Introduction
Definition of Psychodynamic Psychotherapy
The psychodynamic approach purely aims at the production of a deeper knowledge about an individual’s feelings, as well as other psychological processes [1]. It helps people to take a deep look into the workings of their minds and feelings as well [1]. Thus they can bring changes or improvements to their lives by learning their potential to a greater extent [1]. This way of therapy also works to help people determine the unconscious motivations that are the evident cause often of the person’s behavior patterns which again include his thoughts and thus feelings [1].
Overview of Personality Disorders
Among mental health conditions, personality disorders are those that are characterized by the long-lasting and pervasive pattern of a person’s way of thinking, processing information, interactions, and relationships that cause significant emotional distress and disruption of one’s social functioning [2]. The nature of such disorders can often be worrisome even in clinical practice, and they often make the treatment of axis I disorder difficult [3].
Importance of Psychodynamic Approach in Treating Personality Disorders
According to psychodynamic psychotherapy, personality disorders are powerful to treat [4]. A type of psychotherapy called psychodynamics allows people to better understand themselves in terms of thoughts, feelings, and the conflicts that hold them back thus, leading them to better behavior [1]. Concerning the approach the therapy also helps people to fully understand some of the unexpressed factors that often limit the thinking process, emotional aspect, and actions [1].
Understanding Personality Disorders
Definition and Classification of Personality Disorders
Personality disorders are a group of mental health conditions that characterize a person by instability, persistent, and disturbed patterns of thinking, habitation, mood, and relating to others [5]. The current Diagnostic and Statistical Manual of Mental Disorder (DSM-5) classifies 10 personality disorders into three major clusters (categories). The common symptoms in every cluster which we have studied are different [5].
Common Traits and Symptoms of Personality Disorders
The main manifestations of the personality disorder can be such as odd or unstable behavior, distrust and suspicion, taking risks, sharp and uncontrolled mood swings, problematic relationships, and problems at school and work, people who are prone to the need for instant emotional gratification [6].
The Psychodynamic Perspective
Historical Background and Development of Psychodynamic Theory
This aspect of the psychodynamic model is generally linked to Sigmund Freud who was influenced by his adviser who was Professor of Anatomy Ernst Wilhelm von Brucke [7]. Freud propounded the theory and it was later significantly elucidated by other scholars such as his daughter Anna Freud, Carl Jung, Alfred Adler, and others [1]. The consequence (of this) was the psychodynamic representation that is being used today [7].
Key Concepts in Psychodynamic Psychotherapy
Psychodynamic therapy does this by eliminating the floodgates and allowing people to express their feelings while at the same time helping to understand themselves better [8]. It depends on the personal interactions between the therapist and client to bring out the content of unconsciousness which is deeper than the person’s knowledge, like fears, and wishes but also the inner conflict with which the person consciously is not sure [8]. Psychodynamic therapy’s key principles are related to focusing on the effect level and catharsis on emotions, exploration of fleas from distressing thoughts and feelings, identifying the circles and hooks, and discussing past experiences, and beliefs [9].
Application of Psychodynamic Principles to Personality Disorders
Along with psychodynamic therapy proven effective in treating personality disorders, it also emerged as a promising treatment for mood disorders, depression, and anxiety [10]. Firstly, it tackles the basic and establishing factors of psychology, eliminating the symptoms and improving people’s states of mind. Psychodynamic modality holds the therapeutic relationship as fundamental which illustrates how an individual feels when relating to their friends and loved ones [9].
Efficacy of Psychodynamic Psychotherapy
Research Evidence Supporting the Effectiveness of Psychodynamic Therapy
It is certainly worth mentioning that there is a satisfying body of empirical evidence from well-designed controlled outcome research supporting the effectiveness of psychodynamic psychotherapy [11]. According to research, psychodynamic therapies are especially helpful for people with depression, anxiety, personality, somatization, or any other similar disorders [12].
Comparison with Other Therapeutic Approaches
Psychodynamic therapy concentrates on uncovering the past to reform the present, while some contemporary therapies concentrate more on the present moment with no concern about the past getting sometimes noticed right away [13]. Say, for instance, cognitive-behavioral therapy (CBT) is based on shifting the ways you think or act, so that lessens the depressive mood [13]. Humanistic therapy brings out people’s capacity to make conscious decisions and it is affirmed that they can achieve their capabilities to the maximum extent [14].
