The Evolution of the Psychodynamic Approach
The psychodynamic approach has undergone a profound evolution from its classical Freudian origins, shifting its theoretical focus and expanding its understanding of human psychology and therapeutic intervention. This evolution can be understood as a movement towards a more relational model and a broader conceptualization of psychological distress and healing
.
How Did Psychodynamic Therapy Evolve?
1. Shift to a More Relational Focus:
◦ Initially, classical Freudian psychoanalysis was considered a "one-person psychology," primarily focused on the individual's internal conflicts arising from drives
.
◦ This evolved into a "two-person psychology" and a progressively relational model, with a predominant focus on mother-child bonds
. This relational aspect also extended to include later interpersonal relations at later stages of the life cycle, as well as work, societal, cultural, and political influences
.
◦ Psychodynamic therapy became more relational, while still referring to the id, ego, and superego
. The interaction between therapist and client is now viewed as a co-created event
.
2. Evolution of Psychoanalysis – From Classical Drive Theory to Pre-Oedipal Period and Attachment Experiences:
◦ The major shift was a greater trend towards relations and ego functioning rather than just drives/unconscious functioning
.
◦ The focus moved from classical drive theory, which emphasized inherent sexual and aggressive impulses, to the pre-oedipal period, particularly the first year of life and the early attachment experiences between mother and child
.
◦ This shift recognizes that psychological disturbances are often a result of deficits in the mental elements necessary for healthy development, stemming from a lack of certain elements in these crucial early relationships, rather than just internal conflicts
.
3. Greater Emphasis on Defense Mechanisms:
◦ Freud's initial focus was primarily on repression as the main defense mechanism producing neurosis
.
◦ The approach evolved to place more importance on a wider range of defense mechanisms
.
◦ Anna Freud (1936), a key figure in Ego Psychology, significantly expanded on this, refocusing descriptive theory on defenses and bringing them into line with the tripartite structural theory
.
◦ Defenses were later classified from immature/pathological to mature/healthy, with the understanding that the more immature defenses used, the greater the psychological disturbances
.
4. Rejection of the Death Instinct and Reconceptualization of Aggression:
◦ The death instinct concept (Thanatos), which Freud linked to repetition compulsion and innate aggression, was rejected by contemporary Freudians
.
◦ Instead, aggression came to be seen as a defensive response to threats to the psychological self, particularly those arising in early mother-infant relationships, rather than an innate impulse
.
5. Influence of Object Relations and Self Psychology:
◦ Influenced by figures like Winnicott, Bion (1962), and Bowlby, psychoanalysis highlighted the role of sensitive, empathic caregiving and the impact of deficits in healthy development
.
◦ This led to a shift from a psychology of conflict to one of deficit, where patients are seen as "devoid of objects" or experiencing "psychological deprivation"
.
6. Shift from Drives to Feelings:
◦ The focus moved from innate drives to feelings, emphasizing their regulation
.
◦ Repetition compulsion became understood as a primary motivational element for regulating feelings to maintain a sense of safety, even if the relationships or situations are distressing or abusive (e.g., familiar pain feeling "safer")
.
7. Three Waves of Psychodynamic Psychotherapy:
◦ The evolution is often summarized in three waves, each building on the previous one and becoming more relational
.
▪ First Wave – Classical Freudian Psychoanalysis: Great focus on drives and unconscious functioning; psychological disturbance as a result of conflicts between instincts and defenses
.
▪ Second Wave – Ego Psychology: Associated with Anna Freud, Hartmann, Rapaport, and Kernberg, considering the level of ego functioning and focusing on the ego's struggles with id, superego, and reality
.
▪ Third Wave – British Schools, Object Relations Theory, and Self Psychology: Including Melanie Klein, Fairbairn (1952), Bion (1962), Winnicott, Mahler, and Kohut. This wave marked a shift from a psychology of conflict to one of deficit, focusing on early relations that leave a lasting impact on how one sees oneself and others
.
