How Psychodynamic Therapy Is Used to Treat Depression

Psychodynamic Therapy

How Psychodynamic Therapy Is Used to Treat Depression

Psychodynamic therapy is the oldest of modern therapies. Psychodynamic therapy grew the theories and practices of Freudian psychoanalysis. It is one of the three main types of therapy used to treat depression.

Psychodynamic therapy is a long-term form of psychotherapy that recognizes negative patterns of behavior and feelings that are usually rooted in the past and resolving them.

Brief psychodynamic therapy approach enables an individual to examine unresolved conflicts and symptoms that arise from past dysfunctional relationships and manifest themselves in the need and desire to abuse substances. Brief psychodynamic therapy is goal-oriented.

Psychodynamic therapy can be used for individuals, couples, families, or groups. Psychodynamic therapy works well with other types of therapies as well as medications.

Psychodynamic therapy focuses on the unconscious processes that are manifested in an individual’s behavior. By bringing these associations to the person’s attention they can learn to overcome the unhelpful behaviors and feelings which they caused.

The goals of psychodynamic therapy are to assist an individual in self-awareness and undressing the influence of their past on their present. In psychodynamic therapy, an individual is encouraged to talk freely about whatever happens to be on their mind.

Psychodynamic therapy involves an exploration of the entire range of a patient’s emotions. Psychodynamic therapy utilizes techniques free association and open-ended questions. Psychodynamic therapy also seeks to lower defense mechanisms people tend to develop.

Defense mechanisms may keep painful feelings, memories, and experiences in the unconscious.

There is also an emphasis in psychodynamic therapy on relationships, especially the relationship between the therapist and the individual.

With the help of the psychotherapist, the individual finds ways to talk about feelings that include feelings that are troubling or threatening, contradictory feelings, and feelings that the individual may not have recognized or acknowledged from their past.

The individual develops ways to manage those internal feelings in a healthy way. Psychodynamic therapy also focuses on addressing and recognizing defense mechanisms reactions and behaviors that individuals use to avoid upsetting thoughts and feelings.

Therapists help individuals identify recurring patterns in their thinking, feelings, and behavior, consequently understanding how these patterns are created due to their past. There is no structure in psychotherapy, as compared to cognitive behavioral therapy. 

What Psychodynamic Therapy Is Used For:

Psychodynamic therapy is primarily used to treat depression and other serious psychological distress, individuals who have lost meaning in their lives or have difficulty forming or maintaining personal relationships. Studies have found that other effective applications of psychodynamic therapy include:

  • Addiction
  • Social anxiety disorder
  • Eating disorders
  • Anxiety
  • Panic disorders
  • Post-traumatic stress disorder
  • Personality disorders (i.e., borderline personality disorder)
  • Stress-related physical ailments
  • Physical symptoms that lack a physical basis
  • Persistent feelings of isolation and loneliness
  • Depression
  • Prolonged sadness
  • Sexual difficulties

Choosing a Type of Therapy:

No matter what type of therapy a therapist uses, it is crucial to determine what fits an individual’s personality and their presenting symptoms. Psychodynamic therapy elevates the presenting symptoms but also improves an individual’s self-esteem, and better use of their own talents and abilities, and an improved capacity for developing and maintaining more satisfying relationships.


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Psychotherapy & Depression

How Psychodynamic Therapy Is Used to Treat Depression

During psychotherapy, a person with depression talks to a licensed and trained mental health care professional who helps the person identify and work through the factors that may be triggering the depression.

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Psychotherapy for Depression

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Psychotherapy is often the first form of treatment recommended for depression. Called «therapy» for short, the word psychotherapy actually involves a variety of treatment techniques. During psychotherapy, a person with depression talks to a licensed and trained mental healthcare professional who helps the person identify and work through the factors that may be triggering the depression.

Sometimes these factors work in combination with heredity or chemical imbalances in the brain to trigger depression. Taking care of the psychological and psychosocial aspects of depression are just as important as treating its medical cause.

How does psychotherapy help with depression?

Psychotherapy helps people with depression:

  • Understand the behaviors, emotions, and ideas that contribute to his or her depressed state.
  • Understand and identify the life problems or events— a major illness, a death in the family, a loss of a job or a divorce—that contribute to their depression and help them understand which aspects of those problems they may be able to solve or improve.
  • Regain a sense of control and pleasure in life.
  • Learn coping techniques and problem-solving skills.

What are the types of therapy?