Techniques and Interventions
Exploration of Unconscious Conflicts
Psychodynamic therapy implies that a person should be aware of their emotional processes and the issues they face [15]. Along with that, psychotherapists assist people in dealing with their not-so-evident issues, such as suppressed memories, quarrels that are not settled, and unconscious desires that have an impact on the present equation of a person [16]. This investigation might even bring to the surface personal conflicts that have not been dealt with, negative feelings, and deeply rooted convictions which could be at the roots of their depression [17].
Transference and Countertransference Dynamics
Transference in therapy is the unintentional transfer of a client’s feelings about a SOL [18]. The therapist’s countertransference could be similar but follow the responses, and personal reactions generated by the therapist towards the client [5]. However, if not treated promptly, such issues could be the cause for an unhealthy distance between a patient and a therapist, and thus, generate more harmful effects [19].
Interpretation and Insight-Oriented Techniques
These are attempts by the therapist to connect what is available in consciousness (or preconsciousness) and conscious thought and behavior (i.e., symptoms), with the regulatory functions of the self and the inner objects (which have originated from the unconscious materials) [20]. Insight-oriented therapeutic intervention is a remarkable technique that allows patients to pinpoint such moments in their past that could influence their present behavior and the way they think about themselves and other people [15]. Getting an insight into this makes them see patterns and behaviors that are dangerous or disadvantageous for them and they can change afterward, and this boosts their performance [15].
Challenges and Limitations
Resistance to the Psychodynamic Approach
Resistance, in essence, is the defense in which the unconscious institutes come to life as the client moves from the unconscious to the primary process level [22]. The level of this denial is the rejection of the desires arising from a conflict-free underlying sense of self [22]. Concerning the rise of neurobiological research in psychiatry, there are several arising problems in clinical psychiatry, but nothing has been done to do this thing [23]. “Treatment resistance” is, among others, the phenomenon that is gaining wider attention among health professionals. However, the sources of good support for the psychodynamic foundations fell as the financial and academic opposition to this concept got harder [23]. Insightfully, psychodynamic theories, revealed in psychodynamic therapy (PDT), may create strategies, not seen before, that could be used in the treatment of treatment resistance [23].
Time and Resource Intensiveness
Psychodynamic therapy by definition is time and resource-intensive. In a very short amount of time, because of its goal-based character, it might last around 25 sessions [24]. Long-term psychodynamic therapy may be for the whole duration of about two years or longer. This therapy is an intensive one in the sense that it removes the hiding places where emotions can retreat, and then forces the clients to face these emotions to the maximum extent within the shortest amount of time [25].
Suitability for Different Personality Disorder Subtypes
Psychodynamic therapy went through a modification to treat the particular difficulties related to personality disorder [26]. Evidence for its effectiveness is rapidly growing, with most studies chanting the word and applying it to treat borderline personality disorder (BPD) [26]. Nevertheless, the literature review was not inclusive enough to ensure consistency from meta-analysis, and the earliest studies the authors were able to include in the review were only 14 psychodynamic studies and 11 CBT studies [26]. The disparity in effect sizes is also not comparable as the studies are different in the way the therapy content is written, and the number of variables that cannot be measured is also different in the same group [26].
Future Directions
Integration of Psychodynamic Principles with Other Therapeutic Modalities
Interest in psychodynamic therapy as one psychodynamic therapeutic modality integration with other modalities [27],[28],[29] is growing now. Firstly, psychodynamic and emotion-focused therapies develop through the efforts of psychologists supported by increasing affective and neurophysiological research. One of the main ideas of this approach is that by modernizing the psychodynamic concepts they can be generalized and integrated into various other methodologies (psychodynamic concepts could be made more applicable across the board if redone taking into account recent advances in affective science and neuroscience [27].
