“The goals of psychodynamic therapy include, but extend beyond, symptom remission. Successful treatment should not only relieve symptoms (i.e., get rid of something) but also foster the positive presence of psychological capacities and resources. Depending on the person and the circumstances, these might include the capacity to have more fulfilling relationships, make more effective use of one’s talents and abilities, maintain a realistically based sense of self-esteem, tolerate a wider range of affect, have more satisfying sexual experiences, understand self and others in more nuanced and sophisticated ways, and face life’s challenges with greater freedom and flexibility. Such ends are pursued through a process of self-reflection, self-exploration, and self-discovery that takes place in the context of a safe and deeply authentic relationship between therapist and patient.” (“The Efficacy of Psychodynamic Psychotherapy” by Jonathan Shedler, Ph.D., The American Psychologist, February-March, 2010, p. 98)

According to Shedler, Psychodynamic or psychoanalytic psychotherapy “refers to a range of treatments based on psychoanalytic concepts and methods that involve less frequent meetings and may be considerably briefer that psychoanalysis proper. Session frequency is typically once or twice per week, and the treatment may be either time limited or open ended. The essence of psychodynamic therapy is exploring those aspects of self that are not fully known, especially as they are manifested and potentially influenced by the therapy relationship.” (p. 98)

Shedler writes that there are “seven features that reliably distinguished psychodynamic therapy from other therapies, as determined by empirical examination of actual session recordings and transcripts.” These seven features are:

1.“Focus on affect and expression of emotion. Psychodynamic therapy encourages exploration and discussion of the full range of a patient’s emotions. The therapist helps the patient describe and put words to feelings, including contradictory feelings, feelings that are troubling or threatening, and feelings that the patient may not initially be able to recognize or acknowledge.”

2.”Exploration of attempts to avoid distressing thoughts and feelings. People do a great many things, knowingly and unknowingly, to avoid aspects of experience that are troubling. This avoidance (in theoretical terms, defense and resistance) may take coarse forms, such as missing sessions, arriving late, or being evasive. It may take subtler forms that are difficult to recognize in ordinary social discourse, such as subtle shifts of topic when certain ideas arise, focusing on incidental aspects of an experience rather than what is psychologically meaningful, attending to facts and events to the exclusion of affect, focusing on external circumstances rather than one’s own role in shaping events, and so on. Psychodynamic therapists actively focus on and explore avoidances.”

3.”Identification of recurring themes and patterns. Psychodynamic therapists work to identify and explore recurring themes and patterns in patients’ thoughts, feelings, self-concept, relationships, and life experiences. In some cases, a patient may be acutely aware of recurring patterns that are painful or self-defeating but feel unable to escape them (e.g., a man who repeatedly finds himself drawn to romantic partners who are emotionally unavailable; a woman who regularly sabotages herself when success is at hand). In other cases, the patient may be unaware of the patterns until the therapist helps him or her recognize and understand them.

4.”Discussion of past experience (developmental focus). Related to the identification of recurring themes and patterns is the recognition that past experience, especially early experiences of attachment figures, affects our relation to, and experience of, the present. Psychodynamic therapists explore early experiences, the relation between past and present, and the ways in which the past tends to ‘live on’ in the present. The focus is not on the past for its own sake, but rather on how the past sheds light on current psychological difficulties. The goal is to help patients free themselves from the bonds of past experience in order to live more fully in the present.

5.”Focus on interpersonal relations. Psychodynamic therapy places heavy emphasis on patients’ relationships and interpersonal experience (in theoretical terms, object relations and attachment). Both adaptive and non-adaptive aspects of personality and self-concept are forged in the context of attachment relationships, and psychological difficulties often arise when problematic interpersonal patterns interfere with a person’s ability to meet emotional needs.”

