Psychodynamic Therapy for Depression

Psychodynamic therapy is the kind of talk therapy many people imagine when they think of psychological treatment for depression. That's because the image of the psychiatrist and patient probing the past is a staple of our popular culture. It can be found on sitcoms or in jokes. And psychodynamic therapy has been a major element in movies like Good Will Hunting and Ordinary People and on the stage in plays like Equus.

Psychodynamic therapy is designed to help patients explore the full range of their emotions, including feelings they may not be aware of. By making the unconscious elements of their life a part of their present experience, psychodynamic therapy helps people understand how their behavior and mood are affected by unresolved issues and unconscious feelings.

What Distinguishes Psychodynamic Therapy From Other Therapies for Depression?

Psychodynamic therapy is one of three main types of therapy used to treat depression. The other two are cognitive behavioral therapy (CBT) and interpersonal therapy (IPT). What distinguishes them is the nature of their focus.

Both CBT and IPT are focused on understanding and modifying certain processes or behaviors. For CBT, the focus is on how a person thinks. Thoughts shape what a person does and how a person feels and reacts; CBT focuses on identifying and changing dysfunctional patterns of thought.

With IPT the emphasis is on identifying issues and problems in interpersonal relationships and learning ways to address and improve them. Both CBT and IPT are also time-limited, short-term therapies. The emphasis is on learning new patterns rather than analyzing why the dysfunctional patterns are there.

Psychodynamic therapy, on the other hand, grew out of the theories and practices of Freudian psychoanalysis. Psychoanalysis is based on the idea that a person's behavior is affected by the unconscious mind and by past experiences. Psychoanalysis involves an intense, open-ended exploration of a patient's feelings, often with multiple sessions in a week. The sessions include an examination of the feelings the patient is aware of and those the patient is unaware of before therapy begins.

Psychodynamic therapy is less intense than formal psychoanalysis. Sessions usually occur once a week and are typically 50 minutes each. Patients usually sit up in a chair rather than lie on a couch with the therapist out of sight. But unlike IPT and CBT, both of which have sessions that adhere to a formal, outlined structure and that set specific learning agendas, psychodynamic therapy sessions are open-ended and based on a process of free association.

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In psychodynamic therapy, the patient is encouraged to talk freely about whatever happens to be on his or her mind. As the patient does this, patterns of behavior and feelings that stem from past experiences and unrecognized feelings become apparent. The focus is put then on those patterns so the patient can become more aware of how past experience and the unconscious mind are affecting his or her present life.

Another distinction between the types of therapies is that psychodynamic therapy is not necessarily a short-term, time-limited treatment. While some courses of therapy may end after 16 to 20 weeks, other instances may go on for more than a year.

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.

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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, including the possible psychological meaning behind the imagery or emotional content of dreams. Because the patient is encouraged to speak freely, he or she is able to explore whatever is on his or her mind.

What Can Someone Expect to Get From Psychodynamic Therapy?

The primary goals of psychodynamic therapy are for an individual to achieve greater insight about his or her unconscious conflicts and self-awareness about his or her feelings and motivations. Insight is thought to be the mechanism that can lead to the relief of symptoms. In addition, psychodynamic therapy aims to help the patient develop internal psychological resources and greater capacity for dealing with psychological issues that have caused emotional suffering. The individual does this by confronting issues that have been unconsciously repressed but that still affect his or her life and by learning healthier ways to deal with them so they don't interfere with the effort to live a more fulfilling life.

WebMD Medical Reference Reviewed by Joseph Goldberg, MD on February 1, 2018

Sources

SOURCES:

National Institute of Mental Health: "Psychotherapies."

Student BMJ Archive: "How Does Psychodynamic Psychotherapy Work?"

Psychology Today: "Therapeutic Methods."

Scientific American: "Talk Therapy: Off the Couch and into the Lab."

Shedler, J. American Psychologist, February-March 2010.

American Psychological Association: "Psychodynamic Psychotherapy Brings Lasting Benefits Through Self-Knowledge."

Bond, M. Current Opinion in Psychotherapy, 2006.

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