Advancements in Research and Practice
Due to the outstanding work of a trio of distinguished research clinicians and experts in neuroscience and psychotherapy [30],[31], outstanding scientific developments have recently been made. The growing importance of continuous research related to psychodynamic psychotherapy has settled in the last few years in multiple ways. The most common sources are internal and external [31]. Through the case volume, we disprove once again the ungrounded and unwarranted assertions of the opponents against this type of psychological approach [31].
Conclusion
Recap of the Importance of Psychodynamic Psychotherapy in Treating Personality Disorders
Psychodynamic psychotherapy has been altered to take into account the peculiarities of illness which is often connected with personality disorder, and randomized controlled studies have given a higher indication of its effectiveness, particularly in the treatment of (BPD) [32],[33],[34],[35]. A psychodynamic therapist helps people to decrypt the thoughts, feelings, and conflicts that lie behind the actions they engage in more clearly [34]. Consequently, such a cognitive-behavioral approach to psychotherapy, helps people better to understand some unconscious motives that sometimes act as reasons behind their thinking, feeling, or acting [34].
Hope for Continued Improvement and Innovation in the Field
The prospect of the role of psychodynamic therapy in the future seems promising because of how psychology distinguishes the processes that cause personality and behavior changes. The horizon of the advancement for the sector with safety improvements remains wide [40],[41],[42],[43]. For example, it has been noticed by determinations that children who were in psychodynamic treatment continued to have this improvement not only after the end of the therapy but also two years later so these children were more likely to be in non-clinical rank on measures of global functioning [40].
References:
(1) Psychodynamic Therapy: Definition, Uses, Effectiveness – Verywell Mind. https://www.verywellmind.com/psychodynamic-therapy-definition-uses-effectiveness-5094933.
(2) Overview of Personality Disorders – Psychiatric Disorders – MSD Manual …. https://www.msdmanuals.com/professional/psychiatric-disorders/personality-disorders/overview-of-personality-disorders.
(3) Psychodynamic Approaches to Personality Disorders. https://focus.psychiatryonline.org/doi/epdf/10.1176/foc.3.3.363.
(4) Psychodynamic Psychotherapy for Personality Disorders – Psychiatric Times. https://www.psychiatrictimes.com/view/psychodynamic-psychotherapy-personality-disorders.
(5) Personality Disorders: Types, Causes, Symptoms & Treatment. https://my.clevelandclinic.org/health/diseases/9636-personality-disorders-overview.
(6) Personality disorders: an overview | healthdirect. https://www.healthdirect.gov.au/personality-disorders.
(7) History And Principles Of The Psychodynamic Therapy Model. https://www.betterhelp.com/advice/behavior/history-and-principles-of-the-psychodynamic-model/
(8) Psychodynamic Therapy: Core Concepts & What to Expect. https://www.choosingtherapy.com/psychodynamic-therapy/.
(9) Core Principles of Psychodynamic Therapy Approach. https://www.goodtherapy.org/learn-about-therapy/types/psychodynamic.
(10) Psychodynamic Therapy | Psychology Today. https://www.psychologytoday.com/us/therapy-types/psychodynamic-therapy.
(11) Psychodynamic psychotherapy: developing the evidence base. https://www.cambridge.org/core/journals/advances-in-psychiatric-treatment/article/psychodynamic-psychotherapy-developing-the-evidence-base/FDFB93596F9E502277720F9F4F55563A.
(12) Accumulating Evidence for the Effectiveness of Psychodynamic Therapy. https://www.madinamerica.com/2023/10/accumulating-evidence-for-the-effectiveness-of-psychodynamic-therapy/.
(13) Examples of Psychodynamic Therapy to Treat Depression – Verywell Mind. https://www.verywellmind.com/psychodynamic-therapy-for-depression-5085728.
(14) Different approaches to psychotherapy. https://www.apa.org/topics/psychotherapy/approaches.
(15) Insight-Oriented Therapy: Effectiveness and How It Works – Verywell Mind. https://www.verywellmind.com/what-is-insight-oriented-therapy-5211137.
(16) Unveiling the Unconscious: Psychodynamic Perspectives in Therapy. https://theinternationalpsychologyclinic.com/unveiling-the-unconscious-psychodynamic-perspectives-in-therapy/.