6.”Focus on the therapy relationship. The relationship between therapist and patient is itself an important interpersonal relationship, one that can become deeply meaningful and emotionally charged. To the extent that there are repetitive themes in a person’s relationships and manner of interacting, these themes tend to emerge in some form in the therapy relationship. For example, a person prone to distrust others may view the therapist with suspicion; a person who fears disapproval, rejection, or abandonment may fear rejection by the therapist, whether knowingly or unknowingly; a person who struggles with anger and hostility may struggle with anger toward the therapist…The recurrence of interpersonal themes in the therapy relationship (in theoretical terms, transference and countertransference) provides a unique opportunity to explore and rework them in vivo. The goal is greater flexibility in interpersonal relationships and an enhanced capacity to meet interpersonal needs.”

7.”Exploration of fantasy life. In contrast to other therapies in which the therapist may actively structure sessions or follow a predetermined agenda, psychodynamic therapy encourages patients to speak freely about whatever is on their minds. When patients do this (and most patients require considerable help from the therapist before they can truly speak freely), their thoughts naturally range over many areas of mental life, including desires, fears, fantasies, dreams, and daydreams (which in many cases the patient has not previously attempted to put into words). All of this material is a rich source of information about how the person views self and others, interprets and makes sense of experience, avoids aspects of experience, or interferes with a potential capacity to find greater enjoyment and meaning in life.” (pp. 99-100)

“There is a belief in some quarters,” Shedler writes, “that psychodynamic concepts and treatments lack empirical support or that scientific evidence show other forms of treatment are more effective…(however) Considerable research supports the efficacy and effectiveness of psychodynamic therapy…including evidence that patients who receive psychodynamic therapy not only maintain therapeutic gains but continue to improve over time.” (p. 98)

“The consistent trend…at follow-up suggests that psychodynamic therapy sets in motion psychological processes that lead to ongoing change, even after therapy has ended…the authors (of one study) noted that patients treated with psychodynamic therapy were ‘better off with regard to their target problems than 92% of the patients before therapy’…A newly released study showed enduring benefits of psychodynamic therapy five years after treatment completion.” (pp. 101-103)

As a psychodynamic psychotherapist, I often find the concept of “repetition compulsion” to be very helpful is understanding patients’ self-defeating behaviors. (See paragraph #3 above) This concept was coined by Sigmund Freud, and it describes the unconscious psychological pattern whereby individuals repeatedly reenact past traumatic, distressing, or unresolved experiences, often in relationships or behaviors, hoping for a different outcome or sense of mastery, even when it causes harm. Repetition compulsion manifests as getting stuck in familiar but negative loops, like choosing abusive partners or sabotaging success, because these patterns feel “known” and are an attempt to unconsciously resolve old wounds, but instead perpetuate them. Psychodynamic psychotherapy aims to bring more awareness to these patterns so that healthier behaviors may emerge.

There is a psychodynamic intervention that I often use in working with couples. (See paragraph #4 above) I will utilize the Imago communication strategy which includes each partner “mirroring” or repeating what their partner has just said. I will then invite them to validate what they have just heard. And finally I will invite each partner to imagine what feelings go along with what their partner has just said.

I will then suggest to each partner that they ask their partner, “What do these feelings remind you of from the past, especially in other important relationships?” Frequently couples are able to make the connection between the feelings evoked in their here-and-now interactions and the painful feelings that occurred with a parent or previous partner. I talk with couples about how important it is that we know about our partner’s wounds from the past, so that we don’t inadvertently or unconsciously re-wound our partners in similarly painful ways.

Shedler concludes his article as follows: “The available evidence indicates that effect sizes (measures of the difference between two groups, indicating the magnitude and direction of the effect) for psychodynamic therapies are as large as those reported for other treatments that have been actively promoted as ‘empirically supported’ and ‘evidence based.’ It indicates that the (often unacknowledged) ‘active ingredients’ of other therapies include techniques and processes that have long been core, centrally defining features of psychodynamic treatment.”

“Finally, the evidence indicates that the benefits of psychodynamic treatment are lasting and not just transitory and appear to extend well beyond symptom remission. For many people, psychodynamic therapy may foster inner resources and capacities that allow richer, freer, and more fulfilling lives.” (p. 107)