The two most common talking therapies in modern mental health treatment are Psychodynamic Psychotherapy and Cognitive Behavioural Therapy (CBT). Public perception, and indeed, a large part of the medical community, mistakenly believe that CBT is the most effective approach. However, in his article, ‘The Efficacy of Psychodynamic Psychotherapy‘, psychologist and author Jonathan Shedler compares both approaches and shows that Psychodynamic Psychotherapy is not only effective in the acute phase of treatment, but that patients continue to improve in mental well-being long after their treatment has ended.
Shedler begins his article by dispelling the myths and misunderstandings about psychodynamic therapy and then highlights the underlying principles that distinguish psychodynamic treatment from CBT. These are outlined as follows:
The core features of psychodynamic psychotherapy
- A focus on expressing emotion – Psychodynamic therapy aims to explore the full range of human emotions and helps people find words to describe what may initially feel indescribable. This includes feelings that contradict each other, feelings that are worrying and stressful, and feelings that are hard to name or acknowledge.
- Exploring attempts to avoid distressing feelings and thoughts – Consciously and subconsciously, people will do many things to control or avoid unpleasant thoughts and feelings. The avoidance can be obvious, such as missing sessions or being evasive, through to more subtle ways that are harder to identify, such as subtly shifting topic or keeping conversation factual rather than feeling. Psychodynamic therapists help people recognise and explore the things they are trying to avoid.
- Finding recurring patterns and themes – People may find themselves in painful, recurring situations but be unable to recognise or address them. Or if they do observe themes, they may find themselves unable to break the pattern and escape it. Psychodynamic therapists help identify these themes in patient’s lives and develop strategies to help them break out of problematic behaviours and reactions.
- Past experiences that shape the present – Exploring early experiences can help to shed light on current behaviours and themes in life. Linking these past experiences to present day can help people see more clearly how and why they find themselves repeating familiar and sometimes undesirable patterns of behaviour.
- Focus on interpersonal relationships – The relationships that patients have with others are heavily emphasised in psychodynamic therapy. All aspects of personality and self-concept are constructed in relation to others. Addressing problematic interpersonal relationships can lead to healthier behaviours and connections.
- The therapeutic relationship – The relationship between the patient and the therapist is vital to the outcome of the therapy. The subjective way a person views and interacts with others will manifest in the therapeutic relationship and a skilled therapist will identify this and use it to help the patient see what they are doing, as they do it in each session.
- Exploring fantasy life – Encouraging patients to speak openly about anything on their minds means a deeper variety of fears, dreams, fantasies and daydreams are discussed. This provides much valuable information about how the patient sees themselves and experiences they’ve had.
Is psychodynamic psychotherapy effective?
In a word, yes. Study after study and then meta-analysis of those studies have shown benefits for depression, anxiety, panic, somatic symptom disorders, eating disorders and substance related disorders. In particular, personality disorders which are often resistant to treatment can be effectively treated by psychodynamic therapy.
The therapy not only offers improvement in psychological symptoms, but also in related somatic symptoms such as dermatological, neurological, musculoskeletal and gastrointestinal problems.
A large body of research and ongoing studies show that psychodynamic treatment may be more effective at treating depression than antidepressants.
Psychodynamic psychotherapy is just as effective as CBT in the short term, which has historically been touted as the gold standard for psychological treatments. However, the beneficial results of psychodynamic psychotherapy continue to increase over time, whereas CBT does not.
How can psychodynamic therapy help you?
We employ a range of modalities to suit the needs of our patients, all of which are underpinned by psychodynamic theory. Psychodynamic psychotherapy isn’t just about removing symptoms of illness, but equipping patients with inner capacities and resources so that they can thrive in the future. This allows greater freedom in life, more possibilities for growth and a well-lived life with healthy relationships. Contact us to arrange an appointment.
Schedler, J. (2010) The Efficacy of Psychodynamic Psychotherapy American Psychologist Feb-Mar;65(2):98-109. doi: 10.1037/a0018378