The terms "Psychoanalytic or Psychodynamically-oriented psychotherapy" were originallly associated with Freud and the forefathers of psychoanlytic theory. And, while it may seem antiquated, this theoretical framework is still very much alive today. Psychodynamic and psychodynamically-oriented psychotherapy are used in both short-term and long-term procedures depending on the goals set forth at the beginning of therapy. Both frameworks focus on exploring unconscious drives and unresolved childhood conflicts which seem to continually resurface in adult life and hamper or prevent healthy attachment and intimacy with others.

     The central theme behind a psychoanalytic perspective is that our personality (likes, dislikes, positive and negative parts of us) comes from a place deep within called the unconscious. According to Sigmund Freud, who is considered to be the father of psychoanalytic theory, much of our unconscious is formed during childhood and therefore early childhood experience and development are central to understanding our motivation and behaviors. 

The Id, Ego and Superego

     Freud postulated that our personality and psyche have three fundamental drives (id, ego and superego).  This concept can be illustrated by looking at an iceberg.  You may have heard the saying "…and that's just the tip of the iceberg!" Well, that tip, the top part of the iceberg would be considered the Ego - the executive part of our personality.  It is the part of our personality that we are aware of and everyone sees.  It works on what Freud called the reality principle - how we function in the real world. Its function is to mediate between the id and superego. Again, what lies underneath is a vast universe of complexity.

   The next level is the Superego or "preconscious" part of our personality. The superego is thought to represent our morals and our sense of right and wrong and is developed by the age of eight.

     Finally, the ID, is our animalistic and most basic instinct.  The ID is located in our unconscious and works on what Freud called the pleasure principle (the notion that our sole objective is to strive for pleasure and avoid pain). 

    He also described an array of Defense Mechanisms that we employ in the service of defending ourselves against impending threat to our "self." There are some criticisms about his basic theories and the neo-freudians of today have modified some of his basic tenants. What still remains true though is that whatever theoretical perspective a psychoanalyst or psychodynamic therapist uses, the fundamentals of psychoanalysis are always present—an understanding of attachment, transference, an interest in the unconscious, and the centrality of the psychoanalyst-patient relationship in the healing process.

 

Attachment Theory

   Also fundamental to psychoanalytic theory is the notion of Attachment Theory (primarily associated with John Bowlby, M.D.). It describes the affective (feeling-based) bond that develops between an infant and a primary caregiver. The quality of early attachment evolves over time as the infant interacts with his or her caregiver and is determined partly by the caregiver’s state-of-mind toward the infant and his or her needs. 

      He believed that the quality of a child’s attachment during the formative years (when the brain is developing at exponential rates) influences the quality of relationships throughout life. As the caregiver affects the child, the child also affects the caregiver. In a psychoanalytic treatment setting, the patient’s journey towards self-discovery can mimic the attachment theory features presented by infants, with the analyst representing the caregiver.

 

 Transference

     Another hallmark of psychoanalytic theory is a term Freud called Transference. Simply put, it is a ubiquitous psychological phenomenon whereby our natural tendency and inclination is to respond to certain situations in unique, predetermined ways--predetermined by much earlier, formative experiences usually within the context of the primary attachment relationship. These deeply ingrained patterns arise sometimes unexpectedly, and in unhealthy ways. Thus the transference leads to distortions in interpersonal relationships, as well as nuances of intensity and fantasy. In the context of psychoanalysis, we would say that these transference reactions constitute the core of a person's problem, and that he or she needs to understand their basis in order to be able to make more useful and healthy choices.

    Transference then, is what is "transferred" to new situations from previous experience. As a result, a person’s relationship to lovers and friends, as well as any other relationship, (including the psychoanalyst), contains elements from his or her earliest relationships., and it remains one of the most powerful explanatory tools in psychoanalysis today—both in the clinical setting and when psychoanalysts use their theory to explain human behavior.