General View of the Individual
• Classical Freudian View (First Wave): Individuals are not in control of their conscious mind but are largely driven by unconscious sexual and aggressive impulses seeking gratification
. Behavior is fully deterministic, shaped by childhood experiences and innate drives. The individual is a complex of temperament shaped by early experiences
.
• Contemporary Freudian View: While acknowledging unconscious processes, there is a greater consideration of the environment in which the child is raised
. Aggression is seen as a defensive response, not an innate impulse
.
Generalised Conceptualisation of the Individual
Psychodynamic approaches generally share several core tenets:
1. Unconscious Mental Activity: The notion that parts of our minds are inaccessible to us, and mental processes occur outside of conscious awareness. This is referred to as the dynamic unconscious
.
2. Psychic Determination: The belief that actions are determined by unconscious forces beyond our comprehension. These motivations are shaped by childhood experiences and innate drives. Single behaviors are multi-determined, meaning they are complex and may have multiple meanings and functions
.
3. Conflict Between Different Parts of the Psyche: Psychological distress often arises from conflicts between different internal structures (e.g., id, ego, superego)
.
4. Sexuality & Aggression as Primary Drivers (Classical): In Freud's original drive theory, Eros (sexual/libidinal) and Thanatos (aggressive/destructive) were considered the primary drivers
. However, as noted, contemporary Freudians largely reject the death instinct and view aggression as a defense
.
5. Role of Childhood Experiences: Childhood experiences are critical in shaping the individual and adult personality
. With the advent of attachment theories, the emphasis on the first year of life and attachment with caregivers (pre-oedipal period) has significantly increased. The role of attachment experiences in later childhood and adolescence with peers and teachers has also gained importance
.
Freud's Topographical Model of the Mind
Freud's topographical model divides the mind into three levels
:
1. Conscious: Thoughts, feelings, and memories that we are currently aware of
.
2. Pre-conscious: Mental activity that is not currently in awareness but can be readily brought to consciousness through attention
.
3. Unconscious: Mental occurrences, impulses, wishes, and feelings that are kept out of conscious awareness through repression. These unconscious forces significantly influence behavior without the individual's direct knowledge
.
Psychic Determination
• This core principle states that all our conscious actions and choices are ultimately controlled by unconscious motivations
.
• These motivations are fundamentally shaped by childhood experiences and innate drives
.
• Furthermore, any single behavior is considered multi-determined, meaning it is complex and can serve multiple functions or have various underlying meanings in response to both external reality and internal unconscious needs
.
Neurosis
• In classical Freudian theory, neurosis was primarily seen as the result of unconscious conflict between the different psychological structures in the psyche
.
• This conflict could occur between:
◦ Ego and Id: When unacceptable pleasure-seeking (sexual) and aggressive urges from the id, originating in early childhood, try to break through the ego's censorship barrier into conscious awareness
. This triggers defense mechanisms on the part of the ego to limit psychic tension and allow some gratification, often converting impulses into compromise formations (e.g., phobic, obsessional, hysterical symptoms)
.
◦ Ego and Superego: Leading to feelings of low self-esteem, shame, and guilt due to the ego's failure to live up to the high moral standards imposed by the superego
.
• Neurosis can also arise from conflict between instinctual drives and the outside world
. Freud believed all individuals are more or less neurotic, but some cannot relinquish anxieties and defensive responses from their past, leading to symptomatic neurosis
.
Drive Theory
• Freud's drive theory posited that human behavior is primarily motivated by two fundamental instincts or drives
:
1. Eros (Life Instinct): This encompasses sexual/libidinal instincts, driving desires for connection, survival, and pleasure
.
2. Thanatos (Death Instinct): This aggressive/destructive instinct, according to Freud, explains phenomena like repetition compulsion – the tendency to repeat painful or self-destructive behaviors
.
• As discussed, contemporary Freudians largely reject the death instinct concept, viewing aggression instead as a defensive response rather than an innate destructive impulse
. The motivation for repetition compulsion is reinterpreted as the regulation of feelings to maintain a sense of safety, even in distressing situations
.