(17) Unveiling the Unconscious: Applying Psychodynamic Therapy for …. https://quenza.com/blog/knowledge-base/psychodynamic-therapy-for-depression/.
(18) Transference vs Countertransference in Therapy: 6 Examples. https://positivepsychology.com/countertransference-and-transference/.
(19) Transference & Countertransference: What Is the Difference? https://www.choosingtherapy.com/transference-and-countertransference/.
(20) The Process of Interpretation | Psychodynamic Therapy Techniques: A …. https://academic.oup.com/book/1329/chapter/140309370.
(21) Psychodynamic Psychotherapy for Personality Disorders – Psychiatric Times. https://www.psychiatrictimes.com/view/psychodynamic-psychotherapy-personality-disorders.
(22) Resistance (psychoanalysis) – Wikipedia. https://en.wikipedia.org/wiki/Resistance_%28psychoanalysis%29.
(23) A Psychodynamic Approach to Treatment Resistance. https://link.springer.com/chapter/10.1007/978-981-10-4358-1_20.
(24) Core Principles of Psychodynamic Therapy Approach. https://www.goodtherapy.org/learn-about-therapy/types/psychodynamic.
(25) Intensive Short–Term Dynamic Psychotherapy. https://www.goodtherapy.org/learn-about-therapy/types/intensive-short-term-dynamic-psychotherapy.
(26) Psychodynamic Psychotherapy for Personality Disorders – Psychiatric Times. https://www.psychiatrictimes.com/view/psychodynamic-psychotherapy-personality-disorders.
(27) Promoting the Integration of Psychodynamic and Emotion … – Springer. https://link.springer.com/article/10.1007/s10615-020-00759-8.
(28) Psychodynamic psychotherapy: developing the evidence base. https://www.cambridge.org/core/services/aop-cambridge-core/content/view/FDFB93596F9E502277720F9F4F55563A/S1355514600011755a.pdf/psychodynamic-psychotherapy-developing-the-evidence-base.pdf.
(29) Integrating Psychodynamic Approaches with CBT Improves Therapy. https://www.madinamerica.com/2020/05/integrating-psychodynamic-approaches-cbt-improves-therapy-outcomes/.
(30) Psychodynamic Psychotherapy Research: Evidence-Based Practice and …. https://link.springer.com/book/10.1007/978-1-60761-792-1.
(31) Psychodynamic psychotherapy research: Evidence-based practice and …. https://psycnet.apa.org/record/2012-02457-000.
(32) Psychodynamic Psychotherapy for Personality Disorders – Psychiatric Times. https://www.psychiatrictimes.com/view/psychodynamic-psychotherapy-personality-disorders.
(33) Psychodynamic Psychotherapy for Personality Disorders: A Clinical Handbook. https://www.psychiatrist.com/wp-content/uploads/2021/02/16537_psychodynamic-psychotherapy-personality-disorders.pdf.
(34) Psychodynamic Therapy: Definition, Uses, Effectiveness – Verywell Mind. https://www.verywellmind.com/psychodynamic-therapy-definition-uses-effectiveness-5094933.
(35) Psychodynamic Therapy: Uses, Benefits, Effectiveness – Verywell Health. https://www.verywellhealth.com/psychodynamic-therapy-5218902.
(36) The future of psychodynamic psychotherapy. – APA PsycNet. https://psycnet.apa.org/record/1992-24313-001.
(37) Psychoanalytic and psychodynamic therapies for depression: the evidence …. https://www.cambridge.org/core/journals/advances-in-psychiatric-treatment/article/psychoanalytic-and-psychodynamic-therapies-for-depression-the-evidence-base/03EC8C9F5C9BAE16B47FC73942FBDA18.
(38) Psychodynamic Psychotherapy: A Clinical Manual – Wiley Online Library. https://onlinelibrary.wiley.com/doi/pdf/10.1002/9781119142010.fmatter.
(39) 3 Goals of Psychodynamic Therapy – Oxford Academic. https://academic.oup.com/book/1329/chapter/140302911.
(40) Frontiers | The Evidence-Base for Psychodynamic Psychotherapy With …. https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2021.662671/full.
