My clinical experience, theoretical training and qualification is in Psychodynamic Counselling and Psychotherapy. When people hear of this they can look quite anxious as I think the word ‘psycho’ understandably rings alarm bells and raises quite distressing ideas and images.
As a psychodynamic therapist I am a sensitive, empathic and non-judgemental practitioner. I aim to assist my clients to develop more insight and self awareness around how they manage their life and relationships to help facilitate personal growth and change.
But what do I do? What is this ‘psycho’ bit and what does it mean?
The Historical frame
Psychodynamic Therapy has its origins in the work of Sigmund Freud and is based on the principles of psychoanalysis. Psychoanalysis provides a developmental perspective for understanding our emotional and relational journey in life and childhood experiences are seen as critical in shaping the adult personality.
How does our childhood affect us then?
Psychodynamic theory suggests we internalise ideas and beliefs about ourselves from our subjective experience of being cared for. Most of these beliefs are defended against or denied as they may involve aggressive or fearful thoughts or ideas. This is a similar process many of us adopt when we receive a shocking or painful piece of news. In infancy or early childhood this denial can be so powerful and primitive that the beliefs become unconscious and remain there. These unconscious beliefs, thoughts, feelings and fantasies are understood, in the psychodynamic model, to impact on us as they can influence our emotional experience and then inform patterns of behaviour within our current life and relationships.
The evidence base
The idea of an unconscious shaping our behaviour may seem far-fetched and quite unrealistic to many. However neurobiology of attachment theory conceptualises that during the first year of infancy the infant’s emotional experience of being cared for is unconsciously imprinted into the right-hemisphere of the brain. Neuroscience has established how this unconscious encoded relational experience is activated, at times of difficulty or stress, throughout a person’s life triggering specific expectations of response in themselves and those around him or her and this then informs their related behavioural patterns.
Genetic research also informs us that the child’s subjective experience of the early environment and the quality of parenting assume central roles in how a particular gene develops to affect behaviour.
Relational patterns
So current theoretical models based in research support ideas that first began developing in the late 18th and early 19th century.
This may still sound a little off the wall however when you think about it. Have you ever responded to a difficult relationship situation in the same way as you did in a previous similar relationship situation despite wanting to act or behave in a very different way?
Or do you look back and think why do all my relationships go the same way?
Or do you find life unfolds in a familiar repetitive pattern no matter how much you try to do things differently?
Sometimes you prepare for that stressful meeting or moment with your partner and you go over how you want to act, talk and behave. Yet in the moment when things get heated you respond as usual and then after the event you can be quite harsh on yourself thinking how you should have been, what you should have said.
We can be drawn into acting out these internal unconscious relational patterns that are activated at times of stress. But you don’t see that or are even aware of that. This leaves you turning over the events and berating yourself for not being good enough or for being a failure or making things a mess again. These ruminations may exacerbate your existing low mood and can lead to more sleepless nights full of anxiety and tension poring over past or present life scenarios. Your sense of unease around stressful scenarios only increases and you may find your anxiety and depression taking a more entrenched hold on you.
How does psychodynamic therapy help?
Psychodynamic therapy focuses on the psychological roots of emotional suffering. It involves self-reflection and examination of problematic relationship patterns the understanding of which is informed by exploring linked contributing features arising from a persons past experience. Its aim is to help alleviate a person’s symptoms of anxiety and depression and help shift their problematic patterns of behaviour.
Research has identified there are key features that distinguish psychodynamic therapy from other therapies:
- Focus on affect and encouragement to express, explore and unpack emotion
- Exploring attempts to avoid distressing thoughts and feelings (defence and resistance)
- Identifying repeating themes and patterns in your life and relationships
- Discussion of past experience (developmental process)
- Focus on interpersonal relations
- Focus on the therapy relationship (including transference)
- Exploration of wishes and fantasies both conscious and unconscious
The aim of psychodynamic therapy is to help enable the client to better understand and explore the links between their current symptoms of anxiety and depression with their core, repeating, underlying problematic patterns of relating and behaviour.
My approach
I usually focus on current issues whilst acknowledging the imprint or connection to past experiences. I empathically encourage exploration of your subjective (personal) experience of your relationships and difficulties in your life, as patterns emerge links are made between past and present life situations and scenarios.
At times people I work with don’t know how they feel about a certain situation and may initially be quite dismissive of talking about feelings in general. When you have spent a period of time living with mental health symptoms it may feel easier to push your feelings aside in order to cope. It’s understandable that you may need time to reflect to begin to articulate your feelings.
You can often be so caught up in stressing about what others want or expect from you that there seems little point in knowing your own feelings. However denying your own feelings to accommodate yourself to the perceived needs of others may create a range of feelings and stressors that impact on your mind and overall health and wellbeing. It may also lead to a deep sense of grievance around not being listened to or accounted for.
The physiological impact of depression
Whether you want to know about these feelings or not they exist inside you and denying them or avoiding them is wearing and exhausting. Recent research has identified how stress and anxiety created through denial of affect impacts on the HPA axis (Hypothalamic-Pituitary-Adrenal Axis) leading to ‘allostatic load’ of these systems putting a strain on the body and this is linked to many long-standing and chronic health conditions.
Further research has now identified depression as a ‘systemic disease’ that affects the whole of the organism. This research links depression with chemical and physiological responses that may explain the association between depression and cardiovascular disease, cancer and why people with depression die younger. A crucial point in this research was its finding that after the usual treatment for depression the physiological responses returned to normal.
What about this transference then?
Again a lot has been made of the ‘transference’ relationship a concept that Freud developed in the 19th century. This basically means you can repeat, or enact, your early relational patterns during times of perceived interpersonal stress. As already mentioned the concept may go back a long time yet current research into the neurobiology of attachment supports and validate these ideas. In times of interpersonal stress relational patterns imprinted into procedural memory are activated which are understood to then affect a persons emotional experience and behaviour.
What the transference or attachment research tell us is that the therapeutic relationship itself can become a conduit for exploration of a persons relational patterns enabling and facilitating behavioural change. This means I am interested and curious in how from session to session and moment-to-moment a client responds or relates to me. This can be highly informative and a powerful conduit to unpacking and understanding their unique and individual patterns of relating. Through exploring your subjective experience of the therapeutic relationship you get to practice and develop relational and communication skills within the safe, consistent, empathic and non-judgemental setting of therapy.
In the course of psychodynamic therapy clients can develop their insight and self awareness around their relational or communication patterns. This may enable you to feel an increased capacity to feel more able to cope with stress, conflict or difficulty as it arises in your relationships at home and at work.
The research base
Psychodynamic therapy has a strong research base that indicates its efficacy across a range of mental health problems.