Psychodynamic Therapy: A Psychotherapy of Awareness

Psychodynamic therapy in general is a broad school of psychology and therapy that has common themes among its theories although psychodynamic therapists differ in many ways. Sigmond Freud, Carl Jung, Alfred Adler, Karen Horney, Harry Sullivan, Mellanie Klien, Otto Kernburg, Heinz Kohut, Steven Mitchell, Habib Davanloo, Diana Fasho and many others have contributed to this diverse approach. Most if not all psychodynamic therapies share common themes to include;

Exploration of emotions and unconscious attempts to avoid distressing feelings.

Relationships and social interactions as the context for personality development.

Identification of recurring themes and patterns from past experiences.

Depending on the therapist school of psychodynamic therapy the techniques and practices can be drastically different.

Adlerian Psychotherapy

Adlerian Psychotherapy is based on individual theory which proposes that people are holistic, goal driven and interconnected in a larger society.

Problems arise as all human beings are born smaller, dependent and less knowledgeable than everyone around them. This feeling of inadequacy drives us to find a sense of empowerment and guides our thoughts, feelings and behaviors. With encouragement a person tends to have positive, rational, and constructive life plans.

The Adlerian therapist sees all behavior as being goal driven even the dysfunctional ones. Encouragement or the lack of it in childhood memories, family dynamics, and social connections are puzzle pieces that fit together to give a behavior its importance and ways to create change for the current circumstances.

Experiential Dynamic Therapy

Experiential Dynamic Therapy EDT is a broad umbrella term describing the brief, attachment based and emotion focused therapies. EDT attempts to release past emotional experiences that may be causing problems and maladaptive behaviors.

EDT is brief and emotion focused because it focuses on traumatic events or day to day stressors in a way it’s experienced in the moment and not just in thinking. Defenses or resistances to experiencing these often powerful emotions can emerge and are worked through over time.

EDT therapists rely on a therapeutic alliance to identify patterns and habits of avoiding or overcompensating experiencing the meaning of past distressing emotions. The therapist listening, supporting, and challenging resistances to experience allows for often unconscious defenses to naturally heal and be transformed into something meaningful.

References

Maniacci, M., & Watts, R. E. (2006). Adlerian therapy: Theory and practice. Washington, D.C: American Psychological Association.

Osimo, F., & Stein, M. J. (Eds.) (2012). Theory and practice of experiential dynamic psychotherapy. London: Karnac Books.

Shedler, J. (January 01, 2012). The Efficacy of Psychodynamic Psychotherapy.

Awareness, Mindfulness, and Self-Compassion

As mentioned in the article What is Trauma Anyway, trauma is an strong emotional reaction to an adverse event that happens to over half of adults in their lifetimes. Not everyone has Post Traumatic Stress Disorder which usually is around 6% of the population. There are many theories and educated guesses as to why. The National Institute of Mental Health NIMH calls “protective factors” the variables present that allow for some to have a sense of resilience, purpose, connection or courage to overcome adverse and distressing events.

Protective factors in general can be nearly anything that allow for someone to cope with a difficult situation. It can be abstract like an idea/value or concrete like a behavior. Protective factors can also be a relationship or one's faith. The Substance Abuse and Mental Health Association SAMHSA model for trauma informed care groups traumatic reactions as three E’s;

Event: something happens that is adverse, difficult, shocking, or stressful.

Experience: how an individual interprets and gives meaning to the event.

Effect: the length of time strong emotional or physical reactions linger after the event.

The 3 E’s present the risk factors that are involved in a person developing symptoms related to day to day stress or trauma. Anxiety, depression, addiction, hypervigilance, isolation, being on edge, chronic stomach problems, fatigue issues, and many other symptoms can emerge. Awareness, mindfulness, and self-compassion are three protective factors that can contribute to reducing the likelihood of reduced symptoms and increased well-being. Each of these protective factors have a specific meaning and definition that can be used as frames of reference for building coping strategies.

• Awareness is defined as the perception or knowledge of something. Accurate awareness of something perceived or known is considered conscious awareness. However, it is possible to be aware of something without being directly conscious of it.

• Mindfulness is defined as focusing attention on the present moment experience with an attitude of curiosity, openness, and acceptance.

• Self-compassion has been defined as an attitude that involves treating oneself with warmth and understanding in difficult times and recognizing that making mistakes is part of being human.

Awareness of events, mindfulness of experiences, and self-compassion of how things affect you create a strong framework for resilience, wellbeing, and mental health. Each of these concepts hold strong evidence based practices that allow for different degrees of restoring capacities to grow, connect with others or change.

Psychodynamic therapies focus on increasing unconscious awareness mostly of past life events. A meta-analysis of 17 high-quality randomized controlled trials of short-term psychodynamic therapy reported an effect size of 1.17 for psychodynamic therapy compared with controls (Leichsenring, Rabung, & Leibing, 2004). The effect size was 1.39, which increased to 1.57 at long-term follow-up, which occurred an average of 13 months posttreatment.

