Chapter 3: Psychodynamic Therapies

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Welcome back for another deep dive.

You know how much we love to really get into a topic.

Absolutely.

And today is no exception.

We are going to be taking a look at psychodynamic therapy.

I'm great.

And specifically, kind of getting beyond just Freud.

Yeah.

I feel like that's what everybody thinks of when they hear psychodynamic therapy.

Oh, Freud psychoanalysis.

Exactly.

But really, it's a much broader field.

And there's so much more to it than just those initial ideas.

For sure.

So that's our goal for today is to kind of give a really good overview of what psychodynamic therapy really is.

Yeah, pull back the curtain a little bit.

Yeah.

And how it's evolved and who are some of the key players and all of that.

Absolutely.

Yeah.

So the source material that we're looking at today is chapter three of this book, which is seemingly all about psychotherapy.

Okay.

But I think it's really interesting because it has some really cool stories in it and some concepts that I always thought I understood.

And then reading it, I was like, oh,

maybe not so much.

Interesting.

So for example, there's this one story in the chapter about this guy, Max.

Okay.

And he was just like completely obsessed with getting into Harvard Medical School.

Oh, wow.

And it was like his whole life basically revolved around this goal.

Yeah.

So it's getting really interesting to see how psychodynamic therapy kind of played into that whole scenario.

Yeah.

How can help with things like that?

Yeah, exactly.

And then I'm also excited to learn more about things like object relations.

Yeah.

And like

inferiority complex.

Right.

All of that stuff, which is kind of like, I don't know, I feel like it gets thrown around a lot.

Sure.

I don't know if people always fully understand it.

Right.

The nuances.

Yeah, exactly.

Yeah.

So that's what we're here to do today.

So I guess to kick things off, where do we even start?

Well, the chapter starts off by really acknowledging the legacy of Freud.

You know, you can't talk about psychodynamic therapy without talking about Freud.

Right.

He kind of laid the groundwork.

He's like the grandfather of it all.

Exactly.

But what's really cool is that it quickly moves beyond that and emphasizes how it's really blossomed into this rich tapestry of ideas.

OK.

And so one of the first major shifts was this move away from id psychology, which was all about those primal instincts that Freud was so focused on.

So it's less about being ruled by our desires and more about.

Exactly.

It became much more about the ego.

OK.

You know, ego psychology really emerged and shifted the focus to the ego, that part of us that tries to navigate reality.

OK, so instead of just being like, oh, I have this desire, got to fulfill it.

Right.

Exactly.

Like, wait, there's other things to consider.

Right.

Like, how do I actually make this happen?

Right.

How do I manage this?

How do I make sense of the world?

So it's like the adult in the room, so to speak.

Oh, interesting.

So it's like,

this perspective gives us a little bit more agency, maybe.

Exactly.

It's really about how we develop and adapt throughout life, not just these kind of, you know, basic instincts.

Right.

And another key shift that the chapter talked about is this growing emphasis on relationships.

OK.

It's not just about what's going on inside one person's mind, but it's about how we relate to others.

OK.

And this is where object relations comes in.

OK, I was going to ask for that.

Yeah.

It's about how we internalize our early relationships.

OK.

And we create these mental representations of ourselves and others.

And that really shapes how we interact with the world.

So it's like those relationships become kind of like a template almost.

Exactly.

Like a blueprint.

That we carry with us.

Yes.

It influences how we perceive and connect with others.

Oh, that makes so much sense.

So like, OK, if you had a parent who was always really critical.

Right.

You might grow up expecting criticism from everyone.

Exactly.

Like, you're projecting that onto everyone.

You got it.

And so the chapter goes on to explore six different variations of

There's Adlerian therapy, ego psychology, object relations,

supportive therapy, brief psychodynamic therapy, and mentalization treatment.

OK.

And so they each kind of build on these core principles.

Right.

But they also offer unique perspectives.

OK, cool.

So it sounds like Freud kind of set the stage.

She did.

And then things got really interesting when other people started building upon his ideas.

For sure.

So who should we meet first on this

psychodynamic journey?

Well, the chapter starts with Alfred Adler.

He was one of the first major figures to actually break away from Freud.

Oh, wow.

Yeah.

Back in 1911.

