Psychodynamic Therapy is from the school of psychotherapy i.e. it is interested in the treatment of emotional and psychological disorders in ways other than medicines.

The chosen modality in Psychotherapy is talking which can take place in many different ways as there are many forms of talking therapy.

The definition of Psychodynamic is the relationship between both the conscious and unconscious psyche and how the two work together to form emotions and personalities.

Psychodynamic Therapy is a relationship between client and therapist that aims to uncover the unconscious side of self, the side that unconsciously affects actions and reactions to life.

And the conscious side i.e. the side that is known to self and requires help from a therapist to change.

Psychodynamic Therapy and Substance Use Disorders 

This type of therapy is not specifically used to treat substance use disorders however Psychodynamic Therapy has been shown to treat the underlying signs, symptoms and causes of addiction.

If these areas are treated, once substance free, the ‘areas’ that lead to relapse will have been worked upon with a trained therapist reducing the incidence of relapse.

So Psychodynamic Therapy reduces the rate of relapse with alcohol or drugs by reducing psychological stress and modifying behaviours.

In this type of therapy, the therapists can analysis the mind of their client, building a picture of how they see the world, how their life has unfolded and what early childhood was like.

The therapist can also look at current unresolved conflicts and relationship problems that may lead to relapse as both behavioural and emotion based.

To remain in recovery therapists, recommend clients deal with past and current issues that may lead to ‘high emotions’ and ultimately relapse.

Psychodynamic Approach – The Components of Therapy

In the therapeutic process three main areas can be considered:

  • 1) Interpretation: a deep look at the unconscious components of self that will lead to an understanding of their conscious actions.

The following life event may have occurred.

Suffered a grief as a child – consider this issue in a Psychodynamic Therapy session.

Unconscious – impacts on the way the client reacts to life i.e. fear of losing someone forces them to stay in an unhealthy relationship.

Conscious – Deciding to stay in a relationship even though they know they are not happy.

The client has not realised the root until therapy is undertaken i.e. the reason why they stay. Which is the fear of losing people close to them.

  • 2) Free Association: a Freudian technique. The client is encouraged to share anything that comes to mind rather than follow the therapists’ lead.
  • 3) Transference: the client is encouraged to transfer or re-direct unconscious feelings and emotions towards the therapist. This unique approach allows the therapist and client to consider and process feelings together.

One of the key components of Psychodynamic Therapy is the therapeutic alliance. The stronger the bond of trust between therapist and client the better. As the client will feel confident enough to take risks and share more honestly.

Uncovering how the unconscious affects the conscious will provide the client with ‘light bulb moments.’ These moments are sudden and profound realisations of why they currently act or feel a certain way. Or why they have never been able to stop a negative behaviour pattern.

Situations that may provide the catalyst to drug/alcohol misuse may be:

  • Grief
  • Relationship break ups
  • Employment issues
  • Family arguments or tensions later in life
  • Feeling inferior
  • Chronic self-pity
  • Chronic loneliness

These feelings and situations may have arisen from childhood, adolescence or young adult feelings of:

  • Abandonment
  • Lack of love
  • Lack of intimacy
  • Trust being broken by parent
  • Trauma – the witnessing or participant of
  • Poverty
  • Grief – fear of losing people

The first list may be the explanation or reason given by the client for drug/alcohol misuse the second list is what lies below the inability to deal with life situations or the development of a self-destructive nature.

If subconsciously trying to escape reality, alcohol and drugs may provide the escape required.

Not to mention alcohol and drugs are addictive and if taken for long periods of time a chemical dependence can occur. Creating more problems on top of the ones that already unconsciously and consciously exist.

What is initially believed to be the problem has now been dissected.

Understanding the roots causes of addiction or maladaptive behaviours or emotional reactions to life can in itself be incredibly empowering for the client.

To finally understand ‘why’ they acted in the manner in which they acted or ‘what’ part they had to play in a life situation unfolding can be so profound that almost overnight previous reactions are not repeated.

Session lengths vary in nature however Psychodynamic Therapy is not seen as a quick fix and participants are encouraged to attend over a longer period of time to effect positive life changes.

Psychodynamic Therapy – Adlerian Therapy

Delivering Psychodynamic Therapy or the techniques.

Let’s look at Adler’s Adlerian Therapy and the 4 stages to this approach.

Adler believed that a person harbouring feeling of adequacy and respect will respond better to life’s circumstances. He also believed the active principle of altruism will promote self-worth and self-esteem.

Stage 1: Engagement – creation of therapeutic alliance between client and therapist. At this stage, the problem areas will also be discussed in a light manner.

Stage 2: Assessment – therapist will review the client’s history, birth order and childhood memories. The conversation is more probing in nature.

