What is psychotherapy and how does it help?
So what really is psychotherapy and how does it work? There are many different perspectives and theories about what psychotherapy is and how it works. Therapists spend their entire careers wondering and playing with different approaches in an attempt to find a satisfying answer. If you engage with social media, you may have noticed how common it is for therapists get in unhelpful arguments over theoretical approaches, vehicles of change, and what approach is the most effective. My perspective is this: the therapeutic approach depends on the patient and the needs of the patient. Psychotherapy is a collaborative and interpersonal endeavor that will likely evoke familiar problematic relationship patterns that can be worked through with the therapist in a supportive, contained space. Although this can be strange and uncomfortable at first, the therapy relationship is much different than one you might have with a friend or colleague; grounded in dialogue and respect, the therapeutic relationship provides an opportunity to talk and express yourself openly without censuring your thoughts with a therapist who is able to truly listen, and who has a curious, non-judgemental stance.
What is psychodynamic/psychoanalytic psychotherapy?
Psychodynamic psychotherapy is an evidence-based treatment that places the roots of emotional suffering as the foundation for exploration. Its hallmarks are self-reflection, self-examination, and the use of the relationship between you and your therapist as a window into problematic relationship patterns in your life. Its goal is not only to alleviate specific, tangible symptoms but to also help people lead healthier, more satisfying lives (Shedler 2010). Shedler (2010) identified seven factors that sets psychodynamic psychotherapy apart from other therapies, all of which I use in my work.
1. Focus on affect and expression of emotion
2. Exploration of attempts to avoid distressing thoughts and feelings
3. Identification of recurring themes and patterns in your life and relationships
4. Attention to past experiences (developmental focus)
5. Focus on interpersonal relationships
6. Focus on the therapeutic relationship
7. Exploration of fantasy life (fantasy means your internal dialogue, desires, hopes, fears, and feelings toward others, among others)
Although a common trope of the psychodynamic therapist is someone who is completely neutral or acts as a "blank slate," I believe there is an ethical imperative to eschew neutrality, challenge, and resist the violence and perpetuation of white supremacy and other forms of oppression in the field of psychology. Although it would be untruthful of me to say complete trust and mutuality is possible within a therapeutic relationship, I strive for understanding and collective resistance, and will not avert my eyes from the history and ongoing perpetuation of systemic violence in our society and the field of psychology.
Is psychodynamic therapy effective? Yes. There have been hundreds of studies that have shown its efficacy and effectiveness, not only with symptom reduction, but for enduring changes and benefits. See below for a small selection of research articles.
Abbass, A., Kisely, S., & Kroenke, K. (2009). Short-term psychodynamic psychotherapy for somatic disorders: Systematic review and meta-analysis of clinical trials. Psychotherapy and Psychosomatics, 78, 265–274. doi: 10.1159/000228247
de Maat, S., de Jonghe, F., Schoevers, R., & Dekker, J. (2009). The effectiveness of long-term psychoanalytic therapy: A systematic review of empirical studies. Harvard Review of Psychiatry, 17, 1–23. https://doi.org/10.1080/16073220902742476
Leichsenring, F., Abbass, A., Heim, N., Keefe, J.R., Kisely, S., Luyten, P., Rabung, S., & Steinert, C. (2023). The status of psychodynamic psychotherapy as an empirically supported treatment for common mental disorders - an umbrella review based on updated criteria. World Psychiatry, 22, 286-304. https://doi.org/10.1002/wps.21104
Leichsenring, F., & Leibing, E. (2003). The effectiveness of psychodynamic therapy and cognitive behavior therapy in the treatment of personality disorders: A meta-analysis. American Journal of Psychiatry, 160, 1223–1232.
Leichsenring, F., & Rabung, S. (2008). Effectiveness of long-term psychodynamic psychotherapy: A meta-analysis. Journal of the American Medical Association, 300, 1551–1565.
Messer, S. B., & Abbass, A. A. (2010). Evidence-based psychodynamic therapy with personality disorders. In J. J. Magnavita (Ed.), Evidence-based treatment of personality dysfunction: Principles, methods, and processes (pp. 79–111). American Psychological Association. https://doi.org/10.1037/12130-004
What is a psychologist?
Psychologists in the state of Wisconsin have one of three doctoral degrees (PsyD, PhD, EdD) from an APA-accredited institution and are licensed by the Department of Safety and Professional Services (DSPS). Further, psychologists need to pass the national and state examinations before we can practice independently. Although a postdoctoral fellowship is no longer required in the state of Wisconsin, many psychologists prefer to receive additional post-degree supervised training (1-2 years) in a specialized area of interest (e.g., health psychology, neuropsychology, psychological testing, forensics). After post-doctoral training, the total number of supervised hours often exceeds 6-8000 hours.