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How Psychodynamic Psychotherapy works

Psychotherapy is a type of therapy that addresses mental health issues and emotional challenges individuals face, including anxiety, depression, low self-esteem, panic attacks, PTSD, relationship issues, mental health and personality disorders, anger issues, emotional trauma, insomnia, bereavement and more. It is a talking therapy, whereby a trained therapist facilitates a process that allows individuals to process their emotions and thoughts in a safe and confidential space on a regular basis. 

 

The Therapeutic Frame
 

Psychodynamic Psychotherapy is a form of talking therapy, facilitated by a psychodynamically trained therapist who facilitates a reflective process for processing complex thoughts and emotions. One of the first important steps when initiating this process is setting up of a therapeutic frame - essentially, a contract - which includes topics such as fees, confidentiality, breaks, cancellation policy, missed sessions, rescheduling, data privacy and handling. This enables the therapeutic relationship to be based upon commitment and trust. Psychodynamic therapists aim to cultivate a non-judgmental space where individuals feel increasingly comfortable bringing personal material and their own vulnerabilities over time, which is an important element of effective therapy.



Regularity and Consistency
 

In the realm of psychotherapy, consistency is key. Sessions typically occur on a weekly basis, scheduled for a designated day and time that suits both the therapist and the patient. This routine establishes a sense of regularity, providing individuals with a dependable space to explore their innermost thoughts and emotions.

The weekly cadence of sessions offers a steady rhythm that allows individuals to delve deeper into their psyche. It's not uncommon for a multitude of emotions and memories to surface during these sessions, often stirring up unsettling feelings. However, the structured nature of weekly sessions provides a reliable framework for navigating through these complexities.


The continuity of weekly sessions enables therapists to track progress over time and tailor their approach accordingly. This consistent engagement fosters trust and rapport between the therapist and patient, creating a safe environment for exploration and growth.



Non-descriptive form of therapy
 

Psychodynamic Psychotherapy is a non-prescriptive form of therapy, indicating that therapists refrains from providing exercises or specific steps for the patient to follow. Instead, they engage in active and attentive listening, responding to what the patient brings to each session. Through facilitating reflective conversations, the therapist encourages the exploration of the patient's material at a deeper level.


This therapeutic process embodies courage, an essential quality required to delve into challenging and sometimes distressing thoughts and emotions. Unlike approaches with more structured methods, Psychodynamic Psychotherapy does not adhere to a linear progression or predetermined steps. Instead, it embraces "free association", encouraging the patient to speak their mind openly. This openness fosters a deeper understanding of the individual's inner world, paving the way for meaningful insights and personal growth.



The Unconscious Mind
 

A central element of Psychodynamic Psychotherapy lies in the exploration of the unconscious mind. As Freud suggested, our psyche comprises three distinct layers: the conscious mind, housing thoughts and feelings of which we are aware; the subconscious, where thoughts and feelings reside that are not readily accessible but can be brought to light with some effort; and finally, the unconscious mind, harboring thoughts and emotions beyond our conscious awareness.

The unconscious mind holds particular significance in Psychodynamic Psychotherapy, stemming from the notion that traumatic experiences may lead to the repression of emotions, relegating them to the unconscious realm. While repressing these emotions may have served as a necessary coping mechanism in the face of trauma-induced pain, many individuals seek therapy due to the ineffectiveness and detrimental effects of these historical coping strategies on themselves and others. A primary aim of Psychodynamic Psychotherapy is to make what is unconscious conscious.
 

Our early relationships and upbringing shape the programming of our minds, influencing how we relate to ourselves and others. For new patients, this programming often resides in the unconscious, initially hidden away from conscious awareness. Consequently, there is typically a lack of self-awareness regarding the underlying factors influencing our behaviour, thoughts, and feelings. By bringing the unconscious into conscious awareness, patients can cultivate a deeper sense of self-awareness and emotional intelligence.
 

This heightened awareness empowers individuals to recognise that while they may not always have control over their feelings, they do have agency in how they choose to respond to them. Through this process, patients gain insight into their thought patterns and emotional responses, facilitating greater autonomy and a more nuanced understanding of themselves and their interactions with the world.

 

Repetition Compulsion
 

Often, traumatic experiences from the past find their way, in various forms, into our present lives. Let's consider a scenario where a child experienced consistent neglect from their caregivers during childhood. This early experience could imprint upon the child a unconscious association between intimacy and neglect. As the child grows into adulthood, they may unconsciously seek out partners who are neglectful, drawn to the familiarity of such dynamics without consciously recognising it. This unconscious repetition of past trauma can perpetuate a cycle that takes a toll on our mental health over time.


Psychodynamic Psychotherapy attempts to disrupt these patterns by facilitating a deep exploration of past traumatic experiences, always respecting the patient's pace. Through this process, individuals gain insight into their internal world, uncovering the roots of their behaviour and relationship dynamics. By shedding light on these unconscious patterns, therapy empowers individuals to make more informed choices and forge healthier connections with themselves and others.

 

Holding Environment
 

The experience of undergoing Psychodynamic Psychotherapy can sometimes evoke feelings of discomfort and apprehension, particularly in the initial stages. This discomfort often stems from confronting unprocessed thoughts and emotions that may be challenging to bear. Psychodynamic therapists are adept at navigating these complexities, providing a safe and non-judgmental space for patients to explore their innermost thoughts and feelings.


Therapists carefully follow the patient's lead, responding with empathy. They attune themselves to the patient's narrative and underlying emotions, while also observing any resistances or defenses that may arise. This ensures that the therapeutic process progresses at a pace that feels manageable for the patient, preventing it from moving too quickly or becoming unbearable.


To maintain an objective and non-judgmental stance, many Psychodynamic therapists undergo their own analysis or therapy for several years. This personal exploration fosters greater self-awareness and enhances their ability to provide effective therapy to patients.
 

Furthermore, the therapeutic frame plays a crucial role in establishing clear boundaries and expectations between the therapist and patient. This agreement ensures consistency and reliability in the therapeutic experience, contributing to the creation of a holding environment that is necessary for therapy to be effective.

 

The Working Through
 

As mentioned above, Psychodynamic Psychotherapy is not prescriptive. It does not define what 'good progress' looks like. Its primary aim is to facilitate deep self-exploration and introduce patients to the person they have the most dealings with, i.e. themselves. Progress in Psychodynamic Therapy is not linear; often, discussing and reflecting on traumatic experiences may not immediately resolve the underlying issues. Instead, it's common for these experiences to be revisited multiple times, triggered by various stimuli. This repetition is what we refer to as 'the working through' of therapy.

Consistent exposure to our anxieties, fears, and intolerable feelings demonstrates that these emotions can be endured. It helps reveal how our past experiences shape our current emotional landscapes and may challenge unconscious beliefs that limit our choices. Through this process, individuals learn to recognise their own agency, empowering them to challenge and evolve beyond their familiar patterns of living.

 

Conclusion
 

In conclusion, Psychodynamic Psychotherapy can offer a profound journey of self-discovery and personal growth. Through its non-prescriptive approach, patients delve into the depths of their psyche, confronting past traumas and uncovering unconscious patterns. With the guidance of a skilled therapist and within the safety of the therapeutic environment, individuals gain insight, resilience, and the ability to carve out a more fulfilling path forward.

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