What is Psychodynamic Therapy?

What is Psychodynamic Therapy?

In the 1870s, thermodynamics were a hot topic. No pun intended. It explained energy and heat in a way that
made sense and it drastically advanced the field of physics. Everybody was talking about it and everybody
wanted a piece of it. And one particular scientist at the University
of Vienna named Ernst Wilhelm Von Brücke thought to himself, “Well wait a second, if these laws dictate
our entire world, then aren’t all living beings, including humans, just bodies of energy
that would also abide by these laws?” Ernst published his theory in 1874, which
was a significant year because it was the same year that he began advising a bright, young,
first-year medical student. Albert Einstein. I’m just kidding, it’s Sigmund Freud. Freud really liked Von Brucke’s theory,
so he stole it and took it a step further. He surmised that not only do the laws of thermodynamics apply to the human body, but they also apply to the human psyche. Voila! Psychodynamic theory was born. A lot of early psychologists became founders
and devotees to this theory, including Freud himself and Carl Jung. And it became the basis for the first talk
therapy techniques, including Psychoanalysis. If you’re interested in learning more about
psychoanalysis, then check out my video for more on that. Around the same time, a boy named Alfred Adler was born to a Jewish grain merchant and his wife. Alfred developed rickets at a young age and was not able to walk until he was four years old. His healthy older brother was showered with attention, while his mother had very little patience for Alfred’s needs. At one point he developed pneumonia and the
doctor told his father, “Your boy is lost.” But Alfred beat the odds. He recovered from his afflictions, grew strong, and became fiercely competitive with his older brother. Little did Alfred know, his illness and sibling
rivalry would lead him to develop an entirely new form of mental health treatment… Psychodynamic Therapy. Before we dive in, let’s answer a very important
question. What do we mean when we say “Psychodynamic
Therapy”? Often Psychoanalysis and Psychodynamic Therapy
are used as interchangeable terms, but they’re quite different. And a lot of people – like Anna Freud and
Melanie Klein – developed different flavors of this technique, based on different interpretations
of the human psyche. But Alfred Adler stands out as the first and
most prominent psychodynamic theorist whose impact continues to this day. As such, today I’ll be focusing on Adlerian
techniques to describe Psychodynamic Therapy. To better understand Psychodynamic Therapy,
let’s talk about what it believes. Psychodynamic Therapy believes that striving
for superiority is the core motivation for all human beings. Which…kinda sounds dark. But superiority doesn’t necessarily refer
to trying to dominate other people or wanting a leadership role or having other people admire
you. Instead, superiority means rising above what
you currently are and striving to live a more perfect and complete life. That sounds…pretty nice! Adler proposed that human beings truly believe
that the perfect and complete life is attainable and so we create our own fictional goals for
our lives and believe that those personal goals are the entire purpose of life. If you realize these goals, you realize your
“ideal self”. So logically, a person’s life will be greatly
influenced by these goals that they perceive to be the purpose of life. However, Adler proposed that striving towards
our ideal self will bring up inescapable feelings of inferiority, or not being good enough. He termed this common human experience the
“inferiority complex”. As we know from his story, Adler had a lot
of personal experience with inferiority. But he didn’t think that that was a bad
thing. Adler believed that those feelings of inferiority
have driven every improvement humanity has developed to better deal with our world. Like computers or indoor plumbing. See, the belief is that areas where you feel
inferior influence where you choose to become superior. And wherever you choose to become superior
becomes your “lifestyle”. For example, let’s say that you felt less
intelligent than others at a young age. You might strive to become intellectually
superior. Your routine, habits, and interactions will
then change to achieve that goal of intellectual superiority. Essentially, your lifestyle becomes one of
an intellectual and other people will start to describe you as introverted, bookish, or
smart. So take a moment and think about your own
lifestyle. You live your life the way that you do because
you find it important. The reason you are not in the gym for hours
every day is probably because being extremely physically fit isn’t your ideal self. Or maybe you do go to the gym every day, in
which case…good for you. Psychodynamic Therapy also heavily focuses
on childhood experiences and family environment as the root of many mental health issues and
disorders. Adler developed the idea of birth order, which
is the theory that your position in your family will influence your inferiorities and also
your lifestyle choices. You know, the whole “eldest child is type-A,
middle child is the rebel, youngest child is the baby” thing. When I first heard about birth order, I was
super into the idea because it seemed to fit so well with my own family. But the evidence for a birth order effect
on personality is actually pretty weak. It may seem accurate within a family, but
when scientists look at whole populations, they don’t really see an effect. Psychodynamic Therapy also examines a person’s
level of social interest. Social interest is the desire and capacity
to coordinate and work with other people for the greater good. “The greater good.” “Shut it!” See, unlike, psychoanalysis, which focuses
on internal conflicts, Psychodynamic Therapy is more concerned with interpersonal conflicts. Adler understood that humans are inherently
social beings and so, to be healthy, a person must have real involvement and investment