Stage 3: Insight – the therapist will offer insight on the areas spoken about in the assessment. Following the Adlerian theories such as sibling birth order and what the client tried to achieve in life i.e. life history. The conversation will also consider how they ‘seen’ their own childhoods.

Stage 4: Re-orientation – in this stage the therapist will make suggestions for lifestyle changes. Or to engage in activities that will help the insight continue to unfold. The recommendations are tailored for each participant.

Adlerian Therapy demonstrates a 4 Stage process to delivering a Psychodynamic approach to therapy.

Psychodynamic Therapy – The Sociologists Personality Theories

The Psychodynamic approach to therapy is the combination of many historically prominent Social Scientists work such as Freud, Adler and Erikson to name a few.

Sigmund Freud was interested in the human personality. And segmented it into three parts.

Part one: ID the pleasure-seeking portion

Part two: Ego & development of personality – ego will try to satisfy ID in part 1.

Part three: Superego this is the introduction of moral compass – knowing right from wrong

Alfred Adler was interested in inferiority complexes and the order of birth i.e. first born, middle born or last born.

He outlined two main points when considering inferiority and birth order.

Point one: inferiority is a crucial part of personality as it drives the person to become superior (a better, more skilled individual).

Point two: birth order matters when considering superiority. Child one feels inferior when child two is born. Child two constantly competes to become better than child one and feels superior and child three feels inferior as he/she believes they can never compete with their siblings.

Erik Erikson was interested in psychosocial development. This theory broke ages down into groups and theorised the development at each stage.

Here are some of the stages:

Age 0-1: child learns to build trust – if not will become fearful in later life

Age 1-3: development of self-governance known as autonomy – if not will suffer shame and guilt in later life

Age 3-6: must learn to assert their self – if not will become a follower unable to make healthy decisions in later life

Age 6-12: need to nurture a sense of confidence and pride through life achievements – if not self-doubt will be a part of later life

Adolescence – Develop personality or become confused about who they are in later life

Young adult – Become optimistic by having a healthy relationship – become pessimistic if no relationships develop

Middle adult – contributing to society builds a feeling of connection – disconnected if not contributing i.e. unemployed, unwell.

Late adulthood – they will develop a healthy ego if they can look back and say they contributed to society.

Considering various social scientists theories about personality the Psychodynamic Therapist can now reflect on the unconscious components of their clients i.e. the world they were born onto, the effects upon their psyche as a child/adolescent and what has driven them forward in life?

Drawing upon all the theories they have studied to deliver a well-rounded professional therapy session or block of sessions. With a beginning, middle and end. That will elicit positive change in behaviour and emotional response by the client.

Erik Erikson's Theory of Development

Erik Erikson's Theory of Development

Psychodynamic Therapy and Who it can help

This approach can help those suffering from:

  • Substance use disorders
  • Anxiety
  • Panic disorders
  • Post-traumatic stress disorder
  • Depression
  • Relationship Problems
  • Feelings of chronic loneliness or sadness

Frequently Asked Questions

“Where can I find a Psychodynamic Therapist?”

Abbeycare recommend using the WEB to find Psychodynamic Therapists in the area you live in. Just enter Psychodynamic Therapist and the area you live in.

Before choosing a therapist always check their qualifications and any reviews they may have attached to their profile of work.

“How many sessions of Psychodynamic Therapy do I need?”

This type of therapy is not a quick fix. Sessions last for a longer term and will be negotiable with your therapist. Sessions generally last 45-60 minutes but the therapist may suggest two per week at a shorter length.

“Why should I try Psychodynamic Therapy instead of other talking therapies?”

This is a difficult decision. Sometimes talking with your potential therapist in a pre-screening conversation can help you make your decision.

Psychodynamic Therapy is a good choice if you are making bad decisions in life and don’t know why. Or if you feel your emotional response to life is out of balance.

Perhaps situations in early life have shaped these bad decisions or emotions? Psychodynamic Therapy can help you with these answers, which is another important part of this therapy.

About the author

Peter Szczepanski

Peter has been on the GPhC register for 29 years. He holds a Clinical Diploma in Advanced Clinical Practice and he is a Clinical Lead in Alcohol and Substance Misuse for Abbeycare Gloucester and works as the Clinical Lead in Alcohol and Substance Use in Worcestershire. Peter also co-authored the new 6th edition of Drugs In Use by Linda Dodds, writing Chapter 15 on Alcohol Related Liver Disease. Find Peter on Respiratory Academy, Aston University graduates, University of Birmingham, Q, Pharmaceutical Journal, the Dudley Pharmaceutical Committee, Dudley Council, Twitter, and LinkedIn.