What is Psychodynamic Psychotherapy?

Psychodynamic (or psychoanalytic) psychotherapy refers to a variety of approaches to therapy that are based on methods and concepts drawn from the field of psychoanalysis. Psychodynamic therapy typically meets less frequently and for fewer total sessions than psychoanalysis and may be time limited or open-ended. For many, the word "psychoanalysis" brings to mind ideas about an outdated and archaic method of treatment developed by Sigmund Freud at the turn of the 19th century. However, the field of psychoanalysis today is represented by a diverse range of thought and a multitude of approaches to psychotherapy that have grown out of elaborations and challenges to Freud's pioneering work. 

What Do The Various Psychodynamic therapies Have In Common?

In his discussion of contemporary psychodynamic psychotherapy, Shedler (2006) identified the following as important aspects of psychodynamic thinking: attention to unconscious processes, recognition that people often hold contradictory feelings and motives, the importance of past experiences in shaping how we understand and approach the world, recognition that these past experiences also shape how each patient experiences therapy and that exploration of the relationship between patient and therapist is central to the therapeutic process, and lastly that psychological symptoms hold meaning and serve a function that can be understood through a psychodynamic lens. This last factor is of particular importance to psychodynamic therapy. The process of meaning-making and the development of a coherent narrative about one's life, experience of self, and understanding of self in relationship to others is utilized to help the patient develop agency, autonomy and a more flexible approach to life.

What Does Psychodynamic Psychotherapy Look Like In Practice?

Blagys & Hilsenroth (2000) reviewed the empirical research on the process and technique of psychodynamic psychotherapy and concluded that there are seven features that reliably distinguish it from other forms of therapy:

1. A focus on affect and the expression of emotion

2. Exploration of attempts to avoid distressing thoughts and feelings

3. Identification of reoccurring themes and patterns

4. Discussion of past experiences and taking a developmental perspective

5. A focus on interpersonal relationships

6. A focus on the therapy relationship

7. Exploration of fantasy life, including dreams

It is worth noting that each psychodynamic therapist likely employs these methods differently based on their personality, their idiosyncratic approach to therapy, their work with previous patients, and the unique experience that develops between the therapist and each new patient. In short, no two psychodynamic clinicians will conduct therapy in exactly the same manner.

Is Psychodynamic Psychotherapy Effective?

Meta-analysis is a methodological approach to statistical analysis commonly used in the health sciences to summarize and compare the results of independent studies examining the efficacy of various treatments. This is accomplished by converting the results of different studies into a common metric, "effect size", so that they can be pooled together and considered as a group. Simply stated, meta-analytic studies aim to address how large of an effect a given intervention has on the illness/disorder being treated. In psychological and medical research, an effect size of 0.80 or larger is considered a large effect, an effect size of 0.50 is considered a moderate effect, and an effect size of 0.20 is considered a small effect (Cohen, 1988).

It is helpful to reference the efficacy of psychotherapy in general (as measured by effect size) as a point of comparison before looking at psychodynamic psychotherapy in particular. Smith, Glass and Miller (1980) found an effect size of 0.85 in their examination of 475 psychotherapy outcome studies. Subsequent studies have found similar effect sizes, typically between the moderate and large range. Abbass, Hancock, Henderson and Kisley (2006) conducted a meta-analysis of short-term, psychodynamic psychotherapy which included 23 different studies and just short of 1,500 patients. They found an effect size of 0.97 for general symptom improvement. Interestingly, the effect size increased to 1.51 at follow-up (at least 9 months later). Shedler (2010) notes that the "trend toward larger effect sizes at follow-up suggests that psychodynamic therapy sets in motion psychological processes that lead to ongoing change, even after therapy has ended" (pg. 101). He further notes that five additional meta-analyses found a similar significant trend towards continued progress at follow-up in psychodynamic psychotherapies. Shedler continues; "In contrast, the benefits of other (non-psychodynamic) empirically supported therapies tend to decay over time for the most common disorders (depression & generalized anxiety)" (pg. 102).

It is important to note that meta-analysis is just one of many methods used to investigate the efficacy of an intervention. By nature, meta-analysis looks at trends across aggregate data and likely does not accurately reflect the individual nature of each patient's experience. However, the results suggest that psychodynamic therapy generally has a strong effect, comparable to or exceeding that of other empirically-based therapies. In addition, continued symptom remission following the end of therapy appears to be a factor that may distinguish the effects of psychodynamic psychotherapy from other approaches to treatment.

References

Abbass, A., Kisely, S., & Kroenke, K. (2009). Short-term psychodynamic psychotherapy for somatic disorders: Systematic review and meta-analysis of clinical trials. Psychotherapy and Psychosomatics, 78, 265–274.

Blagys, M. D., & Hilsenroth, M. J. (2000). Distinctive activities of short-term psychodynamic- interpersonal psychotherapy: A review of the comparative psychotherapy process literature. Clinical Psychology: Science and Practice, 7, 167–188.

Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum.

Shedler, J. (2006) That was then, this is now: An introduction to contemporary psychodynamic psychotherapy. Unpublished manuscript.

Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65 (2), 98-109. 

Additional Resources

About Psychoanalysis - American Psychoanalytic Association

That Was Then, This Is Now: An Introduction to Contemporary Psychodynamic Therapy - Jonathan Shedler, PhD (2006)

The Efficacy of Psychodynamic Psychotherapy - Jonathan Shedler, PhD (2010)