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The Pros and Cons of Psychodynamic Therapy

Psychodynamic approach in therapy is best suited for those who want to achieve more than just reducing or eliminating unwanted symptoms. This is an insight-oriented approach that seeks to bring lasting changes through the deeper understanding of one’s mental and emotional processes, which by design takes a long time to achieve.

Many people feel that they have neither time nor energy for this kind of long-term work and that all they need is to get rid of their presenting problem as fast as possible. For those folks cognitive-behavioral therapy (CBT) or purely behavioral methods are most suitable. Many people want to skip any kind of talk therapy all together and just to manage their symptoms with medications. Unfortunately, this seems to be the case with more and more people, and I will discuss why it is unfortunate in the upcoming series on psychiatry and psychiatric drugs.

One of the legitimate criticisms of psychodynamic therapy is that it is often unfocused, that it has no clearly defined goals and no clear direction. It doesn’t have to be that way as there is nothing in the psychodynamic theory that prevents setting achievable goals and working on accomplishing them. In general though it is not as specifically focused as the work of CBT or behavioral therapy simply because CBT and behavioral methods were designed to address problems directly through logical and behavioral interventions whereas the psychodynamic method doesn’t approach problems head on but rather focuses on helping the client find answers and solutions within themselves through the insight-oriented work.

Even though psychodynamic therapy is not about providing direct guidance, it shouldn’t be experienced by the client as something vague, undefined and unfocused. Though the goals may be more general, could change during the process and the way to achieving them may feel more like walking on a winding road through a forest with lots of twists and turns and dead ends than walking a straight line, nevertheless the goals should be clearly defined at the onset of therapy because both the therapist and the patient should know what they are working on. Reviewing therapy goals and evaluating therapy progress has to be a standard practice of any therapy regardless of the modality. Otherwise, therapy may easily turn into something other than a professional service that is supposed to focus on solving clearly defined problems and instead be inappropriately used to fill the void in the patient’s life that is supposed to be filled by friendships and other social and close relationships. Once therapy turns into that kind of endeavor, it carries a great potential for harm and often harm does take place under those circumstances.

Another legitimate criticism of psychodynamic therapy is the excessive emphasis on the relationship between the therapist and the client at the expense of other important things the client needs to work on. While things that arise within the client-therapist relationship can provide important information about the client’s habitual ways of relating to others and are certainly worth being addressed in therapy if the therapist believes they may contribute into the client’s problems, by no means this should become the sole focus of therapy.

Sadly, I’ve heard and continue to hear too many stories from former and present therapy clients where their therapies had quickly become endless explorations of the relational dynamics between them and their therapists to the point that all other problems and concerns those clients wanted to discuss in therapy were dismissed, which felt to them like their lives were put on hold. This also re-created traumatic experiences they had in their past relationships without any healing resolution despite the therapists’ claims that this method was designed to heal past relational traumas.

I had this harmful experience myself in my own therapy and so I have a first hand knowledge of the dark side of making a “relationship” with a therapist the most important part of therapy. When I first sought therapy, I did it for the purpose of getting a professional opinion about the life struggles I was experiencing at the time and the ways to resolve them. I certainly was not looking for a “relationship” with the therapist. At some point, somehow, on my therapist’s insistence, it became about the “relationship” between me and him. At the time I didn’t challenge his suggestion that the “relationship” should be the centerpiece of my therapy work because I trusted that, as a professional a.k.a an “expert”, he knew how therapy works better than I did. Since the “relationship” became the central point to focus on, all other important areas of my life I needed to understand and to improve were pushed aside, which essentially felt like putting my life on hold for the whole duration of therapy.

The potential downsides of psychodynamic therapy don’t have to manifest if the practitioner of this method is a mindful, responsible person who brings the right intentions into his or her work. If done with mindfulness, psychodynamic psychotherapy can be an excellent method for personal growth and for healing emotional traumas that cripple people on many levels. This approach encourages deep personal exploration, which increases self-awareness and makes one more capable of making the best life choices they can make for themselves. This, in my view, is one of the most powerful methods to assist a person in becoming the most autonomous and mature individual they can be. However, as anything powerful, it has a potential to harm as much as it has to heal, therefore, those who practice it should do it with utmost responsibility and mindfulness.

Related posts: “Psychodynmic Psychotherapy”, “Psychoanalysis”, “Types of Therapy”

 
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6 Comments  comments 

6 Responses

  1. Ellen

    If the focus of the therapy becomes largely an analysis of the relationship between the therapist and the patient, or of the patient’s way of relating to the therapist, has the supposed “psychodynamic” therapy evolved into a form “psychoanalysis”? If this is made not clear to the patient or if the therapist is not a trained psychoanalyst, it seems unfair.