      The psychoanalytic treatment setting is designed to magnify transference phenomena so that they can be examined and untangled from present day relationships. In a sense, the psychoanalyst and patient create a relationship where all the patient’s transference experiences are brought into the psychoanalytic setting and can be understood. These experiences can range from a fear of abandonment, to anger at not being indulged, to fear of being smothered, and/or feelings of rage at the perception of being misunderstood.

       One common type of transference is the idealizing transference, usually present in the beginning of therapy. It stems from the notion that most people have the tendency to look towards doctors, priests, rabbis, and politicians in a particular way—we elevate them to a superhuman level yet end up disappointed when we learn that they are mere humans. It explains why we become so enraged when admired figures let us down.

       Interestingly, the concept of transference has become as universal in our culture as it is in our psyches. Often, references to transference phenomenon don’t acknowledge their foundation in psychoanalysis.  But this explanatory concept is constantly in use. Furthermore, some types of coaching and self-help techniques use transference in a manipulative way, though not necessarily negatively.  Instead of self-understanding, which is the goal of psychoanalysis, many short term treatments achieve powerful reactions in clients by making use of the leader as a powerful, charismatic “transference" figure—a guru who readily accepts the elevation transference provides, and uses it to prescribe or influence behavior.  Often, however, the results obtained are short lived.

 

Resistance

     Along with transference, the notion of resistance is another theoretical premise of psychoanalysis. It is defined as a patient's unwillingness to discuss a particular topic in therapy. While the patient may be comfortable talking about a particular topic or family member, they may quickly change the subject every time the nemesis (i.e. their father) comes into the conversation. If the therapist continues to probe this topic, the patient may even show resistance by missing therapy appointments or discontinuing therapy. Other forms of resistance include: Silence or minimal discussion with the therapist; loquaciousness; preoccupation with symptoms; irrelevant small talk that has nothing to do with the reason for therapy; fixation on the past or future; focusing on the therapist or asking the therapist personal questions; discounting or second-guessing the therapist; seductiveness; "forgetting" to do what is agreed upon (homework assignments); missing or late cancelling appointments or failing to pay for appointments.

      To the analyst, such behaviors would signal the possibility that a patient is unconsciously trying to avoid threatening thoughts and feelings, and the analyst would then encourage the patient to consider what these thoughts and feelings might be and how they continue to exert an important influence on the patient’s psychological life. As the analysis progresses, patients usually feel less threatened and therefore are more capable of facing the painful things that first led them to analysis. In other words, they may begin to overcome their resistance. In sum, resistance is considered to be one of their most powerful clinical tools, because it acts like a metal detector, signaling the presence of buried material.

 

Scheduling an Appointment

     With all that said, scheduling the first appointment can be scary because it can feel very disconcerting to delve into the unknown. Don’t be afraid to ask questions about the therapist’s qualifications, training, and fee structure for these therapy techniques. Furthermore, it is appropriate to inquire about the therapist’s comfort level about working with culturally, socially, spiritually or sexual diversity concerns.

     Psychoanalytic and Psychodynamically-oriented psychotherapy is a process and there may be times of great frustration as mentioned above. However, keep in mind that it took many years for your problems or clinical issues to develop and it will take time to sort thorough and understand the particular dynamics of your situation and help you through the healing process.

     In sum, the psychodynamic therapy relationship is based on trust, which is earned over time. After all, when developing a relationship of any kind, it is observing the congruence between promises and actions that trust is developed. A mutual respect of boundaries, ethical guidelines, and the contractual agreement, between therapist and patient will hopefully create an atmosphere in which you, the patient, can feel safe enough (over time) to explore uncomfortable thoughts and feelings, that brought you to seek therapy, and  assist you in experiencing the emotional release needed to break through the sometimes massive barriers to intimacy.  Feel free to schedule an appointment (at 954-779-2855) to discuss whether this treatment modality is right for you and your clinical needs.