Psychodynamic Myth Busting!

1. “It’s all about blaming your parents.”

Due to Freud’s fixation on all things Oedipal, I can understand why people (or AI) may think that it’s all about blaming your parents, but the truth is that therapy isn’t really about blaming anyone. Yes, psychodynamic therapy focuses on the past but with the aim of understanding how it has impacted your present. It is not a case of sitting there and asking you to list everything your parents have done right or wrong but understanding that the world is a complex place and we are all individuals born into contexts we have to make sense of to survive. That includes your parents.

When clients come to me, I try to understand why it is they want to come to therapy now, but also how that early context may have shaped them into the person they are with the difficulties they currently have. Too often we create ways to survive as children that no longer help us. Perhaps as a child, a parent left. Now the therapy isn’t about blaming that parent – although accessing some of the anger and hurt towards them may be part of it – but it’s about bringing into the conscious mind that perhaps you now expect everyone to leave and so feel you constantly have to accommodate everyone else’s needs whilst repressing your own. By understanding it, you have the ability to take control of it, to try something new. No parental blame needed.

2. “It’s just lying on a couch talking about dreams.”

In November 1899, Freud published a groundbreaking book named ‘The Interpretation of Dreams’. If you have some free time and enjoy rambling through dense literature, I’d definitely recommend it! To save you a bit of time, Freud suggested that dreams could be used to access the unconscious mind, a part of ourselves we carry with us each day without understanding how it impacts us. Using my previous example of the abandoned child, the client may come with the presenting problem that they keep finding themselves in situations where they have agreed to things they wish they hadn’t. Lurking in their unconscious is the fear of abandonment and a belief that they must be unlovable in some way for their parent to have left them. Our work would be to bring that into their conscious mind so they can question it, grapple with how it is impacting their need to say yes to everyone, fearful if they say no they will be rejected and how it is no longer serving them as they grow to resent always saying yes.

Now this may all feel a little tangential, but Freud suggested those really deep-down unconscious thoughts sometimes slip into consciousness in our dreams, albeit it in a distorted way. It’s actually not that far off what scientists now suggest regarding dreams being a way for our brains to process the day’s events.

If a client brings a dream, am I interested? Yes. Do I actively ask them what they have dreamt, ask them to keep dream journals or insist dreams are the only thing we will talk about? No.

Oh, and I don’t have a couch.

3. “It takes years and years to work.”

This is a really good myth to question as there are so many short-term models out there as the NHS and charities looks to offer patients short-term, cost-effective therapies; it makes sense to ask how the psychodynamic approach lines up with this.

There are many ways to skin a cat, and psychodynamic therapy is the same; it all depends on what you are looking for. Personally, I offer open-ended therapy which means, for the most part, the client gets to decide. I am happy to do shorter term work – around three months – just as much as I have enjoyed seeing clients for years.

YEARS?! I hear you cry! Well, yes. Really deep psychodynamic work can take years, but you absolutely don’t need to come for years to see real, meaningful change from it. It just depends on your circumstances and your aims for therapy.

4. “There’s no evidence it works.”

Aha! My favourite myth to bust!

So, in days gone by psychoanalytic theory was all presented through case studies, a somewhat unscientific way to go about introducing a new health care measure by our standards today. Nowadays we are used to heaps of quantitative studies all based in measurable data. But how do you measure mental health? Unsurprisingly your short-term models that deal more with cognition like CBT thrive in this arena as they follow schemas reducing the number of variables therefore making it more appealing to quantitative researchers and they use questionnaires as part of the process: lovely, tangible data! You can imagine that the fluid psychodynamic structure that encourages clients to bring whatever they wish to sessions struggled to achieve the same success.

That has changed, however, with researchers always finding new ways to measure the success of therapy. If you are interested, here are a few research papers that support psychodynamic therapy as an evidence based, effective form of treatment.

• The Efficacy of Psychodynamic Psychotherapy
• Psychodynamic psychotherapy: developing the evidence base
• The effectiveness of psychodynamic psychotherapies: An update

5. “It’s only about the past.”