Like bold.

It was.

He actually challenged Freud's emphasis on sexuality as like the primary driver of human behavior.

OK.

He said it's not all about sex.

There's more to it than that.

Right.

And he believed that social influences were just as important, if not more so.

OK, interesting.

So what did Adler focus on instead?

Well, he believed that everybody experiences feelings of inferiority.

OK.

And that was a universal human experience.

He didn't see it as a bad thing.

OK.

He saw it as something that motivates us to strive for something better, to overcome those feelings and achieve competence and mastery.

OK.

So it's kind of like that feeling of not being good enough or comparing yourself to others, which we all do.

Let's be honest.

Yeah, exactly.

And so Adler believed this feeling actually motivates us to achieve our goals.

Oh, interesting.

So it's like our desire to overcome that feeling is actually what shapes our goals and motivations.

Exactly.

And he also believed that we create what he called fictional finalisms.

OK.

And those are like self -created goals that guide our behavior, even if they're not always realistic.

So it's like that idea of like, I have to achieve this thing in order to be happy.

Yeah, exactly.

Or successful or whatever.

Right.

And remember Max from the chapter.

Yes, the guy who was obsessed with getting into Harvard Medical School.

Exactly.

His story is a great example of how this can play out in real life.

OK.

He felt inferior because his younger brother was kind of always the favorite.

And so he channeled all of that into this ambition to get into Harvard.

Right.

Thinking it would prove his worth.

Right.

Like if I could just get into Harvard, then I'll be good enough.

Exactly.

So his therapist, using this Adlerian approach, helped him kind of shift his focus away from this kind of narrow goal toward what Adler called social interest.

OK.

So he encouraged Max to think about how his talents and ambitions could benefit others.

Oh, that's nice.

So instead of just being like, how can I prove myself?

It's like, how can I actually contribute to something?

Exactly.

And his Harvard obsession didn't completely disappear.

Right.

But his motivation changed.

OK.

He became passionate about improving the mental health system.

Oh, wow.

Driven by this desire to make a real difference.

That's cool.

So it's like the underlying goal was still there.

Yeah.

But it kind of manifested in a more positive way.

Exactly.

It was redirected.

Yeah.

I like that.

OK.

So Adler was all about social influence and striving for superiority.

What about ego psychology?

How did that build on Freud's ideas?

Yeah.

Well, ego psychology really took Freud's concept of the ego and expanded on it.

OK.

You know, emphasizing its inherent abilities.

Right.

And how it develops throughout our lives.

It's not just about managing these urges.

It's about growth and adaptation and mastery.

OK.

Yeah.

That's a much more like empowering view of the ego.

Exactly.

So who are some of the key players in the ego psychology movement?

Well, you've got folks like Hartman and White who really kind of expanded on Freud's ideas.

Hartman, for example, introduced the concept of the autonomous ego, arguing that the ego has its own energy and drive to learning row and become competent in the world.

OK.

So it's not just this referee between our desires and society's rules.

Right.

It has its own motivations.

Exactly.

And White took this idea even further suggesting that we're motivated not just by drive reduction, like satisfying hunger or thirst, but also by a need for effectiveness and competence.

We want to feel like we can make an impact on the world.

And master new skills.

Yeah, that resonates with me.

There's definitely a sense of satisfaction that comes from learning something new.

Exactly.

Or achieving a challenging goal.

Right.

It's like our ego is cheering us on.

Yeah, exactly.

Like, yes, you did it.

Yes.

And perhaps the most famous figure in ego psychology is Eric Erickson.

OK.

You might have heard of his eight psychosocial stages of development.

Oh, right.

Like trust versus mistrust.

Yeah.

And identity versus role confusion.

Yes.

He took Freud's psychosexual stages and expanded on them.

OK.

Showing how our development continues throughout our lifespan.

Right.

Shaped by social and cultural influences.

OK.

So they're not just these like set in stone stages that we go through and that we're done.

It's like, no, we're constantly.

It's ongoing.

Yeah.

OK.

That makes sense.

And it highlights these turning points in our lives where we grapple with these challenges and develop new capacities.

Oh, this is giving me such a new appreciation for how complex the ego is.

It is complex.

And like all that it does.

Yeah.

OK.

