Why Did I Become a Psychodynamic Psychotherapist?
I was initially trained in cognitive psychology in the 1990s at McGill University, Canada. My doctoral dissertation research was on cognitive processes underlying comprehension of natural text. More than 20 years later, I completed education and licensure requirements in Chicago, Illinois. As a clinical psychotherapist intern at one of Chicago’s City Colleges, I predominantly applied Cognitive Behavioral Therapy (CBT) techniques. It was practical and a technique for which I already had academic expertise.
I remember students thanking me for promptly “fixing” them. For example, I pointed out that the unbearable situation leading to a suicidal ideation was due to their catastrophizing; I taught them practicing deep breathing or progressive muscle relaxation to defend themselves against the onslaught of stress or anxiety attacks. I saw most of these students for about 5 sessions, as we had more students in need of psychotherapy than we could make time for at the college’s wellness center. It was rewarding to help students through their rough times. However, it was during that period, I experienced a surge of discomfort at the thought that without understanding the origins of the symptoms, improvements brought by CBT may be short-lived. I was worried that some students may risk falling back to square one at some point.
For the next several years, I started to explore therapeutic approaches that aim at what drives the symptoms. I had an opportunity to immerse myself in a two-year psychoanalytically oriented educational program and a postgraduate fellowship at the Chicago Psychoanalytic Institute. Since then, I have been providing psychodynamic psychotherapy, which has led to a considerable amount of positive clinical outcomes. From time to time, I also use my old CBT tools, specifically when it was called upon for crisis management, including panic attacks, situational depression and episodic stress.
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What Is Psychodynamic Psychotherapy?
Theoretical Background
Psychodynamic psychotherapy is often referred to as psychoanalytically oriented psychotherapy. Psychoanalytically oriented approaches follow Sigmund Freud’s theory developed at the end of the 19th century and beginning of the 20th century. Psychodynamic theory is an umbrella term that is not based on unified theories. Contemporary psychodynamic approaches continue to emphasize unconscious processes, early childhood experiences in shaping personality as well as manifestations of defense mechanisms. They, however, usually deemphasize infantile sexuality, in favor of acknowledging both innate and internal processes as well as the external environment’s contribution to adult personality. There are many schools of thought in addition to the classic Freudian theories. They include Object Relations, Self Psychology and Interpersonal Theories.
A psychoanalytic term that has found its way into popular everyday English expression is “defense mechanism”. People often use the term in conversation to mean the way we protect ourselves from feeling hurt. Many therapists across different styles of therapy use the term synonymously to self-protection. Defense mechanism as a psychoanalytic term, however, refers to unconscious mental processes that enable our mind to reach compromises to conflicts that we are unable to resolve. The term was first used by Freud in his paper “The Neuro-Psychoses of Defense” (1894). Examples of defense mechanisms include repression, acting out, regression, denial, disassociation, projection, splitting, displacement, intellectualization, isolation of affect, sexualization, reaction formation, suppression, humor, altruism and sublimation.
Psychodynamic Therapy
Psychodynamic therapists work with clients in the context of their personality and their unique lives. They focus on the client’s affect and help them to explore a full range of their feelings and emotions. This includes good feelings, ambivalence, discomfort or distressing feelings. They also include feelings that the client may not initially recognize that they have been struggling with. Over time, the client comes to understand that their unconscious attempts to avoid uncomfortable or distressing feelings fuel the inner sources of their symptoms, inhibitions or negative moods. They come to see what is standing in the way of living a more satisfying life
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Psychodynamic therapists work with clients in the context of their personality and their unique lives. They focus on the client’s affect and help them to explore a full range of their feelings and emotions. This includes good feelings, ambivalence, discomfort or distressing feelings. They also include feelings that the client may not initially recognize that they have been struggling with. Over time, the client comes to understand that their unconscious attempts to avoid uncomfortable or distressing feelings fuel the inner sources of their symptoms, inhibitions or negative moods. They come to see what is standing in the way of living a more satisfying life.
Psychodynamic therapists provide a safe, caring and nonjudgmental space to help connect the client’s current thoughts, feelings and behaviors to their deep and unconscious mind. In the exploration of recurring themes and patterns, sometimes attention is called to past experiences, especially early experiences with their parents. Here, the purpose is not to study the past for its own sake, but rather to understand how the past affects the client’s experiences in the present and the way they relate to others. This knowledge may help the client to break away from the confinement of their past and to live or at least experiment with an orientation that is more congruent with spontaneous authentic experience, a feeling of being alive and with a greater sense of freedom.
