introduction: therapies and modalities
All forms of psychotherapy start from the belief that meaningful human contact is intrinsically healing. There are many approaches to establishing and maintaining this “therapeutic” contact, and you have likely heard of a number of them: older therapies like Freudian, Jungian, or Adlerian, for example, or newer ones like narrative therapy, bibliotherapy, or motivational interviewing.
Each “modality” is generally represented by its creators and practitioners as being utterly separate from all of the rest, with its own unique techniques and methods for psychological and emotional healing. Some of this is, frankly, ego-driven on the part of the modality’s “inventor,” and some it is marketing designed to catch the eye of potential new clients, and some of this representation is for the purpose of secure grants and funding for research. That said, however, there are in fact real differences between psychotherapeutic approaches.
These differences begin as emotional and philosophical intuitions and ideas about what motivates human beings and how to alleviate suffering. While these initial intuitions and ideas usually begin with only one or two therapists or theorists, over time they are gradually elaborated into larger constructs, concepts, and methods by the many therapists and clients who contribute thoughts and observations and experiences to the larger body of understanding.
As modalities grow, they are slowly codified into specific theories of how the mind works, often accompanied by a “toolbox” of specific “interventions” and techniques that are accepted as useful ways of helping people understand themselves and resolve their emotional distress: Talk therapy, guided meditation, dream journals, expressive dancing, hitting mattresses with tennis racquets, free association, body work, and even just sitting together in silence.
There are hundreds of these interventions, and within each modality there is continual discussion back and forth about which techniques work best for whom and how best to apply them. However, for someone approaching therapy for (perhaps) the first time, the most important thing to remember is that each theory and corresponding “modality” is basically just a set of rules and expectations about how the therapist is supposed to behave—and the kinds of things the client is supposed to talk about, pay attention to, and do.
And the goal of all of this is to relieve psychological suffering through effective, meaningful human contact.
With that in mind, let’s now turn to the question in hand: What is “psychodynamic” psychotherapy?
Psychodynamic Psychotherapy
Psychodynamic psychotherapy (which is what I practise) focuses on internal experience and making sense of the things that happen to us; what we feel and why we feel it. In other words, it tries to understand the movement and relationships (the dynamics) of and between the thoughts we think and the feelings we feel (our personal psychology).
In our day-to-day lives, most of the time anyway, we do the things we do without realising what we’re doing or why. When these things cause us problems, it then leads to the common feeling of being out of control and of being unable to change—of being in thrall to “bad habits” we hate, depression we cannot shake, being “triggered” by trivial events, and overcome by anxieties that won’t go away no matter how “rational” we try to be.
The psychodynamic view is that the thoughts and actions which cause us so much trouble are actually ways of escaping from uncomfortable emotions, or forgetting about the things that make us feel them. Denial and repression; escapism through food, drugs, sex, and entertainment; obsessive work, or cleanliness, or exercise; rigid and dogmatic rationality that ridicules “silly and stupid” feelings—effectively, these are all simplistic ways of hiding from strong emotions, bad thoughts, and difficult memories.
You are not broken
Contrary to a more mechanistic view of mind and emotion, the psychodynamic approach does not assume that these so-called “maladaptive behaviours” (this term is inaccurate and misleading on a number of levels) are the result of faulty cognition, or a “chemical imbalance, or a broken brain. Quite the opposite: they are active, intentional adaptations we make in order to manage difficult circumstances and unresolved traumas.
To put it another way: We choose to act in these ways because it makes us feel better, it makes us feel safe, like we have some kind of control over the world. Even if we don’t know why, even if it’s only for the briefest moment, and even if it brings serious side-effects with it—it works, and until now that’s all that has mattered.
However, while our respective coping/survival/protection strategies were effective in the past and have gotten us this far, they probably aren’t as effective as they used to be, and today probably cause more problems than they solve.
Understanding our Personal History
This is largely because we each chose our preferred coping mechanisms at a time when we were too young to really understand what we were doing or what the consequences would be. As children, with a limited range of options, we found a strategy that worked and so we used it.
In order to develop a mature and balanced approach to difficult events and emotions, we need to understand what makes the childlike ones so powerfully attractive. A large part of this is understanding what we were feeling at the time that made us need to reach for a coping mechanism in the first place—because often, the more intensely we rely on an unhealthy/unhelpful strategy in adulthood, the more intense the childhood aversion/fear/trauma was. And the tighter we cling to it, and the harder it is to shake and re-shape.
