Psychodynamic psychotherapy

Hidden conflicts drive symptoms1

Some problems are partly an outgrowth of the unconscious mind; therapy tries to reveal and resolve those conflicts.

It starts early1

Psychopathology is seen as developing mainly from early childhood experience, organised around relationships with other people.

The mind defends itself1

Defence mechanisms form to avoid the unpleasant consequences of inner conflict, and therapy names them.

Insight heals1

Trust in insight is treated as critically important for the therapy to work.

Free association1

You say whatever comes to mind, even if it seems irrelevant or embarrassing, so hidden material can surface and be interpreted.

Noticing resistance1

Holding back, forgetting or blocking during the session is treated as information, not failure.

Working with transference1

Feelings once directed at parents or siblings show up toward the therapist and are explored in the room.

Dreams1

Some therapists ask you to report dreams and associate to them to find hidden meanings.

Free association1

For example, mid-session a client mentions a seemingly unrelated childhood memory and apologises for rambling; the therapist encourages them to go on, since such thoughts can then be interpreted.

Conscious resistance1

For example, a client deliberately leaves out a recent setback out of shame or distrust; the holding back itself becomes something to explore.

Repression resistance1

For example, a client's mind goes blank, or they cannot recall an event, just as free association nears a painful subject.

Transference1

For example, a client becomes sure the therapist is bored with them, as they once felt their busy father was; the feeling is explored in the room rather than set aside.

A defence in words3

Describing a strict father he deeply resents, a man says only: "Yes, my father was a rather firm person, I suppose I do feel some antipathy towards him even now." Cool words for painful experience mark intellectualisation.

A dream1

For example, a client reports a dream of missing a train and associates freely to it; together they look for what it may mean.

Freud's discovery4

When a patient refused to free-associate, Freud first saw resistance; he came to see that analysing the transference was the work itself.

As large as other therapies2

A 2010 review in American Psychologist found effect sizes as large as therapies promoted as evidence based, with gains that continue after treatment ends.

Long-term therapy1

A 2020 meta-analysis found small but significant benefits over other therapies for complex disorders, with caution because studies differ and have method limits.

Weak spots1

A 2013 meta-analysis of psychoanalysis lacked control groups; for major depression short-term psychodynamic therapy may manage symptoms less well than medication.