The contemporary psychodynamic approach to counselling developed from the psychoanalytic tradition begun by Freud and his contemporaries. One of its core tenets is the awareness that the unconscious has a major role to play in internal conflict and pathology, and that resolution of these can be achieved via work performed within the container of a therapeutic relationship.
The way that psychodynamic therapy orients away from Freud’s conception of the psychotherapist as detached observer and the client as object of observation, and toward the concept of the therapeutic relationship instead, particularly appeals to me. Psychodynamic approaches acknowledge that healing, as bell hooks (2004) writes, “does not take place in isolation”. The psychodynamic practitioner understands that therapist and client “are the two major variables in the approach, rather than treatment and disorder” (Sundararajan, 2002), and that “detached following of rules describes the novice rather than the expert, who is affectively involved with the task” (Sundararajan, 2002). The mechanism of change is found in two equally meaningful presences in the room (Laws et al., 2017), the dynamic of transference and counter-transference between them, and a commitment from both to address the anxiety, defences and resistance that may arise during their work together.
Studies of practitioner characteristics that can harm the therapeutic alliance highlight inaccurate interpretations (especially those responding to client resistance), inflexible adherence to interventions, and a lack of attention to the repair of ruptures in the relationship (Moyers, Miller, & Hendrickson, 2005). As such, a skilled psychodynamic practitioner seems to me to be one who is always seeking to balance their learning and knowledge of technique with the experience of the relationship in the moment. It is for this reason that in my thinking around psychodynamic counselling, I feel it necessary to also include a passing nod to theorists beyond this particular orientation, such as those of the feminist and client-centred approaches.
hooks, b. (2004). The will to change: men, masculinity, and love. Atria Books: Harvard, New York, NY
Laws, H. B., Constantino, M. J., Sayer, A. G., Klein, D. N., Kocsis, J. H. Manber, R., ... & Arnow, B. A. (2017). Convergence in patient–therapist therapeutic alliance ratings and its relation to outcome in chronic depression treatment. Psychotherapy Research, 27 (4), 410–424. doi: 10.1080/10503307.2015.1114687
Moyers, T. B., Miller, W. R., & Hendrickson, S. M. (2005). How does motivational interviewing work? Therapist interpersonal skill predicts client involvement within motivational interviewing sessions. Journal of Consulting and Clinical Psychology, 73 (4), 590-598. doi:10.1037/0022-006X.73.4.590
Sundararajan, L. (2002). Humanistic psychotherapy and the scientist-practitioner debate: An “embodied” perspective. The Journal of Humanistic Psychology, 42 (2), 34-47. doi: 10.1177/0022167802422004
Thoughts on Therapy and Mental Health