The biggest difference between Freud’s psychoanalytic approach and the modern one can perhaps be generalized as the difference between good science and bad. In bad science the scientist observes the object but never actually accounts for themselves as a variable in the equation. Good science, though, does, and modern psychodynamic therapies do this by pivoting from Freud’s one-directional method of practice - with the therapist as an all-knowing observer, and the client as object of observation - to an awareness of the importance of the therapeutic alliance, where the presence of both people is an equally meaningful part of the process, and the mechanism of change is ultimately found in the relationship between the two.
Freud’s one-directional approach to practice can perhaps be said to reflect the hierarchical, patriarchal model of thought that continues to dominate today - the one-up and one-down - whereas we can but hope that the focus on the therapeutic relationship is indicative of a differently structured future. That’s the direction psychoanalysis seems to me to have taken – a strong therapeutic alliance is widely accepted as being a critical mechanism of action in the psychotherapy, and so much can be learned from our unconscious reactions to being an active participant in one.
Thoughts on Therapy and Mental Health