The Role of Childhood Experiences in Shaping the Individual
• A cornerstone of the psychodynamic approach is the belief that childhood experiences are critical in shaping the adult personality
. Personality is seen as a complex of temperament significantly influenced by early life
.
• In classical psychoanalysis, the psychosexual stages (oral, anal, phallic, latent, genital) were paramount, with failure to successfully navigate these stages (especially the Oedipal phase at 3-5 years) believed to cause pathological character traits and predispose to neurotic illness in later life
.
• With the emergence of attachment theories (Bowlby, Winnicott, Bion), the emphasis significantly increased on the first year of life and the early attachment experiences with primary caregivers (the pre-oedipal period)
. These early relationships are seen as the fundamental basis for adult deficits
.
• The influence of childhood experiences also expanded to include attachment experiences in later childhood and adolescence with peers, teachers, and other significant figures
.
Attachment Theories
Attachment theories, primarily influenced by Bowlby, Winnicott, and Bion, fundamentally reshaped the psychodynamic understanding of development and pathology
.
• Core Idea: The quality of the relationship between the mother/primary caregiver and the child is seen as the fundamental basis for all deficits in adulthood
. Psychological disturbances result from deficits in the mental elements necessary for healthy development, specifically a lack of sensitive and empathic caregiving in these early relationships
.
• Donald Winnicott:
◦ The Good Enough Mother: A mother who can meet the infant's needs in the earliest stages and can withstand the infant's projective identifications
.
◦ Holding Environment: A supportive, reliable environment where the child can be themselves, make mistakes, and transition to autonomy. Failure to provide this can lead to a false sense of self
.
◦ Mirroring: The mother reflects and interacts with the child, allowing the child to see themselves in the mother's face and integrate these interactions, forming a sense of self
. If the "gleam in the mother's eye" is absent, grandiosity is repressed
.
◦ Transitional Object: A comfort item (e.g., blanket) that helps the infant tolerate the reality of separation from the mother
.
• Wilfred Bion (1962):
◦ Projective Identification (extended from Klein): Bion saw this as playing a normal role in the mother-baby dynamic. The infant uses it to make reality bearable by depositing primitive emotional states (beta elements) onto the mother
.
◦ Maternal Reverie: The mother's capacity to receive, contain, and transform the infant's "beta elements" (primitive emotional states) into "alpha elements" (things that can be thought about and processed). This "container-contained" function allows the child to develop the capacity to understand and withstand their own inner world
. The therapist takes on this container role
.
• John Bowlby: Although not detailed in the given sources, Bowlby's attachment theory is a foundational influence, explicitly mentioned as a contributor to the shift towards focusing on early attachment experiences
.
Transference
• Freud's Discovery (1905): Freud noted the emergence of past unconscious psychological experiences being applied to the physician in the moment
. He coined transference as the unconscious displacement by the patient onto the analyst of "new editions" of old feelings and fantasies, originally experienced towards significant figures (often parents) in childhood. Transference thus represents a repetition of the past, in accordance with the principle of repetition compulsion
.
• Initial View: Freud initially saw transference as interference or resistance to the process of free association
.
• Later View: He later proposed that transference interpretation was essential for analytic cure
.
• Transference Neurosis: In therapy, a regression occurs where the patient re-enacts their original (infantile) neurosis in the relationship with the therapist, known as transference neurosis
.
• Types of Transference:
◦ Positive Transference: Warm, trusting, and hopeful feelings towards the therapist. Contemporary Freudians see this as a basis for building good therapeutic relationships, but also watch for pathological aspects like idealization (a defense against negative feelings)
.
◦ Negative Transference: Angry, hostile reactions by the patient to the therapist
. The therapist must contain and understand these feelings
.
◦ Erotic Transference: The expression of erotic feelings by the patient towards the therapist
.
• Klein's Perspective (1952): Klein claimed that transference originates in the same processes that determine early object relations (fluctuations between loved and hated, external and internal objects). She emphasized the interconnection between positive and negative transferences through exploring the early interplay of love and hate
.
• Contemporary Freudians: View transference not just as a repetition of the past, but as a new experience infused by both past and present influences
.
