Psychodynamic Theory

Psychodynamic theory is a theory utilized in mental health and counseling to get to the underlying causes of human behavior or emotion. The theory was developed and expanded upon by Sigmund Freud and his followers. For many years the theory was the primary school of thought which drove mental health therapy services. The psychodynamic theory provided the foundation for psychoanalytical therapy which uses the psychodynamic theory as a foundation to drive practice with clients who have mental health disorders. However, in recent decades the theory has come out of style due to concerns of scientific validity, controversy surrounding Sigmund Freud and the emergence of other theoretical movements. Despite these concerns the theory has benefits in therapeutic practice with specific clients or disorders. The theory has also lost popularity due to other theoretical orientations such as behaviorism gaining more prominence in the mental health field. Despite these setbacks I believe that the psychodynamic theory is congruent with my belief system and personality which would make me more inclined to utilize the theory. 

The psychodynamic theory was developed by Sigmund Freud in the 1950s. The theory was focused on how unconscious and conscious motivations drive human behavior. "Freud's theory was primarily an instinct-theory. The basic innate drives, libidinal and aggressive... the id, invade the ego and compel it to make use of objects as means to subjective instinctive gratification, the pleasure of organic, and therefore psychic, detensioning.” (Basham, 2011 19). Freud theorized that the human mind was comprised of the id, ego and the superego which helped to form the personality of an individual. The id is the most basic element of the mind as its goal is immediate gratification. The id is driven by the pleasure principle which strives to get all needs and wants met. If these needs are not met it creates anxiety within the person. However not all human wants can be met right away which is where the ego comes into play. The ego’s role is to keep the id in check through the use of the reality principle. This makes it so that the ego can satisfy the id’s desires through socially acceptable means. The superego emerges from this conflict between the ego and the id. The superego is the area in which our conscience is contained as it tells us the difference between right and wrong. Freud's concepts of personality have been critiqued for not being able to be proven scientifically as the unconscious cannot be measured. 

Freud theorized that the conflict between the subconscious and conscious parts of the personality results in anxiety. In order to resolve this inner conflict people develop defense mechanisms in order to cope. “Psychodynamic theory does not conceptualize motivated unconscious defenses primarily in terms of individual traits. Rather, a person's mechanisms of defense are understood in terms of his or her personality structure and level of psychological development. “ (Weinberger, 2008 1061). Some forms of defense mechanisms can be positive and beneficial for coping with anxiety. For example sublimation is taking unacceptable thoughts and changing them into socially acceptable behaviors. However not all defense mechanisms are useful. Other forms of defense mechanism can be negative and damaging to the individual psyche in that they are destructive rather than constructive. Some examples of these defense mechanisms include regression in which a person reverts to an earlier stage of development or projection in which a person’s negative feelings are attributed to others. Analyzing and developing appropriate ways to cope without defense mechanisms can be an important part of psychodynamic therapy. 

While these components of the psychodynamic theory have largely been accepted other components of the theory have been more controversial. Freud theorized that the personality is formed in the early stages of life through psychosexual development. The personality is formed through conflicts that are managed through these five stages of development. The five stages are defined as the oral stage, anal stage, phallic stage, latency stage, and the genital stage. During the oral stage a child must be able to explore with his mouth, during the anal stage a child must be able to achieve the task of toilet training, during the phallic stage a child must be able to become appropriately aware of his body while respecting others, during the latency stage the child must be able to consolidate the skills learned in the earlier phases and in the genital stage the child must be able to develop a detachment from their parents in order to become independent. Within each of these stages if an individual is unable to resolve the conflict of that stage they may remain stuck. If a child is unable to overcome the oral stage of psychosexual development they may become fixated on activities that focus on the mouth such as overeating or smoking. This part of the theory has been controversial due to the sexual nature of the phases. Due to this controversy this part of the theory has been largely been discounted and is no longer utilized in therapy. 

