The first method of psychotherapy that focused on unconscious conflicts and motivations was Freudian psychoanalysis. However, in the past hundred years the therapeutic techniques based on psychoanalysis evolved. Psychotherapy practitioners categorize techniques derived from psychoanalysis as “Psychoanalytical Therapy,” “Psychodynamic Therapy,” or “In-depth Psychotherapy.” On the other spectrum stands the behavioral psychotherapy.
The psychodynamic psychotherapy aims to create patients’ awareness of their inner world. While increasing their insight of the inner conflicts (rooted in the past or in the presence) helping to resolving the conflict’s destructive force causing the symptoms. The psychodynamic psychotherapies aim to induce deeper personality changes fostering patient’s emotional development as well as more conscious and fullfiled life.
On average psychoanalytical psychotherapy lasts longer than cognitive behaviour therapy. It often requires a few years of treatment. The investment of time, money, and emotional energy can produce significant rewards in terms of improved relationships, creativity, professional and social progress.
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Classical Psychoanalysis
Classical psychoanalysis, developed by neurologist Sigmund Freud (1856–1939), is the foundation of psychotherapy.
Freud believed each person has three inner parts: the “Id” for unconscious drives, the “Ego” for reality connection, and the “Superego” as a conscience shaped by external values, like those of parents.
Freud saw sexual drive (libido) as central to mental energy, expressed in age-typical phases from infancy to adulthood. He believed that disruptions in early libido development is the rootcause of patient’s futer problems.
Freud viewed mental disorders, especially the neuroses as the effect of unresolved childhood problems. Psychoanalysis aims to make these unresolved conflicts conscious. Analysts pay attention to patient resistance to processing unconscious experiences and the defense mechanisms developed to balance desires and reality.
In sessions, patients freely share current thoughts and feelings, a technique Freud termed “free association,” central to psychoanalysis. Freud believed patients would eventually reveal a “pattern” that clarifies their conflict to the therapist. By re-experiencing early feelings, especially towards family, the patient “transfers” childhood wishes and emotions onto the analyst, allowing early situations and experiences to be interpreted.
Psychoanalysis versus Contemporary Psychoanalytical Technics
Since its initial formulation Freud, psychoanalysis has evolved and are largely replaced notably through Ego Psychology, Self-Psychology, and Object Relations Theory. The position of patient lying on the sofa has been abandond in favour of the position of equality in which patient and psychotherapist sit close to eachother.
Today, classical psychoanalysis is rarely practiced due to its long duration and limited empirical support for effectiveness. Contemporary psychodynymic psychotherapysts also revised Freud’s narow explination of the conflict’s exclusivelly sexual nature. They aknwololdged that the conflicts can be caused by unresolved traumatic child events but also by much more “prozaic” problems like lost of social position, conflcts at work or in the relationships, also without pre-existent negative chidlhood experiances.
Psychoanalytical Therapy
The term “psychoanalytical psychotherapy” belonging to psychodynamic psychotherapies, has been established by C.G. Jung, who wanted to distinguish his method from Freud’s psychoanalysis. It was Jung who abandoned the sofa and turned the psychotherapy into a dialog between the therapist and the patient. The modification introduced by Jung became a standard used by several variations of psychodynamic psychotherapy.
The other difference of today’s psychoanalytical therapy is lower frequency of the sessions compared to the original psychoanalysis. Freud use dto see his patients 5 to 6 times per week. Today the frequency has been reduced to once per week or even less.
Transference Focused Therapy
The Transference Focused Therapy (TFT) is used for treatment of personality disorders. The therapist is concentrating on the interpretation of transference in “here and now”. TFT concentrates on present psychological conflicts, addressing underlying motivations and relationship conflicts causing the patient’s distress. The therapist helps to manage patient’s emotions and impulses, providing the cognitive corrective support. The therapist’s approach is active and goal-oriented, requiring quick diagnosis, with therapy sessions conducted in an everyday conversational setting where patients observe the therapist’s gestures and expressions.
Depth psychology-based therapies are proven effective for treatment of depression, various forms of anxiety, OCD, PTSD, and the TFP for treatment of Borderline Personality Disorders, using transference-focused and mentalization-based approaches.
Dynamics of Psychodynamic Therapies
The analytical treatment process is the most comprehensive form of psychotherapy. Psychodynamic or in-depth psychotherapy focus on unconscious conflicts often stemming from childhood trauma or negative upbringing experiences. Therapists aim to raise patients’ awareness of their inner world, which influences their insight of their past and present relationships and helps them understand and resolve their problems.
The conteporary psychodynamic psychotherpy focus on the transference in the interaction with the therapists and on its intepretation. Here, patients revisit painful memories, gaining cognitive and emotional insight within a stable therapeutic bond. On average psychoanalytical psychotherapy lasts longer than cognitive behaviour therapy. It often requires a few years of treatment. The investment of time, money, and emotional energy can produce significant rewards in terms of improved relationships, creativity, professional and social progress.
Transference in Psychodynamic Psychotherapy
The term “transference” originates from Freudian psychoanalysis. It refers to the patient’s feelings and attitudes towards the therapist influenced by the patient’s old patterns. Transferences are typically unconscious involving the fundamental dynamics from infancy.
We all “transfer” our feelings in our everyday lives. Both loving and constructive feelings and attitudes can be transferred, as well as aggressive and conflicting old relationship dynamics.
Example: An employee is repeatedly devalued harshly and unfairly by her supervisor. Nevertheless, she admires him and tries to please him through good performance and an attractive appearance. In relationships as well, she repeatedly seeks out strong partners, often experiencing violence, yet she does not leave. In doing so, she transfers feelings that actually belong to her violent father onto her boss or partner. She desires confirmation or affection from them, which she longed for from her father but never received.
Countertransference in Psychodynamic Psychotherapy
In psychodynamic psychotherapy, countertransference refers to therapist’s emotional reactions towards the patient based on therapist’s own feelings, biases, and desires. The observation of this phenomenon traces back to Sigmund Freud. Freud noticed that the transfer of feelings between patient and the therapist works in both directions. Because of countertransference there is a risk that therapist departs from his objective position.
In the therapeutic relationship understanding the process of transference and countertransference is considered fundamental. Analysing the flow of feelings between the patient and the therapist allows to reconstruct patient’s past disease-causing relationship patterns. In the second step they can be addressed, understood and neutralized in the therapeutic setting.
Working with Transference and Countertransference
The transference from patient to the therapist, if understood, is always a valuable therapeutic tool. In contrary the countertransference must be considered a disruptive factor. Transference and countertransference processes are a kind of “time machine”, as old, usually childhood constellations and the associated feelings are activated during the therapeutic process.
To handle this constructively in therapy, the psychotherapist must be aware of his own “blind spots”, his transference tendencies. That’s why the training in the psychodynamic psychotherapy requires the therapist to be analysed by an experienced supervisor.
The process of transference interpretation explores the connections between patient’s current problems and his childhood dynamics helping to find ways out of the crisis. Thus, working with transference requires specialized training and extensive personal therapy for the therapist.
