What is Psychodynamic Therapy?

As an alternative to conventional therapy, psychodynamic therapy is a form of addiction support which looks at past experiences and resulting underlying feelings and behaviours in order to explain and remedy current substance abuse.

Determining if psychodynamic therapy is a viable option for an individual’s rehab requires a look at not only what the treatment is and how it works, but also where its limitations lie and who it is most appropriate for.

Understanding Psychodynamic Therapy

Psychodynamic therapy is a form of addiction treatment which concentrates on the role past events play in the development and reinforcement of addictive behaviours.

It looks at how such experiences shape unconscious motivations and conscious behaviours, and draws from the ideas of Sigmund Freud that have encouraged interest in the psychology of the unconscious mind.

The objective of drawing connections between past events and present behaviours is to enhance an individual’s awareness of unresolved conflicts and broken relationships and enable them to remedy the impacts they have on addictive behaviours [1].

Central to this therapy’s effectiveness is the core therapeutic relationship between a patient and their psychodynamic therapist. Built on a foundation of openness and mutual understanding, this bond allows discussions to be free and incisive.

Such freedom means sessions can delve into an individual’s childhood, deep emotions, and underlying beliefs about the world in order to effectively identify events or experiences that could be unconsciously driving addictive behaviours.

What is psychodynamic treatment like?

During a psychodynamic therapy session, a patient is encouraged to speak freely – this technique is known as free association. Its purpose is to prompt discussion through which individuals, free of judgement, can uncover and analyse things in their own time.

During free association, individuals talk until they naturally stumble upon something in their unconscious mind that might form the core of their addiction. This can take time, but the natural process means that there is no stress or emotional shutoff.

Another core idea of psychodynamic therapy is transference: the expression of feelings and thoughts to a therapist that belong to a previous stage of life, such as an old relationship or younger age.

This technique is useful because it helps bring emotions from the unconscious mind to the surface and unravel them in a safe and controlled way. Past experiences are given an outlet, allowing their origin and addictive influence to be analysed.

How does psychodynamic therapy help?

The chief virtue of psychodynamic therapy is that it engages with addictive motivations that lie beneath the surface. It’s stress-free and patient approach allows these hidden feelings to come naturally, helping encourage healthy and productive engagement.

The psychodynamic approach gives those who have developed substance use disorders a space to focus on things they might otherwise feel uncomfortable talking about. Trauma, for example, can be a very sensitive topic to discuss.

Dual diagnosis is very common among those who develop addictions [2], and psychodynamic therapy is multifaceted in that it can not only find the root of addictive behaviours, but also those of psychological disorders that have made it possible.

For example, sessions may identify addiction to have arisen because of depression. Psychodynamic therapy can then employ its techniques of free association and transference to get the source of that depression, ensuring comprehensive healing.

Having worked through their addiction via psychodynamic therapy, individuals can find themselves benefitting from very subtle yet impactful improvements.

Not only are they better equipped to handle their addiction going forward, but they will also have gained vital skills in identifying problematic feelings, discussing them, and developing healthy coping mechanisms for understanding and processing the past.

Turning defence mechanisms into coping mechanisms

One of the core aims of psychodynamic therapy is the identification of defence mechanisms that individuals employ and the pains/difficulties these practices are used to treat.

A defence mechanism is a behaviour which counters a problem in a repressive and avoidant way. Abusing substances, in this sense, is a means of dulling the effects of unconscious pain and allowing an individual to function without properly facing it.

Coping mechanisms, however, are healthy means by which individuals handle their problems. They provide outlets for pain, allowing them to function while engaging with the pains locked away in their unconscious mind in a controllable and helpful way.

Psychodynamic therapy seeks to help patients exchange their unhealthy defence mechanisms for useful coping mechanisms. There are a variety of these techniques individuals can employ during addiction treatment, but the most popular include:

Turning to the support of loved ones or different types of treatment when times get hard
Talking through difficult emotions instead of bottling them up
Engaging in fun and health distractions such as entertainment or social activities
Practising journaling or another form of consistent expression that acts as both a daily outlet for emotions and a log of how experiences affect mood
Focusing on self-care and paying close attention to personal hygiene and health
Investing in nutrition, sleep and exercise as a way to maintain stable emotional health and optimise physical performance
Trying mindfulness as a method of remaining calm and in touch with the present

How likely is it that psychodynamic therapy will work for me?

Psychodynamic therapy’s chances of being an effective form of addiction treatment depend on several key factors. Due to reliance of sessions upon open conversation and trust, a number of things need to go right in order to get optimal results.

1. The patient-therapist dynamic

The effectiveness of psychodynamic therapy sessions hinges on the compatibility between a patient and their therapist.