The psychosexual stages are not even the most controversial concepts that have arisen from psychodynamic theory. That honor goes to the Oedipus complex. Freud believed that during the phallic stage of psychosexual development a boy begins to have feelings towards his mother and will desire to take the place of his father. Hence the name Oedipus complex coming from the Greek tale of Oedipus who inadvertently killed his father and married his mother. Freud does not exclude females from this concept either. Freud believed that females develop penis envy which is resentment towards men due to not having a penis. The child’s ability to resolve these issues resulted in the development of a superego which is the moral center. However this ability to develop a strong superego was not present in the female resolving her concept during the phallic stage. Rather Freud believed that females were incapable of developing a strong superego. These parts of Freud's theory created discontent from not only those studying the theories but also from within Freud’s own inner circle. Freud’s own followers such as Carl Jung broke away from Freud and began developing their own theories. These theorists were known as Neo-Freudians.

Despite the controversial aspects of psychodynamic theory, I believe certain components and the therapeutic techniques that have grown from the theory are beneficial in working with clients who have various issues. The theoretical foundation of psychodynamics that states most client issues faced are the result of unresolved issues from their early development is a concept which I agree with and believe to be accurate. This foundational belief allows the therapy to focus on resolving these issues to make progress. Psychodynamics is focused on having insight into your problems which I believe should be the first steps in beginning therapeutic services and should be the driving force of treatment. The concept of having unconscious motivations is also fascinating to me. Being able to uncover these motivations is like uncovering a mystery in the human mind. This can be an exhilarating process for both the therapist and client alike. Psychodynamics is also focused on personality reconstruction which has intrigued me as the focus is on changing something so innately fundamental as an individual’s personality. “The cutting edge of modern psychodynamic though focuses on character disorders, especially narcissistic and borderline conditions. Pathology is seen as manifested in the disturbed quality of relationships” (Rutan, 2007 2). The focus on personality is to make an effort in changing the way in which individuals relate to others. As individuals with personality disorders can find it difficult to have functioning relationships with others psychoanalytical therapy can be beneficial in resolving these issues. 

I also believe the psychoanalytical theory is superior to other theoretical frameworks in the way in which services are provided. Psychoanalysis’ focus on the relationship of past events with current functioning results in its superiority of other theoretical orientation such as behavior or humanistic frameworks. Rather than providing unconditional positive regard, which the humanistic framework does, or focusing solely on changing behaviors, which the behaviorist framework does, psychoanalytic therapy brings unconscious drives into the consciousness and allows the client to develop insight into their own intra-psychic conflicts. The use of the concepts of defense mechanisms can be beneficial in developing this insight. Specifically, I believe strongly that individuals often utilize the defense mechanisms of transference and countertransference during therapy sessions. Transference involves the client unconsciously projecting thoughts or feelings which are intended for one person but are directed towards another. During therapy clients can often develop transference with their clinician. Countertransference can also occur during sessions in that the clinician begins to become entangled with the client and will inadvertently have misdirected feelings towards the client. Being aware of these concepts is beneficial for any clinician despite their theoretical orientation. Working with the client to have them become aware of their defense mechanisms can also be very beneficial in moving the treatment along and allowing the client to build some insight regarding their issues.  This framework appeals to me partly due to these defense mechanisms as I have become skilled in determining what defense mechanisms a client is utilizing and how insight can be provided regarding the mechanisms.

Psychoanalytic therapy strives to uncover the unconscious roots of human behavior, problems, and dysfunctions. Through this form of therapy a client learns more about their intra-psychic processes and deeper meaning into their issues rather than other forms of therapy. Rather than placing a Band-Aid on a patient’s issues this form of therapy attempts to assist the client heal from their past trauma or recover so that their past is no longer debilitating them. The purpose of counseling should be more linked to the past as many of the problems we have as human beings strive from the past. Clinicians need to be able to assist their clients in developed deeper-rooted understanding of their problems. I prefer this form of therapy to just listening and giving positive regard which is often focused on in other therapies. I do not agree that therapy should just focus on the present while allowing people to manage their past issues all on their own. 

