What is Psychodynamic Psychotherapy?


Psychodynamic psychotherapy is based “on the idea that unconscious thoughts, feelings and behaviors affect our conscious life,” said Deborah L. Cabaniss, M.D., clinical professor of psychiatry at the Columbia University College of Physicians and Surgeons and the director of psychotherapy training in the Department of Psychiatry at Columbia. Identifying these hidden elements—bringing them to light—gives us important insights, which help us in making thoughtful, intentional decisions.

She shared this example: You’re anxious about accepting a new job. You’re not sure where this anxiety is coming from, but you assume it’s there for good reason. Which means you might decline the offer. However, when you take a closer look, you realize that you’re actually anxious about doing better than your siblings. Knowing this can help you make a better decision about your career.

Psychodynamic psychotherapy also is rooted in a developmental view: “Our early experiences affect the way we think about ourselves, relate to others and adapt to stress later in our lives,” Cabaniss said.

Unlike CBT, psychodynamic psychotherapy is flexible and excludes homework. It’s patient-driven, meaning that the therapist doesn’t come to session with an agenda. Patients usually pick the topics to discuss, Cabaniss said. This is important because nothing is random. Our thoughts, feelings, actions, dreams and experiences are connected. They’re all clues into our concerns, into our unconscious. Exploring these clues is paramount and can even be life-saving.

For instance, in his paper, Shedler writes about a patient, Steve, who was recovering from a heart attack. Steve’s memory was just fine, but he kept “forgetting” to take his medication. Even after Steve’s doctor talked to him about the medication’s importance, he still kept forgetting and had no idea why. When they started discussing this in therapy, Steve’s thoughts went to his younger brother. Turns out, his brother was always taking pills because he was sick. He wasn’t good in school or sports and was a disappointment to his parents. Steve (unconsciously) feared that taking medication would also make him sickly, weak and unloved. After exploring these fears, he stopped forgetting his medication.