Psychotherapy and Psychoanalysis
On this page, I will attempt to describe my practice of both psychotherapy and psychoanalysis.
Psychodynamic psychotherapy is a form of talk therapy that usually takes place once or twice weekly. This is to distinguish it, in part, from psychoanalysis which oftentimes draws upon similar assumptions of ailment and cure but typically takes place three or more times per week. What follows below carries my philosophy of practice for both low- and high-frequency treatment.
Psychodynamic psychotherapy is a form of talk therapy. Talk therapy means that what happens primarily in therapy is that the patient or client talks to the therapist and the therapist listens, sometimes is quiet, and also talks back. It generally offers the patient the opportunity to speak about whatever is on their mind and receive the therapist’s response. The dialogue, discourse, and interchange between the patient and therapist—including forms of nonverbal communication like tone of voice, body language, and facial expression—is the avenue by which the therapy takes place. This process yields the opportunity to organize the meaning of the patient’s experience with greater clarity, complexity, and depth.
Psychodynamic psychotherapy is an insight-based therapy. This means that one of the primary goals of this kind of therapy is for the patient to have greater insight or awareness into themselves and what organizes them. This can take place at multiple levels within a person. Sometimes people have never had the opportunity in life to be listened to carefully by someone they trust to care about their experience. For such people, speaking to a therapist about something meaningful inside can be extraordinarily impactful. Other times, people have had the opportunity to be listened to by others, but the others have always been impartial or selective in their hearing or attention. The opportunity to dedicate time to pursue understanding oneself free from these constraints is therefore a novel endeavor.
A common assumption within psychodynamic psychotherapy is that relationship with caregivers during developmental years will have a significant impact on someone’s life trajectory. This is because of the following: the context of childhood for human beings is that we are born helpless and dependent upon our caregivers for our survival and we emerge slowly out of total dependence as we age. Because our literal survival is at stake in developmental years, maintaining attachments with caregivers and ensuring that we continue to receive care from them has “life or death” stakes. Everyone’s childhood required some form of adaptation for survival, some with more impactful requirements. Theory goes that these adaptations take place without conscious awareness or choice and become invisibly embedded in personality. Sometimes using these old, adaptive strategies becomes too costly and therapy becomes a hopeful place for change.
Psychodynamic therapy can include strategies from other forms of more behavior-based therapies like cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), and acceptance and commitment therapy (ACT). In these behavioral treatments, the therapy is usually shorter-term and focused on management symptoms like anxiety, depression, rumination, or emotional dysregulation. These therapies draw upon our ability to exert “top-down” control over ourselves, oftentimes—as in psychodynamic psychotherapy—informed by awareness of underlying patterns. For example, cognitive behavioral therapy will oftentimes emphasize growing awareness of connections between thoughts, feelings, and behaviors, identify thoughts that are irrational, and interrupt behavior that supports irrational thoughts. Dialectical behavioral therapy tends to emphasize that paying attention to the calmness of our body helps us foster our ability to behave wisely and curb destructive impulses. Acceptance and commitment therapy emphasizes the patient’s ability to use their agency in the face of the reality of their circumstances and their feelings to live according to their own values. In addition to behavior-based therapies, therapies like internal family systems (IFS) therapy is another common form of talk therapy. In internal family systems therapy, the parts of one’s mind and the interactions between parts of one’s mind are given images that allow the patient to learn things about different internal states and feelings. Oftentimes aspects of CBT, DBT, ACT, and IFS are incorporated into psychodynamic psychotherapy.