So before we move on, can we just circle back to object relations for a moment?

Sure.

Because I feel like it's kind of a tricky one to grasp.

Yeah, it can be.

I just want to make sure that I'm understanding it correctly.

Yeah, absolutely.

So at its core,

object relations theory suggests that our early relationships shape our internal world.

Yes.

Especially those with our primary caregivers.

Yes.

And how we kind of internalize those interactions and create these mental representations of ourselves and others.

Exactly.

That influence how we relate to the world.

Yes, throughout our lives.

OK.

So let's say hypothetically, I had a caregiver who was emotionally distant.

Right.

And unavailable.

OK.

How might that shape my object relations?

Well, you might develop this belief that people are unreliable or that your needs won't be met.

OK.

You might unconsciously seek out partners who are also emotionally unavailable.

Oh, interesting.

Recreating that familiar dynamic.

OK.

Or you might avoid close relationships altogether.

Well, OK.

Fearing rejection or abandonment.

Wow.

So it's like we're unknowingly carrying these patterns from our past into our present.

Well, it's like a blueprint.

Yeah, it's kind of like a blueprint for how we connect with others.

Exactly.

And the chapter highlights a few key figures who contributed to our understanding of object relations.

OK.

Mahler, for example, outlined these stages of self -development that emphasize how we separate and individuate from our caregivers in those early years.

OK.

And she believed that disruptions in these stages could contribute to serious disorders like psychosis.

OK.

So those early experiences are really foundational for developing a stable sense of self.

Exactly.

OK.

And then there's Kohut and his self -psychologist, which emphasizes the importance of having our needs for mirroring and idealization met in childhood.

OK.

Remind me, what are mirroring and idealization?

Yeah.

So mirroring is about having our feelings and experiences reflected back to us by those we're close to.

OK.

It's that feeling of being seen and understood.

OK.

And then idealization is about having someone to look up to, someone we admire and want to be like.

OK.

So if those needs aren't met in childhood, what happens?

Yeah.

Kohut believed that could contribute to the development of narcissistic personality traits.

OK.

And he actually described different types of narcissistic personalities.

Oh, OK.

Like the mirror -hungry personality.

OK.

Who's constantly seeking attention and admiration to fill that void.

Right.

And then the ideal -hungry personality who's always searching for someone to look up to and admire.

Oh, that's fascinating.

Yeah.

So it's not just about being self -centered.

It's about.

Right.

It's often a way of compensating for these feelings of emptiness,

inadequacy.

OK.

That stem from unmet needs.

OK.

That's really interesting.

Yeah.

And object relations theory can help us understand those underlying dynamics.

Right.

Providing valuable insights into how our past experiences shape our present relationships.

OK.

This is all starting to connect.

Yeah.

In really interesting ways.

It all comes together.

We've got Adler with his focus on social influences.

Yes.

And striving for superiority.

Yeah.

Ego psychology emphasizing growth and adaptation.

Yeah.

And now object relations highlighting the impact of early relationships.

It's all connected.

Yeah.

It's like building this multi -dimensional picture of the human psyche.

I like that analogy.

Yeah.

And the chapter goes on to explore other forms of psychodynamic therapy that have emerged over the years.

OK.

What's next?

Each with its own unique features and applications.

OK.

I'm ready.

Well, there's supportive therapy.

OK.

Which is kind of on the opposite end of the spectrum.

OK.

From traditional psychoanalysis.

It's less about digging into the unconscious.

OK.

And more about providing emotional support.

Strengthening existing defenses.

OK.

And helping people cope with immediate challenges.

So it's more about bolstering what's already there.

Exactly.

Rather than uncovering these hidden conflicts.

Yeah.

It's more about support and coping.

OK.

And it can be incredibly helpful for people going through a crisis.

OK.

Or for those who maybe aren't suited for more intensive therapy.

OK.

Yeah.

That makes sense.

They need a more structured approach.

Right.

Yeah.

What about brief psychodynamic therapy?

Yeah.

So brief psychodynamic therapy is basically an adaptation.

OK.

Of psychodynamic principles to the realities of modern life.

OK.

Think shorter time frames.

OK.

More focused goals.

OK.

And a more active role for the therapist.

OK.

So it's like streamlining the process.

