Understanding psychodynamic psychotherapy

Psychodynamic psychotherapy, henceforth "psychotherapy", is not the same as other therapies.

It developed from psychoanalysis and shares features with this discipline, but is not so rules-oriented. Psychotherapy accepts the centrality of the unconscious and resistance, but also encourages a dynamic relationship between therapist and patient. Acknowledging that when you enter therapy, you will have a real relationship with a real human being (the therapist) is an important aspect of this therapeutic art.

What is psychotherapy?

What then is psychotherapy? What sets it apart from the other therapies available? Its central goal is simple to state, but difficult to achieve: to make conscious what is in your unconscious.

Along the way, you will feel seen, understood and have the opportunity to air some childhood memories. If the work is to be profound, even life-changing, you will be challenged by the therapist, too. It is thought that whatever is submerged in the unconscious is causing you pain in the here and now. Bringing it to the surface is no easy matter. It takes time, and it can be painful work.

How early experiences shape us

Thought patterns begin forming in early infancy. These are shaped into beliefs – by parents, schools and society more generally – as we grow older. These beliefs inform all of our behaviours. Some seem to lie at our very core, becoming integral to who we think we are. And we are not even aware of their existence. They have slipped into the larger part of our minds – the unconscious.

It is likely that what has brought you into therapy is emotional pain, in the here and now. Your life might have become intolerable, and you know that you need help. What you are unaware of, however, is that your contemporary thinking (I sabotage relationships) and behaviour (I drink too much in social groups) have grown out of years of you carrying unconscious beliefs.

"Psychological distress is not reality; it is not caused by reality; it is – more accurately – a relationship to reality" (Stephen Frosh: For and Against Psychoanalysis, Routledge, 1997). It is this relationship with reality that psychotherapy can help to change.

Understanding relationship patterns

For instance, you might have experienced bullying as a teenager at school (as I did). This reality is not going to go away or alter. However, your discomfort upon seeing groups of uniformed, teenage boys in the streets in the here-and-now, we can work on. We can bring acknowledgement of painful past experience, from the unconscious into your conscious mind, in the therapy room. Only then will your contemporary feelings begin to shift.

For instance, you might tend towards relationships with emotionally unavailable women. Once we get beyond the first four or five sessions, we might discover that we are talking increasingly of your relationship with your mother. She was begrudging (unable in fact) to demonstrate her love for you. This remains the case into her old age and your adulthood.

A pattern discovered through psychotherapy is that you perhaps (unconsciously) seek out emotionally unavailable women, in the hope that you will receive the love, this time around, that was so lacking when you were a vulnerable child. No romantic relationship can fully heal wounds that originated in childhood. Without recognising and working through these experiences, relationship patterns may continue to repeat themselves.

What is resistance?

One thing that we will encounter is resistance. We might reach a point where you begin to avoid and deny the deeper truths of your life. Resistance can manifest in many ways. For instance, you begin to claim that you can't remember much of your childhood, as it was a long time ago. What you can recall is that it was normal, perhaps even happy.

You are caught in a bind. You have a sense that our work will help you greatly in the long run. However, another part clings to your old narrative: failed romantic relationships are simply the result of my own bad choices. You are torn.

It is here that you are most likely to fix upon a pretext for ending our work: it's taking too long. The therapist keeps asking the same questions. I'm not getting as much out of it as I used to. I want to be living now, not talking about living.

Why therapy can take time

Be prepared for these kinds of thoughts. A skilful and experienced therapist is there to guide you through ambivalence and gently highlight your resistance to change; change is painful.

Our work is never entirely conclusive; it is a part of life's journey, but it does always conclude. How far we travel on our journey together, through acknowledgement, empowerment, forgiveness and enlightenment, will largely be up to you.