As I have mentioned, the past plays a part in the work, but it is always in the service of better understanding the present. The focus is always on you now, how you are feeling now, how you are relating to others now. In fact, the present relationship between the therapist and the client can be one of the most informative things to explore as it often reflects how the client relates to others outside the room. Do you automatically see the therapist as holding the power in the relationship? Do you see someone older and immediately experience them as cold and uncaring? Do you see someone younger and think it’s a waste of time as they’re too young to know anything? It’s all part of the work and very much based in the here-and-now.

6. “The therapist just sits there silently.”

Back in the day, the idea was that the client would lie on a couch and the analyst would sit just out of sight, a blank slate for the client to project onto. And in all honesty some psychodynamic/psychoanalytic practitioners nowadays do follow this still. But most of us have evolved along with the theory. In sessions I sit opposite a client, both of us in chairs able to see one another, my rather expressive face and all. We are there to form a relationship so that we can work through your most difficult feelings together, most practitioners realise that to do this, the client needs an authentic human being sat in front of them rather than a blank slate.

Regarding the silence, many people who come to therapy don’t have a space that can be completely theirs to fill as they like. Because the therapy room is all about giving the client that space, the sessions sometimes contain silence. That silence can feel odd at first, but it can also be incredibly meaningful and useful. That being said, if the silence feels punitive, I will reach out, ask a question, give a prompt. The most important thing for me is creating a space that feels safe. If silence doesn’t feel safe, then we’ll work with that!

Once the client begins to talk, it becomes a conversation. I will ask questions because I want to get to know you, clarify things to make sure I understand what you are saying and offer thoughts – never advice or suggestions – on what you bring.

7. “It’s only for ‘deep’ or severe problems.”

Developing a better understanding of yourself can benefit anyone. It can help with complex issues but it’s also great for people with relationship struggles, low mood, anxiety or low self-esteem. We all have an unconscious that sometimes leads us to respond in ways we wish we didn’t; psychodynamic therapy is for everyone!

8. “It ignores practical coping skills.”

It’s true that psychodynamic therapy is not about a ‘quick fix’ (if one exists…). It is not a place for you to come and be given techniques, but that doesn’t mean it’s impractical. Understanding underlying patterns can lead to long lasting change. By better understanding why you behave and feel the way you do, you gain control over how you respond. It doesn’t mean that the abandoned child won’t get a tight chest when they feel someone rejects them, but by understanding it, the adult can take note and choose not to respond by saying ‘yes’ in an attempt to alleviate the discomfort. The adult can choose to say, ‘not this time’, hold the discomfort and perhaps even have an opportunity to see that the person asking responds, ‘that’s absolutely fine, maybe next time.’ No leaving, no rejection, narrative disproved.

Of course, the person may turn around and say ‘how dare you! I’ll never ask again!’ but this adult who understands their own process will be more able to think ‘I feel sad because I feel I have been rejected and now I fear that person may leave. I notice that I now want to go back and say yes but I will then feel angry with myself later. I am going to hold my boundary and if it’s received badly then that is probably about the other person’s unconscious material, a rejection of a part of me doesn’t mean I am all bad or unlovable’. Of course, this is simplified but you get the gist.

In being able to enact this kind of deep-rooted change, one can have more agency over their life and in doing so, psychodynamic therapy often creates benefits that continue long after the therapy finishes (sometimes referred to as a ‘sleeper effect’). We are in the business of helping individuals to learn how to help themselves rather than ‘fixing’ it for them.

9. “It’s outdated Freudian theory.”

Don’t get me wrong, Freud was a pioneer, but we can appreciate now that some of his theories were also hugely problematic. He introduced concepts that were mind bending at the time (even if he did pinch quite a few without any reference to the original authors). Some of the theories he came up with are now part of pop culture language – ‘Oops, Freudian slip!’; ‘I’m repressing it’; ‘It’s just a defence mechanism’; ‘she’s projecting her issues onto you’; ‘I think it’s an unconscious thing’; the list goes on! But just like Darwin, he didn’t get everything right. Some of his theories are outdated, homophobic, sexist and downright bizarre. I am lucky to live in a time where I can be informed by some, discard others and revel in the copious amounts of literature that has been created by theorists since Freud.

Psychodynamic theory has adapted over the years and now includes attachment theory, object relations and relational psychoanalysis. It may have started with Freud, but it is no longer considered an almost religious act of worship to practice as Freud did. The way I practice, and all other psychodynamic practitioners I know, is a far more flexible and evidence-based form than that of Freud’s.