Exactly.

While still retaining those core psychodynamic elements.

Yes.

Why the shift towards shorter therapies?

Well, research has shown that longer term therapy isn't always more effective.

OK.

And plus, you know, people don't always have the time.

Right.

Or resources for years of therapy.

Yeah.

And some people actually respond better to a more focused time limited approach.

OK.

It creates a sense of urgency.

Good.

And momentum that can be therapeutic.

So it's about making it more accessible.

Exactly.

And efficient.

Yes.

But what about those deeper issues that might require more time to unravel?

Right.

Well, that's where careful assessment and planning comes in.

OK.

A skilled, brief psychodynamic therapist can determine if that approach is appropriate.

OK.

For a particular client or if they need something longer term.

OK.

So there's still that assessment phase.

Yes.

OK.

That makes sense.

Yeah.

Anything else we need to know about brief psychodynamic therapy before we move on?

Just that it still incorporates those key principles.

OK.

Like the therapeutic relationship, resistance and interpretation.

OK.

Just in a more condensed way.

OK.

Got it.

Yeah.

So we talked about supportive therapy.

Brief psychodynamic therapy.

Yes.

What else is there?

OK.

So the last one the chapter covers is a newer approach called mentalization based therapy or MBT.

OK.

And this was developed specifically for folks struggling with borderline personality disorder.

Oh, OK.

That's a really challenging condition to treat.

It can be.

And so the idea behind MBT is to help people develop what's called mentalization.

OK.

Which is basically the ability to understand your own mental states and the mental states of others.

OK.

So it's like being able to step back.

Exactly.

And recognize like OK.

Yeah.

I'm feeling really angry right now.

Right.

That's making me want to lash out.

Exactly.

Or my friend seems distant.

Maybe they're going through something.

Yeah.

It's about having that awareness of what's going on inside ourselves and others.

You nailed it.

OK.

And people with borderline personality disorder often struggle with this.

Right.

They might misinterpret other people's intentions.

OK.

Get overwhelmed by their own emotions.

Have difficulty understanding why they're behaving in certain ways.

OK.

So MBT helps them develop this crucial skill.

OK.

That's really interesting.

Yeah.

How does it actually work?

Well, it's an integrative approach.

OK.

It draws on psychodynamic principles.

OK.

But it also incorporates elements of cognitive and systemic therapies.

OK.

The therapist works to create a safe and supportive environment.

OK.

Where the client can explore their thoughts and feelings and behaviors and start to develop that mentalization capacity.

OK.

They might use things like role playing.

OK.

Mindfulness techniques or even direct feedback to help the client understand their own mental states.

OK.

So it's like helping them become more aware of their

Exactly.

And how it connects to their outer world.

Yes.

OK.

It's a really valuable approach.

Yeah.

Sounds like it.

Especially for borderline personality disorder.

OK.

Yeah.

But what about psychodynamic therapy as a whole?

Right.

Does it actually work?

That's a great question.

I mean, we've heard about all these different approaches and theories.

Yeah.

But what does the research say about its effectiveness?

That's a question that has been debated for decades.

Right.

You know, for a long time, psychodynamic therapists were hesitant to participate in controlled studies.

OK.

They argued that the richness and depth of the therapy.

Right.

Couldn't be captured by standardized measures.

I can see where they're coming from.

Right.

It's hard to put a number on something like therapy.

Exactly.

Which is so personal and subjective.

Right.

But over the past few decades, there's been this growing recognition.

Yes.

That we need rigorous research.

We do.

To understand what works.

For sure.

And for whom.

Exactly.

And so psychodynamic therapists have increasingly embraced this challenge.

They have.

And participated in studies that use sophisticated methods.

Yes.

To analyze outcomes.

Yes.

So what has this research revealed about its effectiveness?

Well, the chapter dives into this technique called meta -analysis, which basically combines the results of many studies to get a bigger picture.

OK.

And numerous meta -analyses have been conducted on psychodynamic therapy.

Looking at everything from depression and anxiety to personality disorders and even somatic symptoms.

Wow.

OK.

And what's the verdict?

Overall, the findings are encouraging.

OK.

Psychodynamic therapies, especially when compared to no treatment at all, have consistently shown positive effects.

