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.