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A Brief Introduction to Psychodynamic Psychotherapy

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Freud inspired us to believe in the unconscious. The unconscious stores our unresolved issues, repressed deep-rooted painful feelings, memories, and fantasies from infancy and childhood.

Our conscious defences against exploring the unconscious include denial, blocks, resistance, repression, and projections, and can lead to acting out, addictions and other destructive behaviours.

After Freud came Melanie Klein and the theory of object relations. Klein focussed on the first few months of infancy. The mother is the primary internalised object, and the infant’s early relationship with the mother is the prototype for future relationships.

  • It comes down to the breast and the baby’s experience.
  • The good breast is loving and loved, gratifying and trustworthy.
  • The bad breast is withholding, frustrating, persecutory and hated.

Klein believed that the infant would split off unbearable conflicting feelings of anxiety and fear and project them onto the mother as anger and aggression.

When the baby learns to accept that she is separate from the mother and the loss that entails, she could internalise the mother and the breast as good objects.

Winnicott coined the phrase “Good-enough mother”; she did not have to be the idealised perfect object. He also named the comfort blanket or teddy as the transitional object, representing the breast and enabling the baby to manage separation from the mother and self-soothe.

Bowlby’s attachment theory says that early separation from the mother, resulting in maternal deprivation and the loss of the unique primary attachment figure, would result in a grief reaction in the baby, from protest to despair to detachment.

In adults, this could lead to insecure relationships, anxious attachments, problems with trust and intimacy, anxiety and depression.

Projective identification is when unwanted unconscious aspects of the self are split off and projected into another, who then acts out the feelings. These feelings can be experienced as unbearable because they are too painful or shameful and therefore are repressed.

For example, Mary is furious and never allows herself to become angry. Instead, she projects her anger onto her partner, who finds himself unusually angry and behaves accordingly. Mary can then criticise and attack him for his unacceptable behaviour while unconsciously recognising and identifying with it.

Freud believed there were three parts to the personality, the id, the ego, and the superego.

  • The id is present at birth and carries the primitive instinctual energy, urges, needs and desires and libido. It is driven by two instincts, sex and death. One expresses the positive drive for life, survival, self-preservation, social good and productive actions, love and pleasure. The other is where hostile forces such as violence, aggression, hate and destruction originate.
  • The superego develops by the age of five. This holds the positive values and morals necessary in the family and society, but it can also be controlling, persecutory, critical, and judgmental.
  • The ego is about reality, rational and conscious decision making and the ability to function in the world as an adult.

One of the aims of therapy is to bring the unconscious forces of the id and the superego into consciousness, to dispel the repressive and anxious defence mechanisms in the ego and to facilitate good ego strength.

Freud believed that events in infancy and childhood shape our personality and sexuality. He was the first to acknowledge that children are sexual beings.

  • The oral phase is from birth to 18 months. This is when the baby learns about trust, intimacy and attachment through the pleasurable experience of feeding. Negative experiences can lead to mistrust, difficulties with intimacy, eating disorders, and alcohol and drug addictions.
  • The anal phase, from 18 months to three, is about toilet training, body functions, holding on and letting go, and establishing competence and autonomy.

In adulthood, anally retentive people can be rigid and controlling, obsessed with order and cleanliness, with defences against unconscious guilt and shame, sometimes leading to OCD.

Anally expulsive people can be messy, wasteful and chaotic, often out of control, but also with the same defences against guilt and shame.

  • The third phase, the phallic phase, comes between three and six. The child discovers their sexual organs and is unconsciously aware of parental sexual activity, which excludes them. This is where the Oedipal complex is situated: the boy wishes to get rid of his father and possess his mother. The incest taboo manifests, and the child’s task is to identify with the same-sex parent, despite feelings of rivalry, jealousy, and guilt. Conflicts that are mishandled here can cause much anxiety and confusion in adult life.

The Latent phase is the following developmental phase, from six to puberty. After that, the child’s energy is directed towards learning and socialising, exploring the world and developing self-confidence and a sense of purpose.

The Genital phase from puberty onwards brings all the issues of adolescence, with an active libido, establishing identity and a desire for independence.

Transference is the projection of feelings about a relevant person, such as love, hate, and anger, onto the therapist. Transference is an unconscious expression of thoughts, feelings and fantasies, both positive and negative, about the therapist and is a valuable source of information, a diagnostic tool.

Countertransference is when the therapist has feelings for the client.

She may take on the role of rescuer, caretaker, and nurturer. She may feel omnipotent and wise, expert and all-knowing.

Negative feelings in the therapist include anger, dislike, anxiety, judging, boredom and more.

Erotic transference is often denied or repressed because acknowledging sexual feelings in the room could put the client in touch with embarrassment, guilt, shame, curiosity, desire, or lustful fantasies.

Erotic transference from the client to the therapist is often about an unconscious longing to be merged. For example, being in love puts one back in touch with the merging of mother and baby. Sex is the vehicle in adults that can lead to this feeling of merging.

By acknowledging the client’s erotic transference, the therapist makes it safe for the client to get in touch with their unconscious fantasies. It also makes their sexuality containable and acceptable.

In the erotic countertransference, the therapist becomes a maternal rescuer or erotic partner. Of course, therapists need to feel valued, but flattery, flirting, and seduction, though sometimes tempting, are not the best way.

The psychodynamic approach is intellectual and explanatory, quite deterministic. It requires strong boundaries, a firm contract of time and place and non-disclosure from the therapist. The therapeutic alliance is crucial, requiring trust, honesty and cooperation from the client, non-judgmental acceptance from the therapist and respect from both.

Exploration of the client’s inner life and interpretations by the therapist leads to acknowledging unconscious material, defence mechanisms and repeating patterns, enabling insight, self-awareness, and change in mood and behaviour.

Of course, you need not accept all of these ideas. Still, they are a solid foundation for any psychotherapeutic work, particularly for clients with depression, anxiety, addictions, relationship problems and existential questions.

Finally, I would like to say that CBT deals with symptoms, and psychodynamic psychotherapy gets to the causes.

Carol Martin-Sperry is a sex therapist and the author of three books about couples and sex. Carol is a fellow of the British Association for Counselling and Psychotherapy. 


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