I enjoy utilizing the techniques associated with the psychoanalytic approach that are designed to uncover the unconscious hidden meaning. Free association is a technique which strives to do just that. Through this technique, a client is given the power to come into the office and say whatever comes to their mind on an issue. The client is urged to not censor themselves or analyze a topic. They should be able to say the first thing that comes to mind. This technique allows the clinician to be able to provide interpretation and insight to an issue which might not have occurred to the client. I would also enjoy using analysis of resistance and transference during therapy sessions. By addressing these issues of resistance directly in the session the therapeutic process can progress rather than being stalled by issues created by the client. Through these techniques a client can achieve resolution over their past and can move on with their life.

Despite all of the praise I have for the theory I do not agree with all of the components of the psychodynamic theory. I disagree with the concepts of the theory which imply those women are inferior to men. Concepts such as penis envy imply that women are incapable of developing a strong superego and therefore are incapable of having a strong moral foundation are inaccurate and biased towards women.  I would also not put as much emphasis on the psychosexual aspects of the theory in my work with clients. While certain components of the psychosexual aspects can be beneficial utilizing all of them can be unsettling for certain clients.  While I do believe the personality is formed in childhood which is a part of the psychosexual framework, I do not agree with the fact that the personality is completely formed in childhood through those stages. As a person grows and has new experiences their personality can develop and continue to change. Despite these concerns regarding the theory, I believe that it is beneficial in working with clients and effective for treatment. 

The effectiveness of psychodynamic theory has been debated for many years due to the concerns over the scientific reliability of concepts that exist in the unconscious. As these concepts are not measurable critics of the theory argue that the psychoanalytic model is not evidence-based and therefore cannot be effective. “Both the National Institute of Mental Health and the American Psychological Association have called upon psychodynamic practitioners to start demonstrating their outcomes” (Roseborough, 2006 166). As the field of psychology becomes more focused on developing a medical model various forms of interventions must demonstrate that they are working. However, it can be difficult to measure whether or not an individual has been able to develop superego. In response to the need for outcomes Roseborough (2006), was able to study a population within a mental health facility who received psychotherapy. They were provided with outcome questionnaires over a long period of time to determine the efficacy of the treatment. The study demonstrated that their similar positive outcomes were present for the clients of the mental health facility indicating that the treatment was effective in that facility. 

Studies conducted on a larger scale about psychoanalytic treatment also found similar conclusions. In his meta-analysis of the research that exists on the use of psychodynamic theory in therapy, Shedler (2010) found that the theory was effective in the treatment of mental health disorders. “The scientific evidence tells a different story: considerable research supports the efficacy and effectiveness of psychodynamic psychotherapy. The discrepancy between perceptions and evidence may be due, in part, to biases in the dissemination of research findings” (Shedler, 2010, 98). Through his research, he also discussed the negative press psychodynamic theory has received which has contributed to the views that it is ineffective. Rather than observing the evidence many have made comments about the theory without facts to back their opinions.

There has also been a considerable number of debates on whether the benefits of psychotherapy are only present in the short term for the patients. Leichsenring (2008), in his meta-analysis of different versions of long term psychotherapy discovered that the benefits of psychotherapy can have long-lasting effects.  “According to comparative analyses of controlled trials, LTPP showed significantly higher outcomes in overall effectiveness, target problems, and personality functioning than shorter forms of psychotherapy” (Leichsenring, 2008 1551). He also reported that long term psychotherapy is better than short term psychotherapy due to the fact that an extensive period of time is needed to get to the deep-rooted and unresolved issues that many individuals have within themselves. Individuals who suffer from mental illnesses must first work on dealing with the symptoms of the mental illness before dealing with their unconsciousness and this can take some time. 