Mindfulness based interventions introduce exercises that teach and practice embodied and somatic ways of presence and acceptance. Mindful interventions have been proven to reduce stress, anxiety, and depression associated with physical illness or psychological disorders (Baer, 2003, Bohlmeijer et al., 2010, Chiesa and Serretti, 2010, Chiesa and Serretti, 2011, Cramer et al., 2012, de Vibe et al., 2012, Eberth and Sedlmeier, 2012, Fjorback et al., 2011, Grossman et al., 2004, Hofmann et al., 2010, Klainin-Yobas et al., 2012, Ledesma and Kumano, 2009, Musial et al., 2011, Piet and Hougaard, 2011, Sedlmeier et al., 2012, Zainal et al., 2012).

Self compassion has been conceptualized to questionnaires and practices that have in those who with higher degrees of self-compassion appear to predict the reduction of symptoms in people with unhealthy perfectionism (Mehr and Adams 2016), thought rumination (Svendsen et al. 2017), depression (Krieger et al. 2016). anxiety, and stress symptoms (MacBeth and Gumley 2012), and greater self reported psychological well-being (Zessin et al. 2015)

Awareness, mindfulness and self compassion are not the only protective factors as many exist with backing from evidence based research and have practical techniques. However these factors seem to have a strong correlation to the events, experiences and effects of adverse situations in a way that can produce a holistic sense of wellbeing and mental health. How these practices and ways of coping with stress can be used in specific circumstances will be a topic for another day.

References

American Psychological Association. (n.d.). Awareness. In APA dictionary of psychology. Retrieved from https://dictionary.apa.org/awareness

Bishop, S.R., Lau, M., Shapiro, S., Carlson, L., Anderson, N.D., Carmody, J., Segal, Z.V., Abbey, S., Speca, M., Velting, D. and Devins, G. (2004), Mindfulness: A Proposed Operational Definition. Clinical Psychology: Science and Practice, 11: 230-241. https://doi.org/10.1093/clipsy.bph077

National Institute of Mental Health. (2019). Post-Traumatic Stress Disorder.

Neff, K. (2003). Self-Compassion: An Alternative Conceptualization of a Healthy Attitude Toward Oneself. Self and Identity, 2, 85-101

Shedler, J. (January 01, 2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65, 2, 98-109.

Substance Abuse and MentaHealth Services Administration (US). (2014). Trauma-Informed Care in Behavioral Health Services. Rockville (Treatment Improvement Protocol (TIP) Series, No. 57.) Available from: https://www.ncbi.nlm.nih.gov/books/NBK207192/

What is Trauma Anyways

People often hear the word trauma and think Post Traumatic Stress Disorder PTSD. According to many national institutes and survey agencies, traumatic events are experienced at least once in the lifetime of 50%-70% of people. Adverse events are not considered traumatic in themselves but the reaction to these events are considered traumatic. It's very common to feel confused, distressed, or numb following a traumatic event. Long term effects include hypervigilance, drastic mood changes, avoidance, anxiety, depression, addiction, and dissociation.

If most people experience traumatic events what makes us not all traumatized? Typically around 6% of people in the population are or can be diagnosed with PTSD. How can several people experience something horrific but only a few experience lingering effects months and sometimes years after the event?

Psychological trauma is a term used to describe the mental and emotional effects of an adverse event that linger and persist after the event has passed. There are many treatment options but some fail to have the depth or practicality to offer the holistic approach necessary for these issues.

Many people who have been affected by past life events still live fulfilling lives. They have children, jobs, relationships and purposeful hobbies but still struggle with linger effects of traumatic responses to adverse events. Depression, anxiety, addiction are the most common themes people experience but sometimes these problems are not the real problem. In some cases a person can have several mental health diagnoses or conditions that pile on each other and can become very unhelpful.

It does not have to be childhood trauma or stress from adolescence, it could be something that happened a few years ago or even a few months ago. The past is anything not here and now in this moment and if it lingers unacknowledged it can force its way into our daily life with or without our conscious choice. It only makes sense to go to the core of the issue and allow this process to alleviate the surface level symptoms and problems.

By no means does this negate biology because some people are born with vulnerabilities for schizophrenia, bipolar disorder, autism, ADHD or addictions. The biomedical model has been the dominant mental health treatment in the United States since the 1950s but has failed to improve or has shown deterioration in public mental health. Despite the allocation of billions of dollars to biomedical research and psychotropic medications, mental disorders are diagnosed much the same way they were in the 1950s and there has been no substantial evidence to be able to test someone for depression or bipolar through a blood sample or by brain imaging.

In conclusion, everyone isn’t traumatized but traumatic events, stress, adversity and emotional pain seem to be a part of the fabric of life. Some people can shake these events off instantly or in a few days or weeks but some it can take longer or even a lifetime. From this perspective, focusing on symptoms not as clusters of disorders or problems but signs of reactions to past experiences that need to be processed and changed seems to be a beneficial way to heal and thrive.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Association.

Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995).

Post Traumatic stress disorder the national comorbidity survey. (n.d). Archives of General Psychiatry, 52(12), 1048-1060. doi:10.1001/archpsyc.1995.03950240066012.

Ross, C. A., & Halpern, N. (2009). Trauma model therapy: A treatment aproach for trauma, dissociation and complex comorbidity. Richardson, Tex: Manitou Communications Inc.

U.S Department of Veterans Affairs (VA) (2021). PTSD: National Center for PTSD.