Psychodynamic Psychotherapy

Those forms of psychotherapy, falling within or deriving from the psychoanalytic tradition,
that view individuals as reacting to unconscious forces (e.g., motivation, drive), that focus on
processes of change and development, and that place a premium on self-understanding and
making meaning of what is unconscious. Most psychodynamic therapies share certain
features, such as emphasis on dealing with the unconscious in treatment and on
analysing transference. Also called dynamic psychotherapy.
- Developed by Sigmund Freud (1856-1939)
Basic Assumptions:

1. Our behaviour and feelings are powerfully affected by unconscious motives.

2. Our behaviour and feelings as adults (including psychological problems) are rooted in
our childhood experiences.

3. All behaviour has a cause (usually unconscious), even slips of the tongue. Therefore,
all behaviour is determined.

4. Personality is made up of three parts (i.e., tripartite): the id, ego, and super-ego.

Psychodynamic Formulation:
A psychodynamic formulation is a hypothesis about the way a person thinks, feels, and
behaves, which considers the impact and development of unconscious thoughts and feelings.
Our psychodynamic formulations need to include:
1. ideas about how unconscious thoughts and feelings might affect our patients’ problems
2. ideas about how those unconscious thoughts and feelings might have developed.

Origin of Psychodynamic Formulation:

Psychodynamic formulation is at junction where therapy, theory and science meet, but past
had few auspicious findings.
• Sietz 1966 started consensus for making dynamic approach which ended without
agreement.
• MALAN 1983 developed formulation method.
• 1987 after advent of DSM-3 multi axial system the perceived the need of psychodynamic
-Psychotherapeutic treatment and
-Descriptive diagnoses
The psychodynamic formulation is our map – it guides every aspect of the treatment. Having
a working psychodynamic formulation enables us to
• make treatment recommendations and set goals
• understand what patients need developmentally
• develop therapeutic strategies and predict the way patients will react in treatment
(transference)
• construct meaningful interventions
• help our patients to create cohesive life narratives Sometimes we share our psychodynamic
formulations with our patients, and sometimes we use them privately to help shape our
therapeutic strategies and interventions.
When we construct psychodynamic formulations, we
1. DESCRIBE the patient’s primary problems and patterns
2. REVIEW his/her developmental history
3. LINK the problems and patterns to the history using organizing ideas about
development

Stages of Psychodynamic Psychotherapy:

Stage 1:   Intellectual Awareness.  The first few months–sometimes lasting up to a year–are
spent obtaining an intellectual understanding of your issues.  You learn all about yourself:
why you are anxious, depressed or angry; how you got that way (linking present habits with
traumatic events during childhood); and what kind of situations in your present life are
problematic.  You become aware of what things trigger you and what people you are
vulnerable to.
During this stage you start off feeling that you are making a lot of progress, as you become
quickly aware of the various aspects of your psychological functioning.  However after a
while you have the feeling that you are not making progress.  It seems to you that you have
learned everything you need to know, but you are still getting into the same situations you
always have.

Stage 2:  Emotional Awareness.  The second stage involves the most difficult part of
therapy.  In this stage you have to understand your feelings and what you do with them.  This
is the part of therapy where you learn to really “know yourself”–something many wise people
have written about.  The hardest part about knowing yourself is recognizing your own faults. 
It is easy to look at the faults of others and how others are making you miserable; but looking
objectively at yourself is perhaps the hardest thing any person can do.
The main thing that stops people from looking at themselves is their unconscious emotional
blocks.  For example, a person may be aware that he is angry at another person and critical of
them.  But he will not want to be aware of the deeper jealousy that causes him to want to put
down the other person.  Getting in touch with all your feelings and how you express them is a
long term project that may last years.

The second-stage process involves taking yourself apart and studying each aspect of your
psychological functioning.  This can be the most painful part of the process, but also the most
rewarding.

Stage 3:  Reconstruction.  Now that you have taken yourself apart, you will need to rebuild
yourself.  Taking yourself apart involves individuation–separating yourself from the self you
were programmed to be by your upbringing.  Perhaps you were programmed to feel afraid of
opening up to people and have deep-seated fears of doing so because in your family
whenever you opened up you ended up feeling misunderstood and belittled.  Reconstruction
involves learning how to open up and developing your own confidence in yourself.  It has to
do with building a new you from the ground up.
Once you have erected this new you, you will begin to relate to people in a different way. 
Family members and friends who are used to looking down on you and feeling superior to
you will have to process their own feelings.  After your emotional separation from them, you
will no longer tolerate bad treatment from them, and they will think you have gotten uppity.  
There will follow a period of adjustment.