Research has also demonstrated that psychotherapy is effective in the treatment of various mental health disorders. This is beneficial as many other theoretical frameworks are restricted in the types of disorders they can treat. Fonagy, 2005 reviewed numerous evidence-based trials and determined that the psychoanalytic model was effective in the treatment of numerous disorders. “In relation to the treatment of mood disorders, particularly depression, anorexia nervosa and some personality disorders, there is evidence to suggest that brief psychodynamic psychotherapy is comparable in effectiveness to empirically supported treatments. No trial has shown it to be superior to alternative treatment.” (Fonagy, 2005 367). This can be beneficial for a therapist who is trained in the perspective to be able to see various clients regardless of their disorder. This also demonstrates the universality of the psychodynamic perspective.  

One of the few critiques found was made by Guntrip, (2011), who suggested that the psychodynamic model has a limited role within the realm of psychology and needs to be able to be expanded to other disciplines. "For sociological as for psychoanalytical purposes, we need a psychodynamic theory which shows how the ego not merely reacts to and adapts to its objects, but is also constituted by its object-relationships" (Guntrip, 2011 np). However, this view cannot be justified in that the psychoanalytic theory is designed for the academic world of psychology. While it would be beneficial to apply it to other environments this cannot always be the case. However I would argue that knowledge of some of these areas can be beneficial in the way in which individuals live their life. 

The research that I found was aligned with and supported my theory. It also served to provide support as to why I believe in the theory and bolstered my view that the psychodynamic framework was beneficial to the way in which I would like to practice therapy with my clients. While the research did support my views there were some weaknesses in the research. The studies that were conducted were mainly on the efficacy of the use of psychodynamic theory in application to therapy. There was very little research on the validity of the concepts discussed in the psychodynamic perspective. This could be due to the concerns highlighted earlier about the difficulty of measuring the unconscious. However, most of the critiques centered on the framework are regarding the lack of measurable concepts. In order to prove itself within the psychological field the psychoanalytic framework and model need to be able to develop measurable concepts which can be used in the medical model that the therapeutic field is heading towards.

Through the research and defining of the concepts within the psychodynamic framework, I was able to define a theoretical perspective within which I can define my work with my clients. I have been able to learn that psychodynamic theory is more than just the psychosexual phases or blaming the client’s mother for all of their problems. It is important to define the theoretical framework I will work within as it assists in building my professional development. However as a professional therapist it would be necessary to remain open to other techniques and frameworks while staying centered and devoted to the psychoanalytic framework. This would assist me in being able to determine which kinds of clients I would work best with. With the openness of the theory it would be able to be utilized with any client. This would also guide me towards an area in which I can specialize. I would be able to go through trainings to improve my ability to interpret defense mechanisms and forms of resistance during therapy. As psychodynamic is congruent with my beliefs and views I would be comfortable utilizing the theory in my everyday practice.

References

Basham, K., Heller, N., Mattei, L., Méndez, T., Northcut, T., Schamess, G., ... & Shilkret, R. (2011). Inside out and outside in: Psychodynamic clinical theory and psychopathology in contemporary multicultural contexts. J. Berzoff, L. M. Flanagan, & P. Hertz (Eds.). Rowman & Littlefield Publishers.

Fonagy, P., Roth, A., & Higgitt, A. (2005). The outcome of psychodynamic psychotherapy for psychological disorders. Clinical neuroscience research, 4(5), 367-377.

Guntrip, H. (2011). Personality structure and human interaction: The developing synthesis of psychodynamic theory. Karnac Books.

Leichsenring, F., & Rabung, S. (2008). Effectiveness of long-term psychodynamic psychotherapy. JAMA: the journal of the American Medical Association, 300(13), 1551-1565.

Roseborough, D. J. (2006). Psychodynamic psychotherapy: An effectiveness study. Research on Social Work Practice, 16(2), 166-175.

Rutan, J. S., Stone, W. N., & Shay, J. J. (2007). Psychodynamic group psychotherapy. The Guilford Press.

Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2), 98.

Weinberger, D. A. (1998). Defenses, personality structure, and development: Integrating psychodynamic theory into a typological approach to personality. Journal of Personality, 

66(6), 1061-1080.