Another focus of Psychodynamic therapy is interpersonal relationships. The client learns about themselves by exploring patterns and themes in their interpersonal interactions including the interactions with the therapist. Psychodynamic therapy is characterized by a close therapeutic relationship between the therapist and the client. In session, patterns of interpersonal interaction, including maladaptive ones tend to emerge and reoccur (see transference). These interactions serve as “experiential” encounters, a closeup view of the client’s underlying conflicts and current functioning. Through corrective emotional experiences, they gain insight into recurring themes and patterns. They learn to articulate their underlying wants and needs and, experience new emotions and desires. Ultimately, the goals are to achieve a greater understanding of the self and others, an enhanced sense of well-being, greater emotional resilience and, healthy relatedness with others.
Psychodynamic Therapy Methods
The main methods in psychoanalytically oriented therapy include free association, dream interpretation and transference analysis. While I employ these techniques from time to time, I generally focus on the content the client brings up in session as the client communicates at various levels. They communicate semantically through their words and, through their nonverbal language as well as accompanying emotions that the therapist observes. They also construct meaning within communicative contexts, such as intention, assumption, inclusion, sequencing and prior knowledge. Processing with the client the content, including the nuanced and implied content, often allows access to the unconscious mind of the clients. It, in turn, may help us better understand and improve their experiences.
Use of Transference in Psychodynamic Treatment
Transference refers to a client’s deep and unconscious feelings towards, expectation of, or response to the therapist, which is not based on the therapist’s actual quality or behavior in session. Often, the patterns seen in transference are driven by the client’s experience in their early relations. Psychodynamic psychotherapy explores the client’s experience in the present moment, including their reactions and feelings toward the therapist, upon whom the client sometimes projects.
For example, the client may become activated following their thought or memory of an encounter, sometimes due to unresolved conflicts early in their life. In therapy, I would try to process the material by providing a “safe holding” and by connecting to the client affectively. As a result, we may see the moment-to-moment interplay of unconscious forces and affect within the client.
These interactive processes serve as “experiential” encounters, providing materials for reflective awareness of underlying conflicts and current functioning. The mutually reflective space that opens allows the client to make meaning of their repetitive unconscious patterns as they emerge. With enhanced self-knowledge, clients become more likely to allow themselves to experience through the psychotherapist a new relational pattern and interact more adaptively, that can be later extended to their life outside psychotherapy.
Who Should See a Psychodynamic Psychotherapist?
Psychodynamic psychotherapy is most beneficial for people who are looking for an insight driven approach for self-understanding. The types of mental health conditions that psychodynamic therapy is best for include the following.
- Depression (especially chronic depression)
- Anxiety or fear (especially the type that is not responding to behavioral or other styles of therapy)
- Unresolved childhood difficulty or trauma
- Complicated bereavement (i.e., unusually disabling or prolonged grief over the loss of a loved one)
- Repeated relationship difficulty
- Feeling of loneliness and isolation
- Low self-esteem
- Psychosomatic conditions (especially frequent panic attacks and stress-related physical ailments)
- Hypochondria — Illness Anxiety Disorder
- Persistent transgenerational conflicts
- Substance abuse
- Personality disorders (e.g., narcissistic personality disorders (NDP) and obsessive-compulsive disorder (OCD))
- Prolonged dissatisfaction in life
Psychodynamic therapy can also help to cultivate a greater sense of meaning and purpose in our lives. For example, it may help us to live or at least experiment with an orientation that is more congruent with spontaneous authentic experience and, a feeling of being alive and with a greater sense of freedom.
Telehealth and In-person Appointments
I provide both tele-psychotherapy and in person sessions. My office is located in downtown Chicago. For fees, insurance coverage and other information, please consult my Psychology Today profile or refer to Blue Cross Blue Shield’s Provider Finder Page to verify if I am in network with a specific BCBS PPO plan. I am also in network with Medicare and UnitedHealthcare (UHC).
You can either call (or text) 773-614-0536 or email [email protected] if you have a question or would like to schedule an appointment.