What is psychodynamic psychotherapy?

Many people who present to GPs, psychiatrists and other health services are given a diagnosis of depression, for which they are prescribed anti-depressants; or anxiety, for which they are prescribed anxiolytics, when the true diagnosis is unexpressed painful feeling for which the treatment is to express it.

This therapy focuses on the connection between our psychological difficulties in adulthood and our unresolved or unsatisfactory experiences in early life. We are often not aware of the extent of these early difficulties or the emotions attached to them. However, they can be re-triggered by current experiences, such as loss of a loved one, job loss or relationship breakdown in adult life that cause distress and confusion that we have difficulty explaining to ourselves and others.

These painful feelings, if unprocessed, can remain in the unconscious mind and continue to influence our current mood and behaviour. They contribute to problems with self-esteem, personality, relationships, and work. Because we are unaware of these processes, common problem-solving techniques – such as seeking the advice of friends and family, reading self-help books, or attending self-improvement classes – often fail to provide relief.

Psychodynamic psychotherapy involves a very particular kind of conversation between the patient and psychotherapist that enables the person to face what s/he really feels, to realize that it is not as painful, shameful or dangerous as feared, to work through it in relationship with the therapist, and finally to be able to make use of real feelings within other important relationships in a constructive way.

Psychotherapy helps patients to become aware of the meaning behind their thoughts, feelings and symptoms. For example, some patients may have difficulty trusting their therapist. Discussing this difficulty in the therapeutic relationship may help them to explore their problems with trust in their other relationships and everyday lives.

The emotional learning that occurs in this form of therapy should be permanent, in that adaptive behaviours have replaced maladaptive attitudes and behaviours, and that these adaptive attitudes and behaviours can be generalized to new people and new situations in such a way that the learning becomes self-reinforcing.

There is now strong and growing research evidence that psychodynamic psychotherapy is an effective treatment for a range of mental health conditions such as depression, anxiety, unresolved grief, and relationship difficulties that have not responded to other forms of treatment, such as medication or cognitive behaviour therapy.