Therapy can be given in a variety of formats, including:

  • Individual . This therapy involves only the patient and the therapist.
  • Group . Two or more patients may participate in therapy at the same time. Patients are able to share experiences and learn that others feel the same way and have had the same experiences.
  • Marital/couples. This type of therapy helps spouses and partners understand why their loved one has depression, what changes in communication and behaviors can help, and what they can do to cope.
  • Family. Because family is a key part of the team that helps people with depression get better, it is sometimes helpful for family members to understand what their loved one is going through, how they themselves can cope, and what they can do to help.

Although therapy can be done in different formats— family, group, and individual—there also are several different approaches that mental health professionals can take to provide therapy. After talking with the patient about his or her depression, the therapist will decide which approach to use the suspected underlying factors contributing to the depression.

Psychodynamic therapy

Psychodynamic therapy is the assumption that a person is depressed because of unresolved, generally unconscious conflicts, often stemming from childhood.

The goal of this type of therapy is for the patient to understand and better cope with these feelings by talking about the experiences.

Psychodynamic therapy is administered over a period of three to four months, although it can last longer, even years.

Interpersonal therapy

Interpersonal therapy focuses on the behaviors and interactions a depressed patient has with family and friends.

The primary goal of this therapy is to improve communication skills and increase self esteem during a short period of time.

Therapy usually lasts three to four months and works well for depression caused by mourning, relationship conflicts, major life events, and social isolation.

Psychodynamic and interpersonal therapies help patients resolve depression caused by:

  • Loss (grief)
  • Relationship conflicts
  • Role transitions (such as becoming a mother or a caregiver)

Cognitive behavioral therapy

Cognitive behavioral therapy helps people with depression to identify and change inaccurate perceptions that they may have of themselves and the world around them. The therapist helps patients establish new ways of thinking by directing attention to both the «wrong» and «right» assumptions they make about themselves and others.

Cognitive-behavioral therapy is recommended for patients:

  • Who think and behave in ways that trigger and perpetuate depression.
  • With mild-to-moderate depression as the only treatment or in addition to treatment with antidepressant medication.
  • Who refuse or are unable to take antidepressant medication.
  • Of all ages who have depression that causes suffering, disability, or interpersonal problems.

Therapy works best when you attend all of your scheduled appointments. The effectiveness of therapy depends on your active participation. It requires time, effort, and regularity.

As you begin therapy, establish some goals with your therapist. Then spend time periodically reviewing your progress with your therapist. If you don’t your therapist’s approach or if you don’t think the therapist is helping you, talk to him or her about it and seek a second opinion if both you and your therapist agree, but don’t discontinue therapy abruptly.

Tips to help you get started

  • Identify sources of stress. Try keeping a journal and note stressful as well as positive events.
  • Restructure priorities. Emphasize positive, effective behavior.
  • Make time for recreational and pleasurable activities.
  • Communicate. Explain and assert your needs to someone you trust; write in a journal to express your feelings.
  • Try to focus on positive outcomes and find methods to reduce and manage stress.

Remember, therapy involves evaluating your thoughts and behaviors, identifying stresses that contribute to depression, and working to modify both.

People who actively participate in therapy recover more quickly and have fewer relapses.

Therapy is treatment that addresses specific causes of depression; it is not a «quick fix.» It takes longer to begin to work than antidepressants, but there is evidence that suggests that its effects last longer. Antidepressants may be needed immediately in cases of severe depression, and the combination of therapy and medicine is very effective.

Last reviewed by a Cleveland Clinic medical professional on 02/02/2018.



Psychodynamic Therapy For Depression and Anxiety: How it Works

How Psychodynamic Therapy Is Used to Treat Depression

Psychodynamic Therapy (PDT), perhaps the oldest form of therapy used today, has its roots in Freudian psychology (as in Sigmund Freud), circa 1900, and essentially works by helping you become more aware of your subconscious in order to gain insight into behaviors that may be self-destructive.

Experts say few of today’s mental health professionals practice an exclusive form of psychodynamic therapy but rather incorporate components of it along with other forms of therapy such as cognitive behavior therapy (CBT).

“What matters THE MOST for good outcomes is the therapeutic alliance between the therapist and the client, regardless of what type of therapy is being administered,” says psychiatrist Michael McGee, MD, chief medical officer at the Haven Treatment Center in California and author of The Joy of Recovery. “It is the alliance that heals.”

Victor Fornari, MD, director of child and adolescent psychiatry at Zucker Hillside Hospital in Glen Oaks, New York and Cohen Children’s Medical Center in New Hyde Park, New York agrees.

“Psychodynamic therapy is very helpful for recognizing, understanding, expressing, and overcoming various conflicts,” says Dr. Fornari.

 “It helps a person to deal with repressed emotions in order to improve her relationships and can be very effective for a variety of emotional struggles.”