Even though a therapist can be well-trained and knowledgeable, and even if a patient is cooperative and ready to heal, sometimes the two cannot work together. A degree of chemistry and mutual understanding needs to be present in order for sessions to work.

This is largely due to the techniques of the treatment, mainly free association.

A patient must feel completely comfortable in order to speak with the necessary ease, and a therapist must be good at drawing upon the right information in order to steer conversation in the right directions.

Incompatibility between a patient and therapist doesn’t mean that psychodynamic therapy isn’t an option. Instead, individuals are encouraged to try with a different therapist as the results may come much more easily with a different dynamic.

2. How symptoms manifest

The extent to which an individual will see improvement after psychodynamic therapy sessions will depend on the ways in which they express their underlying difficulties in the first place.

Of course, substance abuse will be the main expression of unconscious pain, but psychodynamic therapy is most suitable for those who internalise their life experience and cope through bouts of high anxiety, depressive symptoms, and social withdrawal.

Those who externalise their pain – for example, through aggression, anger, and impulsive behaviours – won’t have the same extent of pain in their unconscious mind to uncover as it is already on the surface, requiring more direct types of therapy to treat.

3. The role of trauma

Traumatic experiences at a young age have been found to have a considerable effect on the chances of developing addiction in later life [3], and psychodynamic therapy is most effective for those whose trauma is at the core of their substance abuse.

For those who this doesn’t apply to – for example, their addiction has arisen due to another mental health condition – the techniques of the treatment will be left probing for triggers that are not responsible for the addictive behaviours at play.

Psychodynamic therapy may help slightly in discovering the origin of other mental and emotional pain, but in terms of efficiency, the crooks of an addiction would be better identified and treated via different forms of therapy, such as CBT.

In what ways can psychodynamic therapy be limited?

When considering the different options available for addiction treatment, it is always worth looking at the argued limitations of a certain kind of therapy.

This allows individuals to see the downsides of an option and whether it is likely to work for them.

Psychodynamic therapy is considered one of the least active forms of addiction therapy. When compared to conventional individual therapy or Dialectical Behavioural Therapy (DBT), it can be slow to identify and engage with triggers.

The technique of free association is deliberately slow, and some may find its aimless and flexible approach emotionally taxing or frustrating.

The therapy’s primary focus on the past can also be seen to grant events in an individual’s life too much power over current thoughts and feelings. While the treatment is positive in its aims, individuals can feel unable to actively change.

As noted above, the effectiveness of psychodynamic therapy also depends on the chemistry between a patient and therapist. Finding a suitable therapist can be time-consuming, and individuals may lose motivation while they search for the right match.

Common queries about psychodynamic therapy

Psychodynamic therapy is different from a lot of conventional forms of addiction treatment, so it’s normal for individuals to have additional questions about it and how it works.

1. How long does it take to get results?

Knowing how long an individual can expect to spend within a type of therapy can be a big factor in whether they choose to try it. Addiction can’t be beaten in a day, but everyone will have goals that they want to meet in terms of when they achieve sobriety.

In psychodynamic therapy, individuals can expect to attend around 10-20 sessions in order to allow free association to locate appropriate memories and experiences for psychodynamic analysis.

The treatment length usually amounts to around 6 to 12 months, though some individuals can expect to attend meetings for up to 2 years to ensure their recovery is comprehensive and long-lasting.

2. Can any therapist provide psychodynamic therapy?

When researching addiction treatment facilities and trying to determine the best route to recovery, individuals may look at a facility without considering if a certain treatment can be provided there, assuming that psychodynamic therapy is available everywhere.

However, while psychodynamics are widely drawn upon and explored in the education of therapists, in order to conduct the treatment, professionals must undergo specific training that teaches them how best to help people.

Individuals may find that elements of psychodynamic treatment can be found in other therapy programmes. If this will be enough, they must consider how unconscious their triggers may be; speaking to a medical professional can help in determining this.

3. How does the treatment differ from psychoanalysis?

Individuals may easily conflate the practices of psychoanalysis and psychodynamics, but they are actually different forms of psychological treatment.

Psychoanalysis refers to the analysis of the unconscious mind – the identification of underlying processes that dictate choices and behaviours – which has fallen out of scientific favour in the last half century due to a lack of empirical backing [4].

Exploring the unconscious in this sense, first devised by Sigmund Freud, has had a lot of influence over psychological theory yet has become more of a gimmick than serious treatment.

Psychodynamics, however, is under continuous scientific scrutiny and has been found to have positive results [5].

This greater positive influence arises from psychodynamic therapy’s greater focus on how the unconscious affects behaviour in a meaningful way.