What Good Psychodynamic Therapy Is All About

Troubled character patterns are the bread and butter of psychodynamic therapists. The castrating hysteric, the self-defeating masochist -- these are patterns that disable and limit people.
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Psychodynamic psychotherapy works. This is the powerful conclusion of a study, "The Efficacy of Psychodynamic Psychotherapy," in the recent American Psychologist by noted clinician and researcher, Jonathan Shedler. Shedler meticulously evidences psychodynamic psychotherapy's robust effectiveness, including how the process sets in motion improvement that accrues long after therapy has ended.

So what is this treatment all about?

Psychodynamic psychotherapy derives from psychoanalysis, a widely caricatured and misunderstood treatment. Early on, psychoanalysis became famous for things like "making the unconscious conscious," or "doing dream analysis," or "understanding one's Oedipus complex"-- descriptions which unfortunately don't give a clue as to why the process is useful or what it can accomplish.

Actually, it is the troubled character patterns of humanity that are the daily bread and butter of psychoanalysts and psychodynamic/psychoanalytic psychotherapists -- the castrating hysteric, the covertly stubborn defiant obsessional, the orally hungry needy tormenting borderline, the self-defeating masochist, the disavowed or not so disavowed sadistic narcissist. These and a few others, with lots of interesting permutations and combinations, are the categories of people that make up the world. This is what psychoanalysts make conscious -- the patterns that disable and limit people -- ones that give ulcers either to individuals themselves, or to recipients in their orbit.

Psychoanalysts and psychodynamic psychotherapists understand these patterns, and help the afflicted come to understand them in themselves and others. They help people expand awareness so they can respond strategically instead of reacting impulsively or holding back endlessly. They help people separate the wheat from the chaff, see the forest through the trees, find the leading edge, sort through competing priorities, and make rightful claims and necessary renunciations. They help them develop an ethical flexibility of mind and attitude -- knowing when to be a stickler and when to give a wink and a nod, when to finesse a situation and when to play strictly by the rules, when to speak up and when to suck it up. They help people navigate power dynamics, make adaptive distinctions and discriminations, and pick their battles. A psychoanalytic "read" can "pull" for good outcomes, and help avoid blunders or traps. Psychodynamic therapy helps tame people's baser instincts and harness optimal aggression, assertion, competition, intimacy and sexuality instead of ending up mired in destructive, cut-throat aggression, impotent rage, dehumanizing sexuality or paralyzing depression and anxiety. It helps people be patient or impatient as circumstances dictate, suffer appropriately but not excessively, and rejoice to the utmost when warranted. It helps people grow, change, integrate, modulate, decrease self-absorption, regard themselves accurately, take themselves seriously but not too seriously, free up emotional energy in service of mastery and generativity -- in short, become their best selves.

The reverberations go well beyond the individual, fostering richer and fuller family life, as well as functional and productive organizations, all with enormous ripple effect. This can help break the kinds of destructive cycles which, if left untreated, keep echoing through the generations.

Psychoanalysts and psychodynamic psychotherapists do their work in context specific ways, intervening skillfully, and having a rationale for how they respond rather than (Woody Allen notwithstanding) arbitrarily adhering to a rigid set of rules. This, along with the rest, constitutes the artful complexity of what they do.

In essence, then, they are doctors of the complexity of the mind. They contextualize, narrate, synthesize and integrate -- they "complexify," then they simplify -- boiling psychological matters down to their essence. They are doctors of the complexity of context specificity within the broad framework of knowledge of the life cycle, human development, conflict and compromise.

Conveying the essence of what they do is crucial because it is not implausible to say that much of the failure in the world is a failure of psychology -- a failure to make these principles relevant and achievable as tools of enlightened self-interest.

Some of this, of course, may sound like a foolish utopian dream. But indulge the ideas a bit further. Think about the cumulative effect in psychological terms of "one small step for man, one giant leap for mankind." No matter what the starting point, small psychological shifts can make a big difference.

Are there disappointments in psychoanalytic knowledge, inadequacies of it? Sure. The field shouldn't promise more than it can deliver. Obviously it can't prevent all misery or catastrophe. There are malignant carcinomas in this healing discipline as in any other, and civilization surely sows the seeds for its discontents.

But, at its best, contemporary psychoanalysis and psychodynamic therapy may well be the best we've got for much of what ails us. Too many people need it, or some aspect of it, often in piecemeal or indirect ways. If they can see the value and integrity of what Shedler's study shows the treatment has to offer, it just might make a real difference for humankind.

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