Countertransference
• Freud's Initial View (1905): Freud originally saw countertransference – the effect of the client on the unconscious feelings of the psychotherapist – as interference or an obstacle to psychoanalytical work
. He saw it as the therapist's own transference onto the client
.
• Evolution of Understanding:
◦ Heimann (1950): Distinguished reactive countertransference, referring to the therapist's reactions to the client's experiences and preoccupations
.
◦ Melanie Klein's influence (through projective identification) profoundly changed its perception. It came to be seen as beneficial and an informative process into the client's unconscious issues
. Kleinian therapists, for example, use countertransference to determine the client's developmental deficits by analyzing the feelings evoked in them by the client
.
◦ Winnicott: Explored a broader, objective form of countertransference, viewing it as an understandable and normal reaction to the patient's actual personality and behavior
. He used the mother-infant dyad analogy, suggesting therapists must explore and manage their "hatred" (difficult feelings) towards patients. When managed, countertransference can provide a better understanding of the client
.
• Types of Countertransference
:
◦ Proactive: Concerned with the therapist's own past experiences, current preoccupations, hopes, and fears
.
▪ Concordant: Patient evokes feelings in the therapist related to the therapist's own past experiences
.
▪ Complementary: Patient evokes feelings related to the therapist's archaic object representations (e.g., therapist feels burdened by the patient)
.
◦ Reactive: The therapist's reactions to the client's experiences, preoccupations, hopes, and fears
.
▪ Complementary: Therapist experiences the patient as the original object was felt
.
▪ Concordant: Therapist feels as the client felt in dealing with the original object
.
• Management: Therapists manage countertransference through personal therapy, clinical supervision, or both
.
Interpretation-Relationship Debate (Gabbard & Westen, 2003)
• The sources indicate that there has been a waning of the interpretation-relationship debate
.
• This means that the long-standing discussion about whether therapeutic change primarily comes from specific interpretations or from the therapeutic relationship itself has become less pronounced
.
• The field moved in favor of multiple modes of therapeutic action
.
• There was a notable shift from reconstructive interpretations (linking to the distant past) to here-and-now interpretations about the interactions between the therapist and client
.
• This shift is supported by recent research findings about the unreliability of early autobiographical memory, suggesting less emphasis on exact historical reconstruction and more on present relational dynamics
.
Talk Therapy
• Psychodynamic psychotherapy is primarily a talking therapy
.
• The key interventions are the therapist's verbal communications, which can be categorized along a spectrum of interventions that moves from supportive to interpretive as therapy progresses
.
• Talking in therapy is not an end in itself, but rather a channel through which patients' discoveries can be expressed and examined with the therapist
.
Interpretations
Interpretations are a cornerstone of psychodynamic technique, aimed at fostering insight
.
• Definition: Verbal interventions used in psychoanalytic psychotherapy that promote insight by taking the unconscious and making it conscious, offering new meaning and motivation
.
• Process: Therapists typically work from surface to depth, analyzing the patient’s resistances and defenses (e.g., lateness, silences) before interpreting the content of underlying unconscious fantasies
.
• Timeliness: Interpretations must be timely and given when the client is ready for them
.
• Dream Interpretation: Considered "the royal road to the unconscious" by Freud (1905b), it is an important technique for discovering a patient's unconscious fantasy life
. The manifest content (what is remembered) is believed to conceal unconscious latent meaning, revealed by asking the patient for personal associations to dream elements
.
• Types of Interpretation:
1. Genetic/Reconstructive Interpretation: Links the patient’s current thoughts or behavior to their developmental or historical origins, making an explicit link with the past. These have been somewhat neglected in recent years in favor of transference interpretations
.
2. Transference/Here-and-Now Interpretation: Makes explicit reference to the patient-therapist relationship, where the patient’s current feelings and behaviors towards the therapist point to conflicts from the past being re-enacted in the present transference situation
. This aligns with the shift mentioned in the interpretation-relationship debate
.
• Working Through: Freud emphasized the importance of working through, which is the process where patients need sufficient time to make sense of and emotionally integrate interpretations, linking intellectual insight with emotional knowledge, often aided by transference
.