in society. In childhood, social interest can be nourished
in a family environment of respect, trust, support, and understanding. Or it can be squashed in an atmosphere of
competition, mistrust, neglect, domination, or abuse. Children from the latter kinds of families
are more likely to strive for their ideal self at the expense of others through selfish
means. Okay, so now that we know what Psychodynamic Therapy believes, let’s look at how it’s done. Unlike psychoanalysis where the client lays
down on a couch and the therapist is just out of view, Psychodynamic Therapy happens
face to face. It’s also the first form of therapy to implement
the empathetic therapist, which is now standard practice in modern counseling. See, the therapist is not a detached, emotionless
blank slate like in psychoanalysis. Instead, the therapeutic relationship becomes
an integral part of treatment. The therapist has positive regard for the
client and shows genuine interest in their well-being. The first few sessions will typically just
focus on gathering info on the client’s concerns and building that therapeutic relationship. The primary goal of Psychodynamic Therapy
is to make the unconscious…conscious. The therapeutic relationship with the therapist can reveal how the person interacts with their friends or family. The therapist then engages in consciousness
raising by sharing their observations with the client. Suddenly, unconscious emotions, desires, and
relationship patterns become visible. And when the client examines themselves, they’re more able to make changes in problematic areas. Consider this client who received divorce
papers from his wife a few weeks ago. After discussing the issue over a few sessions,
the therapist begins to challenge him and engage in consciousness raising. Counselor: It sounds like you’re saying
your wife hasn’t been emotionally present for you in the way you would like her to be. Robert: Yeah, I mean. She’s there, but…I don’t know. We’ve both made a lot of mistakes. Counselor: I notice that whenever we talk
about Rachel’s responsibility in the divorce, you seem to have difficulty criticizing her
behavior. Have you noticed that yourself? Robert: No, I’d never thought of it like
that before. But I think you’re right. I mean, that makes a lot of sense. Counselor: And what do you think makes you
stop short of being critical? By making the client conscious of his reluctance
to criticize his wife, it opens up a new conversation and may spur the client to further examine
the dynamics of his relationship with his soon-to-be ex-wife. Another tool used in session is contingency
control. This is a way of reframing a selfish goal
in a humorous way so that the client can mock it rather than feel condemned by the therapist. For example, if you are a perfectionist, the
therapist might have you imagine yourself as a mad scientist with frizzy hair, bent
on taking over the world by building a giant lego robot. But the scientist can’t achieve this goal
because they’re too focused on the color and type of lego to begin with. Not only is it funny, but the client can understand
how silly it is to allow something so small dictate such an elaborate plan. Another technique used by Psychodynamic Therapy
is choosing. This technique allows clients to step outside
of their comfortable lifestyles so they can pursue new lifestyles. One tool that’s commonly used is the “as
if”. Let’s say a client says that she would really
like to ask out her next-door neighbor on a date. But she says that she’s shy and says, “I’m
not really the kind of person to start a conversation”. The therapist may task the client with acting
“as if” they are that assertive person who does make the first move. She doesn’t have to become that person,
she just has to act like it. If the client follows through, she’ll probably
find out that it works – even if she doesn’t get the date – and that by acting in this
way, she transforms fiction into reality. With all of these techniques, the therapist
can help the client understand their unconscious desires, inferiorities, and lifestyle, develop
a healthy social interest, improve interpersonal relationships, and achieve realistic goals. And treatment doesn’t go on indefinitely,
either. Psychodynamic Therapy is relatively short-term. While there is no set limit to sessions, it
typically involves one session a week for anywhere from three months to a couple of
years. All right, so now we know what Psychodynamic
Therapy believes and how it’s done. But, does it work? Unfortunately, not much research has been
conducted on the actual effectiveness of Psychodynamic Therapy. And it depends on which study you look at. It’s definitely more effective than no treatment. And it’s been found to be about as effective
as psychoanalytic therapy in a few studies. Newer treatments like behavioral and cognitive
methods appear to consistently outperform Psychodynamic Therapy. But, some recent research shows that, when
you control for therapist loyalty, the effectiveness is about the same as most other modern therapies. However, Psychodynamic Therapy has not gone
through the rigorous process of becoming an “evidence-based practice” like Cognitive
Behavioral Therapy or Acceptance and Commitment Therapy. This means that its techniques haven’t been
studied enough to show their effectiveness. So it’s kind of hard to give it a strong
endorsement. Regardless of whether Psychodynamic Therapy
is the right choice for treatment, it has undoubtedly changed the therapeutic landscape. It introduced new concepts like the empathetic
therapist and short-term care, while also building the foundation for newer treatments. So that’s nothing for little Alfred to feel
inferior about. Thanks for watching this episode of Micah
Psych. Achieve superiority by subscribing, act “as
if” you’re a fan by hitting the like button, and you can raise my consciousness by leaving
a comment for me down below. Until next time, I’m Micah. Think about it.

