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The process of psychodynamic psychotherapy


Psychodynamic Psychotherapy – Foundations of Understanding the Approach

Psychodynamic psychotherapy is a therapeutic approach that focuses on exploring unconscious processes and their impact on a patient’s life. It is based on understanding the psychological factors that shape personality and influence an individual’s emotions, thoughts, and behaviors. The therapist and patient delve into internal conflicts, desires, traumas, and interpersonal relationships to uncover the root causes of psychological issues. This therapy aims to bring about lasting changes in the patient’s functioning and personality, not just symptom relief.

Psychodynamic psychotherapy assumes that early childhood experiences influence one’s psyche and how they cope with difficulties in adult life. The therapist plays an active role in creating a safe space where the patient explores their inner world. Listening, analyzing statements, interpreting unconscious content, and examining transference are utilized. This therapy is long-term and can last for several years. Its goal is to transform deeply ingrained patterns of thinking, feeling, and behaving, leading to lasting change and personal growth.

Each patient has a specific reason that causes their suffering and motivates them to seek treatment. A thorough diagnosis of the patient’s pathology is conducted, followed by the proposal of an appropriate therapy. Psychotherapy sessions may occur once, twice, or three times a week for many years.

How does change occur?


We can distinguish two main mechanisms of change. The first one involves listening to the patient during therapy sessions, analyzing their feelings, fantasies, and associations, and engaging in dialogue. In this process, the patient discovers self-knowledge they didn’t have before and gains insight. The task of the psychotherapist is to reveal, name, and communicate to the patient information about their unconscious motives, which are the foundation of their suffering.

In long-term therapy, patients with deep personality disorders experience the second mechanism of change, which resembles the process of child development. By meeting with the therapist for many years, they establish a lasting relationship. In this relationship, the patient unconsciously adopts certain personality traits of the therapist, resulting in change that may initially appear subtle. A similar process to childhood development occurs when the patient imitates and integrates elements of the therapist’s personality.

An essential element of psychotherapeutic work, which initially posed a challenge in therapy for Freud, is the transference of the patient’s feelings onto the therapist. It is now an indispensable part of the psychotherapy process. Without a strong bond and mutual commitment from both parties, without emotionally responding to the patient’s deep and frustrating childhood needs, it is difficult to achieve lasting personality changes. In the final stage of the process, there is a gradual loosening of this bond.

In this relationship, various feelings arise, ranging from despair, rebellion, fear, and shame to anger, resentment, and positive emotions. The therapist’s task is to create a psychologically safe environment in which these emotions can be expressed. As a result, defensive psychological mechanisms are loosened, and the patient has the opportunity to uncover forgotten anxiety-provoking experiences or childhood fantasies. Through re-experiencing these emotions towards the world and oneself in the presence of the therapist, the patient can distinguish fantasy from reality, understand subconscious mechanisms, and reduce tension and symptoms.

It is also important to view the therapeutic relationship as an alliance, assuming collaboration between two individuals for a certain period and with a specific goal. Patient engagement in the healing process and overcoming resistance are essential conditions for therapy. In the case of severe disorders, strong patient motivation often leads to better therapy outcomes than in milder disorders and passive patient resistance.

Finally, the technique of analysis leads to real changes in life through alterations in internal behavioral mechanisms. This includes giving up unrealistic demands, irreversible deficits, and grandiose internal illusions that have been a source of the patient’s suffering for years.

Summary of the method.

Psychodynamic psychotherapy is about conversation and understanding the patient. In-depth comprehension of subconscious mechanisms is crucial before undertaking therapeutic interventions based on dialogue that unfolds during sessions. Interventions can take various forms, ranging from expressive techniques (clarification, confrontation, interpretation) to supportive approaches (expressing judgments about reality, sometimes psychoeducation).

Psychodynamic psychotherapytakes place in a safe and trusted environment that allows the patient to explore their emotions, thoughts, and experiences without censorship. The therapist serves as a guide, enabling the patient to understand themselves and make positive changes in their life.

mgr Michał Kozaczuk
mgr Michał Kozaczuk jest psychologiem i dyplomowanym psychoterapeutą Czytaj więcej

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