Levels of Functioning
The assessment of a client's level of functioning is crucial in psychodynamic therapy as it determines the therapeutic strategy and interventions
. This often refers to the ego's strength and capacity for self-reflection and reality testing
.
1. Neurotic Level:
◦ Clients functioning at this level (e.g., anxiety, depression without comorbidity of personality disorders) typically have a quite healthy and realistic perception of life and an intact ego
.
◦ The therapist can probe and encourage self-reflection and analysis, and go deeper with interpretations
. They are able to use secondary/mature defense mechanisms like sublimation, humor, and suppression
.
2. Borderline Level (Personality Disorders):
◦ Clients at this level exhibit instability and a disturbed psychological self-organization
. They may lack a strong sense of self (fluctuating between seeing themselves as all good or all bad) and object constancy (difficulty maintaining the internal image of a person when they are out of sight). Their ego is more fragile
.
◦ Therapeutic approach requires care to maintain therapeutic boundaries and limits
.
◦ Focus is on the here-and-now (to avoid regression to the past) and includes present and active engagement (no silence, which can be interpreted as disinterest)
.
◦ Consistent clear limits and a strict therapeutic frame (e.g., same session day/time, no contact outside sessions) are essential to prevent unmanageable regressions and emotional dysregulation
.
◦ They typically use primary, immature defense mechanisms like splitting, projection, idealization, and devaluation
. Reality testing may not always be intact
.
3. Psychotic Level (Reality Testing Broken):
◦ Clients at this level experience a breakdown in reality testing, with no proper self or object representations, making it hard to distinguish where the self ends and the other begins
.
◦ Therapeutic intervention requires great care not to further provoke fragmentation and anxiety
.
◦ The approach is supportive and educative, focusing on paraphrasing and repetition, identifying strengths, and building on them
.
◦ Therapists should not encourage opening up or probing deeper, as this can be unhelpful
. Focus is on adherence to pharmacological treatment and self-care
.
◦ The therapist needs to exhibit an authoritative yet empathic stance to make the patient feel safe and contained, without humiliation
.
Critiques of the Psychodynamic Approach
The psychodynamic stream has faced various criticisms throughout its evolution:
• "Cult-like" and "Narcissism of Small Differences": Freud himself noted the tendency for petty rivalries and dramatics between differing therapists and schools, overshadowing engagement with the outside world
.
• More of an Art/Humanity than a Science: Historically, it has been critiqued for not holding up to scientific or positivistic scrutiny (e.g., Eysenck, 1952), being seen more akin to an ideology or philosophy
.
◦ Counter-arguments: Research tools like the Core Conflictual Relationship Theme (CCRT) (Luborsky & Crits-Christoph, 1990) and the Adult Attachment Interview (AAI) (Main & Goldwyn, 1994) have emerged as scientific and objective measures of transference and attachment, showing that patterns derive from early relationships and can change with therapy
.
• Deterministic View: The classical Freudian model, with its emphasis on unconscious motivations fully determining behavior, was criticized for its inability to explain why some people with negative predisposing factors are still able to change and become healthy
. This suggests change is more complex and multifaceted
.
• Unreliability of Early Autobiographical Memory: The waning of the interpretation-relationship debate and the shift to here-and-now interpretations were partly supported by findings on the unreliability of early autobiographical memory, challenging the accuracy of deep historical reconstruction
.
• Cost and Intensity: Psychodynamic psychotherapy, especially long-term treatment, can be an emotionally and financially demanding process
. The intensity and frequency of sessions can make it inaccessible for many
.
• Limited Suitability: Not suitable for everyone. Patients with brain damage, a long-term history of psychotic breakdown, or heavy dependence on alcohol or drugs to cope are generally not ideal candidates
. It is also not helpful when urgent medical or social intervention is needed or there is an immediate risk of harm. Freud initially saw it suitable for neurotic cases, but "analysability" criteria expanded its application. Suitable patients need sufficient ego strength, willingness to accept help, curiosity about their internal world, and the ability to reflect psychologically.