Psychodynamic Psychotherapy

Psychodynamic therapists aim to help people understand and address their problems by becoming more aware of their inner life and its effect on their present experience and relationships.

Psychodynamic therapy is based on recognising that:

  • Problems in the present may have their roots in past experience
  • A person’s inner life or ‘inner world’ is shaped through their past experience
  • For each of us our inner world shapes the patterns of our relationships in the present, including how we feel about ourselves and other people, and how we respond.
  • This often happens without our being aware of what is driving our perceptions and behaviour ie. it happens unconsciously.

A psychodynamic view of psychosis also includes the ideas that:

  • Psychotic experiences are meaningful in terms of the person’s life history
  • Psychosis may function as a way of the mind protecting itself against unbearable mental pain.
  • Vulnerability to psychosis often arises at least in part through early life experiences, such as abuse, bullying or loss.
  • Stresses which trigger psychosis do so because of the meaning they have for that individual.

In therapy, a person’s habitual patterns of experiencing themselves and others, and their habitual patterns of dealing with this, tend to emerge in the relationship and interactions with the therapist. Attention to the patient therapist relationship is central to this type of therapy. Psychodynamic therapy sessions do not have a fixed agenda but consist of developing a conversation focusing on the “here and now” experience of both patient and therapist.

Psychodynamic therapy has its origins in psychoanalytic practice and theory. However many contemporary psychodynamic therapies differ substantially from traditional psychoanalysis (where sessions are offered several times a week often for a lengthy period and the patient lies on a couch.)

When psychodynamic therapy is offered for someone who experiences psychosis, sessions are usually much less frequent, eg. weekly, and therapist and client sit face to face. The therapist will usually take particular care to help the person feel as secure and safe as possible in therapy, and to avoid them feeling more anxiety than they are able to cope with. They may focus on helping the patient be more aware of their vulnerabilities and better able to make use of healthy coping strategies. Psychodynamic therapies like this may be referred to as ‘supportive psychodynamic therapy’

Does it work?

There are no research studies which have examined a contemporary version of psychodynamic therapy for psychosis in the kind of study (a randomized controlled trial) which gives the best chance of avoiding biased results. However evidence from other kinds of research does support the view that psychodynamic therapies are effective for some people with psychosis. There are also many reports of individuals who have found it has helped them.

NICE (the UK body which publishes guidelines on treatments) suggest that psychodynamic principles may be used to help understand the experience of people with psychosis and their relationships, but that more research is needed into contemporary psychodynamic therapies. NICE recommend that supportive therapies (which may include some forms of psychodynamic therapy) may be used when other therapies with better evidence are not available. NICE also recommend family therapy for psychosis, and this can be provided by psychodynamic therapists as well as others.