    • Marina Tonkonogy

      “If the focus of the therapy becomes largely an analysis of the relationship between the therapist and the patient, or of the patient’s way of relating to the therapist, has the supposed “psychodynamic” therapy evolved into a form “psychoanalysis”?”

      Yes, you can say that. I guess, one way to understand psychodynamic therapy is as a “soft” form of psychoanalysis which structure is not as rigid as that of classical analysis and which has some “wiggle room” for using other theories and methods. That’s how the term “psychodynamic” is used in theory. In reality though, it’s used much more loosely. Many self-proclaimed “psychodynamic” therapists have very little knowledge of psychoanalytic theories as they have never bothered to study them. They just have the general belief that the patient has to gain some insight into thier mental process in order to heal and they do it mostly through exploring the patient’s history and looking at how the patient acts toward the therapist or, in other words, through exploring the patient’s transference. They don’t do it as thoroughly though as formally trained psychoanalysts usually do it and, since they have little knowledge of psychoanalysis, they miss or fail to get a lot of important information that provides valuable insight into the patient’s mental state. Also, they often use “whatever works” meaning other methods and theories such as CBT, humanistic, existential and “whatever” else “works”. In that sense, they are “eclectic” practitioners which means basically that they use a variety of different methods from their “bag of tricks”, different for each client depending on what works better with each particular client.

      “If this is made not clear to the patient or if the therapist is not a trained psychoanalyst, it seems unfair.”

      Absolutely. I agree, it is completely unfair to the patient, first of all, because the patient is not informed about the extend of the therapist’s training and also because it is inappropriate for a therapist IMO to employ methods they do not fully understand as far as their purpose and theoretical foundations. That’s not to say that formal training in psychoanalysis is a guarantee of success in using such methods. It’s not. But the formal training at least gives the therapist a much deeper understanding of the patient’s process and the patient’s reactions to the therapist. From my experience working with a so-called “psychodynamic” therapist and a trained analyst I know the difference. The analysts I worked with were not “in my face” with the exploration of our relationship as much as the “psychodynamic” therapist was. They were much more subtle and would just occasionally point out some of the things I was doing. They didn’t insist, implicitly or explicitly, that the “relationship” should become the main focus of therapy whereas the “psychodynamic” guy did.

  2. Ellen

    The only legitimate reason to explore the relationship, whether in psychodynamic therapy or psychoanalysis, would be to help the patient improve real relationships. When a therapist is so insistent about pursuing this relationship approach (possibly, even when it does not appear to working), I wonder if the patient’s welfare is paramount, or whether the therapist might have a personal reason or agenda to pursue this approach. At any rate, it could be a warning to the patient if a therapist pursues this path too aggressively. Thank you for your response.

    • Marina Tonkonogy

      I agree again. And, in fact, that’s exactly what the ethics or psychotherapy prescribe. The ethics command that any method, technique or theory the therapist wants to employ is only to be employed for the benefit of the patient, not for any other reason. In regards to analyzing the way the patient relates to the therapist it is supposed to be done in order to help the patient to improve their relationships in real life outside of the therapy room just like you said. Unfortunately, you are also correct that the forceful insistence by the therapist to explore “the relationship” often indicates that the therapist has a personal agenda other than to do what’s in the patient’s best interests. This could also be a sign of little experience and incompetence.

      Regardless of the reason, no method, whether it’s exploring transference or anything else, should ever be forced on the patient. A good therapy work requires collaboration with the patient and the agreement on how the therapy should proceed. Otherwise, it’s impossible to build trust and safety that are essential for any healing work even to begin. So, yes, whenever you, as a patient/client feel like the therapist is forcing anything on you that you are not comfortable with, the first thing to do is to voice your objection and if the therapist doesn’t “get” it and you are unable to come to an agreement on how you will work together, it’s best not to waste time, money but, most importantly, energy, and to leave before any harm is done. You definitely don’t want to take chances of getting harmed.

  3. anonymous

    In any type of therapy, not only psychodynamic, what are the steps a patient might take is he/she has a sense that a therapist has lost objectivity and become too involved or directive about a patient’s choices and life?

    • Marina Tonkonogy

      Well, I’d say if a patient doesn’t like something a therapist does whether it’s pushing a certain agenda or anything else the first thing to do is to address it. If a therapist is receptive and is able to get on the same page with a patient on how to proceed, then the work goes on. If a therapist insists on his or her methods then it’s time to leave and find a new therapist. You, as a patient, are the only one in the position to decide what you need and what you don’t need. If the methods of a particular therapist don’t suit you for whatever reason – move on. Don’t keep wasting your time, money and,most importantly, emotional energy, and don’t take a risk of getting harmed.

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