The client can bring these emotions to the therapy relationship and address those hurts.

In psychodynamic therapy, a therapist is trained to listen for repetitive patterns, restrictions, and the effects of injuries. This focus includes noticing how the client experiences the therapist’s intentions and attitudes, so as to better understand the unconscious maps of him/herself in the world that the client holds. Often the relationship with the therapist comes to contain many of the frustrations and fears that have characterized the client’s early relationships, or the attitudes that the client has come to hold toward him or herself. This is called “transference”. The client often comes more than one time per week, in order to keep open issues explored in the therapy relationship.

By having an emotionally active relationship of exploration with the therapist, the client comes to see motives and fears that he/she never fully understood before. This is referred to as “insight”, a greater awareness of our shaping fears and how we cope with them. Therapy can be a safe place to feel and explore feelings never before tolerated or faced. By bringing these fears into the light of a safe relationship with the therapist, the client can reconsider whether he/she needs to be ruled by these forces. Our memories are stacked in our brains according to emotional salience, and when the client can experience emotions similar to painful emotional dilemmas in the past, old memories are awakened and attitudes that accompany them can shift according to the new relationship with the therapist.

The relationship with the therapist is also supportive of developing selfhood, as the therapist listens for emerging or inchoate aspects of inner life, and helps to bring words to never before known parts of the self. The therapist’s words, which capture subtleties and varied aspects of the client’s experience, come to form a kind of emotional scaffolding for emerging awareness. The relationship is collaborative, as the therapist offers reflections about how he/she understands what is troubling the client and the client’s response helps to fine tune that mutual understanding. Bringing these feelings about ourselves to the psychotherapy relationship and discussing them in a nonjudgmental and caring setting frees the client to have different perspectives, be more creative, and less driven by anxieties.

Here is an example of a client, who is a composite of people I have seen and is not about any one person. M is a young adult man who came to therapy because he wanted to be free of anxiety and of his parents’ ever-present oversight. He initially felt that the problem was his parents’ resented interferences, but came to see that he had internalized their presence in shaping ways. We explored what the intrusions meant to him: at first, that his parents cared, and he felt loved by submitting to their suggestions, and when he felt particularly lonely, he would invite their concern. Later he came to feel that their suggestions reflected that they didn’t have faith in his ability to know and respond to situations, and in fact that they didn’t listen to who he was and imposed their own picture of who he was and what he should be doing. He realized further that he experienced his parents as wanting him to be empty so they could define him, crushing him when he showed independent thoughts. Seeing that degree of negation in such a formative relationship was a devastating awareness.

Even though he hated his compliance, he came to realize that in the absence of someone to conform to, he didn’t exactly know who he was. In the therapy relationship he would scrutinize me for signs about what I wanted from him, and in the absence of that, he felt a terrible lost feeling. Being in the lost feeling together changed that feeling, and he began to notice opinions he held, his self-crushing response to his independent thoughts, and his fears that having his own opinions would cause me to recoil from him. We explored his sense that I was a self-centered person who required attention to my concerns, and that I would drop him if he didn’t feed my ego. As he came to have insight about the underpinnings of his compliance, he was able to find a selfhood where he could feel grounded, and his anxiety lifted.

Holly Gordon, DMH, San Francisco, CAAbout this Contributor: Holly Gordon DMH (Doctor of Mental Health) is a psychologist who practices in San Francisco seeing adults, adolescents and couples. She is a member of San Francisco Center for Psychoanalysis where she teaches candidates in the Extension Division, and she is an Assistant Clinical Professor in Psychiatry at UCSF. She received the American Psychoanalytic Association Edith Sabshin Award for Excellence in Teaching. She has been in practice for over 25 years. 

To find out more about Holly Gordon, visit her website at www.drhollygordon.com.  

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