OK.

People who engage in these therapies tend to experience improvements in their symptoms, functioning, and well -being.

Oh, that's good.

Yeah.

But I'm also curious about how it compares to other approaches.

Right.

Like CBT.

Yeah.

Is one superior to the other.

That's a really common question and one that sparks a lot of debate.

Right.

Some early meta -analyses suggested that CBT might have a slight edge.

OK.

Especially for certain conditions like depression and anxiety.

Right.

But subsequent research has challenged that.

For starters, it turns out that the therapist's own theoretical allegiance can bias the results of a study.

What, really?

Yeah.

It's called the allegiance effect.

OK.

It's this well -documented phenomenon.

Interesting.

It turns out our biases can unconsciously influence how we design studies, how we interpret data, and even interact with clients.

OK.

So if the researcher is a die -hard CBT enthusiast, their study might be more likely to show CBT in a favorable light.

OK.

Yeah.

So it's not necessarily intentional.

Right.

But it's just like this inherent bias.

Exactly.

It can skew the results.

So how do we account for that when evaluating research findings?

Well, researchers have developed ways to statistically control for it.

OK.

And when they do, the differences between psychodynamic therapies and CBT often shrink or even disappear.

Oh, wow.

Yeah.

The playing field levels out a bit.

So CBT isn't necessarily better.

Right.

It's just that there was this bias.

Yeah.

There was this initial bias.

In the research.

Exactly.

OK.

And so it's important to emphasize that therapy is not one -size -fits -all.

Right.

What works best for one person might not work for another.

Right.

It depends on the person, their situation, all of that.

Exactly.

It depends on a lot of factors.

Yeah.

Like the nature of their difficulties, their personality, their preferences.

Right.

Even the therapist's style and expertise.

Yeah.

So the best therapy is really the one that resonates with the client.

Right.

And helps them achieve their goals.

Yeah.

OK.

That makes a lot of sense.

Yeah.

So when it comes to psychodynamic therapies,

what conditions have they been shown to be effective for?

Well, the research on psychodynamic therapy is actually quite extensive.

It covers a wide range of conditions.

For example, psychodynamic therapy has been shown to be effective for depression.

You know, for decades, cognitive therapy was considered the gold standard.

Right.

But more recent research suggests that psychodynamic therapy can be just as effective.

OK.

Especially for those with more complex or chronic depression.

That's good to know.

So it's not just about changing those negative thoughts.

Right.

It's about understanding those deeper emotional patterns.

Exactly.

And similar findings have emerged for anxiety disorders.

OK.

Psychodynamic therapy has been shown to be effective in reducing anxiety symptoms and improving overall functioning.

OK.

Often with lasting benefits.

That's really encouraging.

So it sounds like psychodynamic therapy is gaining recognition as a viable option for a wider range of conditions.

It is.

And it's particularly promising for those more complex cases that might not respond as well to other approaches.

OK.

So, for example, psychodynamic therapies, especially those that focus on object

have shown great promise in the treatment of personality disorders.

Right.

We talked about how those early relationships can have a lasting impact.

Exactly.

And how approaches like transference -focused psychotherapy and mentalization -based therapy can help people kind of work through those issues.

Yes.

These therapies delve into the underlying relationship patterns and emotional regulation difficulties that often fuel those borderline symptoms.

OK.

Helping people develop a more stable sense of self.

Right.

And healthier ways of relating to others.

It's like they're providing a new blueprint for relationships.

That's a great way to put it.

OK.

Cool.

So while it might not be a quick fix.

Right.

It seems like psychodynamic therapy can be really effective in addressing those deeper issues.

Yes.

That other therapies might not get to.

Yeah.

But I'm wondering about the criticisms.

Sure.

I mean, no therapy is perfect.

Of course every approach has its strengths and limitations.

Right.

And psychodynamic therapy is no exception.

So the chapter does a good job of presenting criticisms from various perspectives.

OK.

For example, some traditional psychoanalysts argue that these newer psychodynamic therapies have strayed too far from Freud's original ideas.

OK.

That they've lost some of the depth and richness of classical psychoanalysis.

So they kind of like abandon the pure gold.

That's the argument from traditionalists.

Then from a cognitive behavioral perspective, the critique often centers around the lack of empirical support.