Stage 4:  Mastery.  Toward the end of the third stage you reach a point where you feel more
balanced and more grounded.  You have gone through individuation and have developed a
new personality that is more adept at taking care of yourself and your feelings.  The new self
has learned to handle people and situation that used to cause you stress.
As you practice handling the various situations that come up, you develop mastery.   The
things that used to trigger you diminish, but not completely.  You are more able to handle
them, but still have occasional relapses.   Eventually you develop a new you that not only
handles things better, but thinks about them better.  For example, whereas you might have
been convinced that the only way to make yourself feel good would be to tell off all your
enemies, now you understand that the way you feel better is to forgive them and move on.

Resistance
Free association is the patient's effort to say whatever comes to mind without editing. It is a
very different way of communicating than most people use in social situations. Resistance is
anything that the patient does that opposes the process of therapy. Early psychoanalysts
likened free association to the flow of electrons in a circuit, thus, whatever the patient did to
impede the electron flow was resistance. Once a resistance was identified, the next step is to
reflect on whether to call it to the patient's attention, and, if so, how and when to do it.
Resistance can also be a way of avoiding unconscious guilt. In psychodynamic therapy,
patients frequently feel humiliated and ashamed when they become aware of their
unconscious fears and fantasies. Avoiding these feelings is one common source of resistance.
Supporting techniques use therapists' understanding of resistances to help patients make more
adaptive choices.
Transference
-Individuals whose self-objects (parents) failed in their mirroring function may continue to
crave for approbation and admiration and manifest this pattern in therapy. This is termed the
mirroring transference.
- Idealizing transference similarly aims to meet defective self-esteem by vicariously
identifying with the perfect therapist.
- Erotic transference is also thought to have infantile roots and occurs relatively commonly in
therapeutic relationships, whatever the gender of the therapist and the patient. It tends to be
highly embarrassing for the patient and sometimes also for the therapist.
Counter-transference
Counter-transference in its broadest sense refers to the thoughts and feelings of the therapist
during a treatment session which are in some ways relevant to the patient's current experience
and thus may be involved in illuminating the patient's reaction or, indeed, obscuring it.
- Concordant counter-transferences are based upon primitive empathic processes within the
therapist. The latter resonates with as yet unverbalized experiences of the patient.
- Complementary counter-transferences arise when the patient treats the analyst in a manner
congruent with an earlier relationship pattern.
- “Reverse transference” where patients treat the therapist as they felt treated when children,
is a special instance of this category.
Current Status:
Research has demonstrated that emotion regulation plays a key role in stress management and
adaptation helping the individual to cope with discharged feelings and thoughts related to the
COVID-19 crisis, communication of the final stage of the individual's life and, therefore,
protecting them from developing clinical levels of psychological distress. The role of
dynamic psychotherapy is essential in moderating people's emotional reactions, although its
implementation requires the adjustment of therapeutic strategies enhancing adaptation and
resilience. From this perspective, it is imperative to improve public awareness and establish
adequate procedures and prompt responses of intervention.
Due to uncertainty surrounding COVID-19, collective distress and individual suffering, the
psychodynamic approach may be able to consistently identify and manage stressful life-event
as well as fostering emotional regulation in order to prevent possible relevant factors
involved in the pathogenesis of both psychological and psychosomatic syndromes. This is of
particular relevance at present with many experiencing grief and sorrow for the loss of a
family member, a reduction of freedom, changes in daily routines and fears associated with
uncertainty and the intolerance of uncertainty. In response to these stressors, the individual
activates unconscious defence mechanisms, psychological strategies that help in reducing the
anxiety associated with the awareness of internal conflicts and externally-charged situations.
Since defence mechanisms are hierarchically organized and own specific psychological
functions, they may cause a wide number of negative consequences as well as playing a
significant role as protective factors against psychological distress and psychopathological
symptoms caused by the COVID-19 outbreak.