Very often this is reflected in the form of the coping strategy we use. The most problematic ones are always the most childlike:
- stealing (I want it!)
- denial and lying (I don’t want it to be true!)
- cheating (I want to win!)
- directly seeking comfort in foods we know are bad for us (Feed me!)
- escapism, drugs, alcohol (Make me feel safe and strong!)
- neediness and disruptive attention-seeking (Love me!)
- distrust and avoidance (I hate this, and I hate you!)
- throwing a temper tantrum (Give me what I want!).
This is one of the reasons why psychodynamic therapists seem so obsessed with their clients’ childhoods, particularly their family relationships. Because human beings learn primarily by example (monkey-see, monkey-do), and the coping strategies we choose are often the same as (or the exact opposite of!) the ones our parents used. And if we didn’t learn them from our parents, we almost certainly learned them because of our parents.
More generally, however, it is our earliest experiences of support or criticism, love or neglect, success and failure which lay the foundation for our entire future self. These experiences can have been with anyone we ever encountered in our youth, and everything that has come after is built upon and interpreted in terms of them.
Talk therapy
The psychodyamic model is built on the finding of thousands of therapists and clients that “working through” our personal histories—taking the time to remember, talk about, and reflect upon our childhood experiences—is psychologically healing. It does so (in part) by creating a coherent sense of your own story and the people and events who have made you who you are. It also helps you put the past into the past, and to recognise when it is interfering with the present. This lets you build and maintain a sense of solid structure within yourself: who, what, where, why, when, and how.
Most importantly, however, it helps you tolerate the “stupid” or “irrational” feelings you have been trying to escape from. Talking openly about emotions lets you see that the opposite is true, everything we do is emotional, and we have feelings about everything. Verbalising them therefore helps you understand that having strong emotions does not make you a monster, or selfish, or childish, or irrational, or immature, or any of the ideas we use to punish ourselves for being “bad.”
Simply put, there is something magically liberating about allowing yourself to remember events you have banished to the back of your mind, and hearing yourself say out loud the things you have so long been terrified of letting out. Doing this over and over again without being punished, or judged, or criticised, or ridiculed, or rejected—being instead praised and encouraged—is a major part of the healing process.
Re-Learning, Re-Adapting
However, your present life is just as important as your childhood. Because it is in the present that you have to actually make the changes you want to make. You will inevitably encounter situations which stir you up and you will then have decide not to react in your old-established ways.
By talking about your present life and how it relates to your past, you create intelligible chains of cause and effect which allow you to see things differently, to understand what is happening and why, and then to behave in a way that is consistent with who you want to be.
This is by nature a process of trial-and-error, and exploring your day-to-day successes and failures in your therapy sessions helps to reinforce the new patterns and integrate them into your self-image.
In other words, you are re-learning how to be in relationship with the people around you, and re-adapting to the circumstances of your life as they really are. Psychodynamic therapy sees this re-adaptation process as having three basic, interrelated elements.
- Our coping strategies and defence mechanisms are activated and strongly influenced by thoughts and emotions that happen outside of our immediate awareness. Because we can’t see them, we can’t understand them, and therefore can’t yet change them.
- The patterns which give rise to these hidden thoughts and emotions don’t spring up from nowhere; they have grown over time and have been continually refined and reinforced through experience. To change them we need new experiences, and those experiences must also be reinforced over time.
- By talking about the past we are looking at old events with new eyes, and we can learn to see what was previously invisible. By talking about the present, we get a clear view of what is really happening. And by talking about the future we direct our development towards what we actually want.
In other words, becoming aware of our unconscious motivations allows us to break old habits, to then have new experiences and cope in a new way, and to gradually, but intentionally reinforce new patterns so that they continue on into the future.
Moopidoo
Each session is a chance to step out of the normal form and flow of space and time and see and experience things in a new way. The focus is on you and only you, because that is also the point. The psychodynamic therapist keeps their needs and automatic reactions out of the conversation so that you can see, feel, and understand those parts of your memory and perception which are normally hidden from view. They do it gladly because they know the value of it, and that it can work no other way.
And as you discover more things about yourself than you ever though you could know, and see yourself becoming the person you always knew you should have been, you’ll (hopefully!) understand and be glad of this somewhat strange arrangement. Because above all, psychodynamic therapy has as its goal to see you, know you, and respect you for exactly who you actually are. It is a feeling that everyone craves, and which everyone ought to experience at least once in their life.