OK.

For some core psychodynamic concepts like the unconscious.

OK.

CBT proponents tend to be more focused on observable behaviors and measurable outcomes.

Right.

So it sounds like those two approaches come from very different philosophical foundations.

Absolutely.

Which naturally leads to some disagreements.

Yes.

And then there are cultural critiques.

OK.

Which point to the individualistic focus of some psychodynamic therapies.

OK.

So critics argue that these approaches don't always take into account the broader social, cultural, and political forces that shape our lives and contribute to our distress.

So it's important to consider the context.

Exactly.

And lastly, there's the criticism that psychodynamic therapy can be a bit too free -flowing.

OK.

Lacking the structure and specificity of approaches like CBT.

Right.

So it can be hard to know what techniques to use and when.

Right.

But it's important to note that psychodynamic therapy is evolving.

And there's been a growing movement towards developing more structured and evidence based approaches.

Like brief psychodynamic therapy and mentalization based therapy.

Right.

Which we talked about earlier.

Exactly.

So these newer approaches are more focused.

More time limited.

And they often incorporate techniques from other therapies.

Right.

So kind of like a hybrid almost.

In a way.

Yes.

OK.

That's really interesting.

The chapter highlights this case study that really brings these ideas to life.

Yes.

It's the story of Mrs.

C who was struggling with OCD.

Right.

And she became completely fixated on pinworms.

Yeah.

It's a fascinating case.

Her therapist used an Adlerian approach to understand her struggles, recognizing that her obsessive compulsive behaviors were actually a way of compensating for deep seated feelings of inferiority.

Right.

So she felt powerless in a lot of areas of her life.

Exactly.

So she kind of created this little world where she could feel in control.

Yes.

Even if it meant obsessing over pinworms.

Right.

Right.

So the chapter describes how the therapist helped her to understand those underlying motivations.

Yes.

And then used various techniques to shift her focus.

Exactly.

Away from those self -defeating behaviors.

Right.

And toward more fulfilling ways of being in the world.

I love that.

It's like you said.

It's like a blueprint.

It's like she got a new blueprint for how to live her life.

Exactly.

OK.

So what about the future of psychodynamic therapy?

Right.

Well, the chapter offers some interesting predictions.

OK.

One is an increasing focus on early childhood relationships and attachment.

OK.

You know, we know that those early experiences lay the foundation for our and social development.

Right.

And psychodynamic therapy is uniquely suited to help people understand and work through those early patterns.

So it's about recognizing those blueprints.

Yes.

And creating new healthier ones.

Exactly.

And this ties into another prediction.

OK.

That psychodynamic therapy will be increasingly used to treat more complex disorders,

particularly those involving personality and interpersonal difficulties.

OK.

So kind of like what we're seeing with focused psychotherapy and mentalization based therapy.

Right.

As our understanding of these complex disorders grows and as more research is conducted.

Right.

I think we'll see even more applications in this area.

That's really exciting to see how psychodynamic therapy is evolving to meet the needs of modern mental health.

It is.

OK.

And the other thing is tailoring treatment.

Yes.

Tailoring treatments to specific patients.

OK.

Recognizing that what works for one person might not work for another.

Right.

It's about finding the right approach for the right person at the right time.

It's like personalized medicine.

Exactly.

OK.

And finally, the chapter predicts the continued rise of brief therapy models.

Yes.

OK.

Which make psychodynamic therapy more accessible and efficient.

Right.

For those who might not have the time or resources for longer term treatment.

Exactly.

This has been such a fascinating deep dive.

I feel like I've learned so much about psychodynamic therapy.

Me too.

It's a really rich and interesting field.

I feel like I've gained a new appreciation for its depth and diversity.

Yes.

And its potential to really help people heal and grow.

Absolutely.

It's a field that's constantly evolving.

But at its core, it's about understanding the human experience.

That's beautiful.

And for those of you who want to dive deeper into this topic, the chapter has a great list of recommended readings and websites that we'll include in the show notes.

Excellent.

And to our listeners, thank you so much for joining us on this deep dive into psychodynamic therapy.

We hope you found it as insightful and thought provoking as we have.

Until next time, keep exploring, keep questioning, and keep diving deep.