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If you are having relationship issues, for example, it may be helpful to consider trauma or neglect in your past—PDT can be a way to explore possible connections.

“If your father always put you down, and find yourself getting into romantic relationships with critical men, that is a repetition compulsion,” explains Dr. McGee.

“Getting back to painful early childhood experiences and then seeing how we enact those painful relational dynamics in our everyday life can be insightful.”

Regardless of the therapeutic approach, Dr. McGee says the work of therapy is to watch the workings of the mind.

In CBT the emphasis is on the way a person’s thoughts shape their feelings and actions—a way to learn new patterns instead of trying to figure out why dysfunctional patterns are there in the first place.

CBT is a more here-and-now, problem-solving approach to behavioral change. In PDT, the idea is that insight will be enough to see the patterns. By making the unconscious conscious, we are no longer as controlled by it,” he says.

How Does Psychodynamic Therapy Work?

The terms “psychoanalysis” and “psychodynamic therapy” are often used interchangeably, says Bryan Bruno, MD, a psychiatrist at Lenox Hill Hospital in New York City. “But psychoanalysis is actually a subset of psychodynamic therapy, which grew the theories practiced by Freud at the turn of the last century,” he explains.

“[PDT] is really for people who want to find greater meaning in their lives, improve self-awareness, and explore and understand the influence of the past on present behavior and emotions,” Dr. Bruno says.

The aim is to explore distressing thoughts and feelings and consider how the past can inform the present.

PDT can tap into dreams, fears, and desires as a source of information about how you view yourself and others and to help you make sense of problematic experiences.

It focuses on recognizing and then addressing defense mechanisms. “These defense mechanisms are the reactions and behaviors that a patient uses to avoid distressing thoughts and feelings,” Dr. Bruno says.

When targeted on specific problems, PDT can sometimes be a faster approach to working through them but this approach needs to be mutually agreed to at the start by you and your therapist.  Traditional psychoanalysis tends to go on for longer periods and be quite intensive typically involving one or more hour-long sessions per week.

In addition to depression and anxiety, PDT can be used to treat attention deficit hyperactivity disorder (ADHD) and phobias such as agoraphobia, explains Adella Nikitiades, PhD, a clinical psychologist for the Montefiore Health System, a healthcare network of healthcare providers and a system of 11 hospitals based in New York state. “PTD for children with ADHD can be focused on the child’s ability to self-regulate, recognize his own feelings, thoughts, and emotions, and gain a coherent sense of self, Dr. Nikitiades explains. “A session with Thomas, 6-year-old boy with ADHD, for example, would include, but not be limited to, the therapist joining the child’s play and providing external structure: ‘When Thomas moved from object to object without any ability to focus or persist on any single toy, the therapist joins the play and asks questions such as: What does the bunny want to do? What is he carrying in his bag?’ ”

Having a central focus (the inability to self regulate or having a fear of elevators, for example) can help tease out the most important issues which inform the structure of each session and helps identify treatment goals.1,2 “Psychodynamic therapy is known for its focus on the patient-therapist relationship and also on the patient’s relationship to the external world and to her life,” Dr. Fornari says.

Is Psychodynamic Therapy Effective?

In a 2015 review of outcome and effectiveness studies of PDT for the major categories of mental disorders published in the journal World Psychiatry, researchers found that PDT is an effective treatment for depression, some forms of anxiety, eating disorders and somatic problems (i.e. irritable bowel syndrome, abdominal pain, and bowel dysfunction)3 but there is little evidence to support it for treating post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), bulimia nervosa, cocaine dependence or psychosis.

Dr. Nikitiades emphasizes that PDT is very good at increasing insight into how you function in different contexts of your life. “PDT can help you learn to understand yourself better,” she says, “and when you understand yourself better, you can start to make changes in your life that bring you closer to the life you wish to live.”

To illustrate how PTD works in real life, Dr. McGee shares an anecdote about a friend raised by a mother who suffered from bouts of depression and later married a mentally-ill woman. “My friend learned to see the world through depressive lenses because of his mother’s mental illness. Dynamically, his desire to love his wife was a way to act his desire to heal his mother.”

If you are interested in using PDT as a path to personal growth and behavior changes, Dr. McGee suggests interviewing therapists on their approach. “Ask them if they explore past early relationships and do dream work,” Dr. McGee says but cautions against relying solely on a PDT practitioner.

  “Good therapy is almost always eclectic. A combination. A synthesis of approaches. I would avoid personally a therapist who was only psychodynamically-oriented. Insight can only take us so far.

Then there is the hard work of changing lifelong habits and developing new relational and other life skills.”


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