27 Replies to “What is Psychodynamic Therapy?”

  1. There's the opportunity for researchers to dwell into this type of therapy. Might be unorthodox but maybe, something good will pay off.

    Thanks for showing us this!

  2. I'm not so sure about inferiority defining what we strive for.
    I've been told that I'm smart from a young age. I always enjoyed impressing adults with my thinking skills. Today I'm a scientist.

  3. That Hot Fuzz reference was amazing LOL

    This was amazingly done. Very informative, thorough, well-communicated and nicely edited. Thank you! I had been looking for a clear description of psychodynamic therapy, so this was really helpful. I may have to check out more of your videos~

  4. At 10:00, isn't that solution more behavioral or CBT than psychoanalytic or psychodynamic? Wouldn't addressing the core causes of the sense of inferiority, inability to act, indecisiveness, self-debasement, etc. be more useful over the long-term as opposed to suggestions aimed at changing behavior? If she has a self-defeating schema and is suggested to act like somebody that she doesn't think she is, will the sense of deceiving herself be eradicated through behavioral rewards, or will she know internally that the core emotions that caused her issues in the first place remain and still cause psychological distress? If unaddressed childhood stress, trauma, or memories are not dealt with, won't they still lie dormant as psychopathological energy?

  5. I dont think the last part of your video is fair with regards to the evidence for PDT effectiveness.

    The new research is the first randomised controlled trial of psychodynamic psychotherapy in the NHS (partly funded by the Tavistock Clinic Charitable Foundation) for adults with severe long-lasting depression.
    The 129 patients who agreed to take part in the study had already found antidepressants – and in some cases CBT – unhelpful. This type of depression is sometimes called “treatment resistant”. The patients were randomly assigned to receive psychodynamic psychotherapy or treatment-as-usual. The patients were treated for 18 months and then followed up for two years. The results showed that when therapy ended after 18 months, patients were no more likely to have improved in the treatment group than the control group. Two years later, however, significantly more people had improved in the treatment group than in the control group.

    Most psychotherapy research fails to follow patients for this long. A recent randomised controlled trial of CBT for treatment resistant depression also found CBT to be helpful for this type of depression. However, the CBT in this trial was unusually long (18 sessions), the depression severity was slightly lower than in the psychodynamic psychotherapy study, and patients were followed up for one year only.
    Because treatment resistant depression is a long-term – sometimes life-long – condition which is likely to return, longer term follow-up periods in trials are critical to understand what impact different therapies have, not just while the patient is in therapy but in the years that follow.

    Psychodynamic psychotherapy is not a quick fix. It can take time after therapy finishes for the patient to put into practice what they have learned, so we might expect to see patients’ lives improving gradually, after therapy ends. If psychodynamic psychotherapy leads to improvements two years after the end of therapy instead of during therapy as the results of the new study suggest, then its potential as a therapy which might deliver long lasting as opposed to transient change should be of interest to patients seeking help.

    A recent review which examined all relevant research on psychodynamic psychotherapy also supports the idea that this type of therapy could help people with a range of psychological difficulties including depression, anxiety and eating disorders.
    This does not mean psychodynamic psychotherapy should now be offered to everyone. Because it’s a longer and more complex treatment, it may never fit into the mainstream NHS model which is based on providing brief therapies for the mass market which are delivered by therapists whose training and therefore time costs much less than a psychodynamic psychotherapist. But it does mean that some of the traditional caricatures of psychodynamic psychotherapy need to be reconsidered, especially the idea that it does not work. It is important that patients are offered a real choice of therapy at the right time, particularly for people whose difficulties are long standing, complex and severe and where a quick fix approach is less likely to work and may even put people off seeking help.

    Please review:





  6. hi Micah, thank you! this is such an amazing video. just another suggestion. would you make a video about theory of personality disorders? that would be great 😀

  7. nice video. thanks !

    I am happy that I was able to find your channel trough the video you guys made for Tom Scott.

    thanks for the video and have a wonderful day / night

    cheers : )

  8. You are lucky you have brothers. At least you have others to take care of the older parents. Who have a greater inferiority complexity.

  9. Very interesting and informative video. Is that a Zelda triforce symbol in the background? Where did you get it?

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