Psychodynamic Psychotherapy

How therapy used to work 7 times a week. Laying on a couch. The therapist says very little. Very, very expensive. Only for a select few. One had to meet very stringent requirements to be a therapist.

The way Psychodynamic therapy is now 1-2 times per week. 50 minutes. Clients often sit across from therapist. Therapy is more of a conversation than a one-sided monologue. Still very expensive. However, lots of opportunities for low-cost psychotherapy are available. One still has to meet very stringent requirements to be a therapist, but these are now related to training and character and are more culturally sensitive.

Misconceptions about therapy It is only for people who have problems. It is only for people who don’t have friends. It is only for people who are weak. It is only for people who are crazy. Being in Psychotherapy isn’t beneficial to your own career as a therapist.

Free Association and Catharsis Free association is the process of saying anything that comes to mind regardless of the content. This type of talking is thought to lead to the unconscious. If you talk long enough, you’ll start hitting on things that are important and begin recognizing patterns. Catharsis is one of the main components of free association. Talking about everything will let you get things off your chest and reduce some anxiety.

II recognize that my ploys for attention have grown increasingly more desperate and are not well-received by others!

My pop songs are amazingly catchy, but I realize that I sometimes wear things that make statements not even I understand in order to be edgy and controversial!

The work of Psychodynamic Therapy Pull these feelings back out of the unconscious. And then sit with them. This is very difficult. Both for the client and the therapist. The therapist’s work is to understand the client and be a container for them while being non-judgmental. The therapist’s work is to formulate hypotheses and have thoughts about what is going on while intervening ONLY when it seems clinically important. The therapist must tolerate ambiguity and recognize that a client may be working on the same issue and saying the same thing for years.

What is the not-work of Psychotherapy Giving advice. Helping people. Not allowing clients to feel their feelings. Being optimistic. Being a friend. Overextending yourself.

How do we pull it out? Talk about the feelings. Recognize what is going on for the client and empathize with them genuinely. Be able to weather the client’s storm. Allow them to have negative feelings toward you if that is what they are feeling without being defensive. Recognize and respect the client’s defenses as things that have worked for them and discuss. Always be curious, never accusatory.

Resistance! Resistance is a client’s way of trying to avoid pain and difficult issues by fighting the process of therapy as well as the therapist.

Is Resistance Inevitable? Yes! Prepare for it! Why? Because change is hard. No matter how much someone is willing to do it (or pay for it), it is still incredibly difficult to change and to recognize things we do not like about ourselves. Especially with someone we may not trust yet. Resistance often happens after someone has shared something very important or personal.

How does resistance manifest? Missed appointments with or without phone calls. Being habitually late. Client goes “blank.” Client changes the subject. Not paying the therapist or never “having money.” Telling the therapist they’re bad at what they do and are wrong about everything. Client begins intellectualizing, rationalizing, or using other defense mechanisms. Insisting that they won’t come back because of price, time, location, decorations, etc. The thing is all of these reasons may SEEM real, but are about the issues discussed in therapy above anything else.

What can you do with resistance? Recognize it. Discuss it. Go with it.

Transference Transference happens in ALL therapeutic situations (and even non-therapeutic ones). It’s when the client transfers expectations of the important people in their history onto other people. This is important because it tells the therapist how the client interacts with others. The client will do to the therapist what the client does to other people in their life.

Here’s what it looks like My mother is an important figure in my life. My mother criticizes me constantly because I am doing nothing with my life. I expect other people to criticize me the way my mother does when I discuss my life. Therefore, I expect my therapist to do the same thing to me. I unconsciously cast the therapist as my mother and respond to them in the way that I do to my mother, regardless of whether they are criticizing me or not. This is perhaps why when the therapist says “well, what are your goals?” the client says “WHAT DO YOU MEAN, WHAT ARE MY GOALS? NOW YOU’RE LAYING INTO ME?”

Here’s what it looks like This doesn’t have to be about the core issue of “not doing anything with their life” many things that the therapist says will make the client feel like they are talking to their mother because that is the role they cast the therapist in. This role can change. It is important to address what is going on and point out patterns. “You know, I just said this and you got really angry in the way you would get angry at your mother. What do you think about that?”

Countertransference Your reactions to what the client is talking about, the role they are placing you in, or your reaction to the client in general. Countertransference is inevitable because we are all people with issues. You need to acknowledge your countertransference to yourself and think about it. Sometimes you have to talk about it with the client.

You will make mistakes! Every therapist makes inaccurate interventions. No one scores a perfect 100. We are dealing with people, not machines! Good therapists CAN and DO make a lot of mistakes. The important thing is that they think about them and apply them to the case formulation. Most mistakes can be repaired from. Many will go unnoticed depending on the relationship with the client.

Working Through Working and talking through painful feelings, issues, why transference occurs, and what feelings are associated with all of these things OVER AND OVER AGAIN until there is no more energy invested in keeping them hidden. This is why people sometimes leave therapy feeling horrible. You do not do this at one time. It often takes years.

What? Why should I delve into my horrible past? No one comes out of childhood unscathed. It is a time when you have little to no control and your relationships with primary caregivers are formed. It’s also when a lot of hurt happens. I believe that we spend the rest of our lives recovering from our childhoods regardless of whether they were good or bad.

Working Through In childhood feelings and emotions seem “dangerous” and like they can destroy us and our parents. Psychodynamic theory believes that we then spend a lot of energy pushing them down. Then they come back up. Then we push them back down again. This is exhausting and takes up a lot of unconscious space.

The Job of the therapist The job of the therapist is to be the “good” parent. The therapist helps the adult (or child they are working with) express these feelings and see them as manageable and okay to have. The therapist does this by sitting with the client through even the hardest times. This shows the client that their painful feelings are incapable of destroying themselves or the therapist. They can then recognize that their painful feelings can’t destroy other people in their lives.

That sounds really painful and time-consuming. What is the point? The client begins to see their feelings as normal, important, and not something to run from. Recognizing and accepting these feelings then allows you to move on with your life and put the energy that you’ve been putting into making sure these feelings don’t come up into something more enjoyable and productive. This doesn’t mean your problems are solved. It just means that you are growing emotionally and are able to be more accepting of yourself and more authentic in the world around you.

This Panda is also emotionally exhausted!