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Psychodynamic Therapy for Depression

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Is Psychodynamic Therapy an Effective Treatment for Depression?

Until recently, it was commonly thought there was little or no evidence to support the effectiveness of psychodynamic therapy as a treatment for depression. Part of the reason was that practitioners of psychodynamic therapy were not as focused on doing empirical research as practitioners of other therapies such as CBT and IPT. But over the past couple of decades, that has changed and more studies have appeared.

Early in 2010, a report published in the American Psychologist reviewed the data from existing studies of psychodynamic therapy and depression. The author concluded that not only did the data show that psychodynamic therapy was at least as effective as other evidence-based therapies, but also the benefits of psychodynamic therapy appeared to be longer lasting.

What Are the Main Features of Psychodynamic Therapy?

Psychodynamic therapy involves an exploration of the entire range of a patient's emotions. With the help of the therapist, the patient finds ways to talk about feelings that include contradictory feelings, feelings that are troubling or threatening, and feelings that the patient may not have recognized or acknowledged in the past. This exploration takes place in a context that recognizes the fact that being able to explain the reason for an emotional difficulty does not mean the person is capable of doing anything about it. The goal then is to foster the internal resources needed to deal with and effectively manage those difficulties.

In addition to a focus on emotions, psychodynamic therapy focuses on recognizing and addressing defense mechanisms -- reactions and behaviors a patient uses to avoid distressing thoughts and feelings. For instance, an individual may try to suppress memories of troublesome experiences or may habitually change the topic when certain topics come up. Other reactions might include being late or missing sessions when the topics have become too troublesome, or focusing on external details instead of the person's own role in something.

As the sessions continue, recurring patterns in the patient's thinking, feelings, and behavior will emerge. Often these patterns are subtle and unknown to the individual. The therapist helps the patient recognize these patterns and try to understand their significance and how they affect the patient's mood and reactions. Often, discussing the patterns will lead to an examination of past experiences that continue to influence the present.

There is also an emphasis in psychodynamic therapy on relationships, especially the relationship between the therapist and the patient. Seeing how the patient reacts inside that relationship gives the therapist an indication of how the patient reacts, feels, and interacts in other relationships. Often, psychological difficulties stem from problems in the way someone relates to others that interfere with the ability to have emotional needs met. An aim in psychodynamic therapy is to recognize those difficulties and to find ways to resolve them or cope with them better.

Psychodynamic therapy also involves the exploration of the patient's fantasy life. Because the patient is encouraged to speak freely, he or she is able to explore whatever is on his or her mind.

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