Zihinsel ve duygusal süreçlerimiz, çoğu zaman farkında olmadığımız deneyimlerden, geçmiş yaşantılardan ve ilişki örüntülerinden etkilenir. Bir kişinin bugün yaşadığı kaygı, ilişki güçlükleri veya duygu durum değişiklikleri, çoğunlukla yüzeyde görülenden çok daha derin ve karmaşık bir arka plana sahiptir. Psikodinamik psikoterapi, işte tam bu noktada devreye giren; bilinçdışı süreçleri anlamayı ve kişinin bugünkü yaşamına olan etkilerini fark etmesini amaçlayan köklü bir psikoterapi yaklaşımıdır.
With the intense pace brought by modern life, the complexification of interpersonal relationships, and the increasing need for individuals to understand themselves, interest in therapeutic approaches aiming to gain insight into the past is also steadily growing. This method, which allows a person to discover not only his symptoms but also the meaning underlying these symptoms, is one of the approaches that has been used for many years in the field of mental health and has taken its place in the scientific literature.
In this article, we discuss in detail what this therapy method is, in which situations it can be preferred, how it is applied, and its differences from other therapeutic approaches.
What is Psychodynamic Psychotherapy?
Psychodynamic psychotherapy is a psychotherapy method based on the view that a person's emotions, thoughts, and behaviors are largely influenced by unconscious processes. While this approach draws from the psychoanalytic theory developed by Sigmund Freud, it has evolved over time into a shorter-term, more structured therapy form better suited to contemporary clinical practice.
The basic tenets of this type of therapy can be summarized as follows:
- The view that experiences acquired by a person during childhood can shape relationship and behavioral patterns in adulthood
- The approach that unconscious conflicts may manifest with symptoms such as anxiety, sadness, restlessness, or relationship problems
- The thought that the relationship between the therapist and the client can provide an observation area to understand the person's other relationships
- The goal of not merely eliminating symptoms, but understanding the underlying dynamics
- The potential for the person to make healthier choices in different areas of life as his awareness of his own inner world increases
This approach aims to contribute to the person developing a deeper awareness of himself. In addition, because it focuses on discovering the meaning behind symptoms, it allows for understanding not only "what" is experienced, but also "why." In many situations evaluated within the field of psychiatry, this method can be considered as part of the treatment plan.
What are the Goals of Psychodynamic Psychotherapy?
The purpose of this therapeutic approach is not only to alleviate symptoms, but also to support the person in better understanding his own inner world. As the therapy process progresses, he begins to realize the motivations behind his own emotions and behaviors; this awareness can over time reflect on his daily life choices and relationship styles. Prominent goals can be listed as follows:
- To support the realization of unconscious thoughts and emotions
- To help understand the effect of past experiences on current relationship and behavioral styles
- To provide insight into the source of recurring relationship patterns
- To contribute to the development of emotional regulation skills
- To support the person in coping with his own inner conflicts in a healthier way
- To strengthen the capacity to make more conscious and consistent choices in interpersonal relationships
- To establish a ground of insight that will nurture self-perception and self-esteem
These goals may vary from person to person and according to the progress of the therapy process. The process is planned in an individualized manner accompanied by an expert clinician and can be reshaped over time according to the client's needs.
For some clients, the goals are not yet clear in the initial stages of therapy; this is quite natural. As the process progresses, both the therapist and the client develop a shared understanding of which issues need to be addressed in more depth. This flexible and exploratory structure is one of the unique qualities of the psychodynamic approach.
How is Psychodynamic Psychotherapy Applied?
This method is usually applied in the form of face-to-face sessions held at regular intervals. Some key features regarding the operation of the process can be listed as follows:
- Sessions are usually held once or a few times a week, on a pre-determined day and time
- The client is encouraged to freely express thoughts, emotions, and memories that come to his mind
- The therapist asks questions that will help the client notice patterns, repeating themes, and relational dynamics in what he narrates
- Connections between past life experiences and current emotions and behaviors are evaluated together
- The therapeutic relationship itself may occasionally become a subject addressed within the process
- As sessions progress, patterns that the person did not initially notice may become more visible
Compared to classical psychoanalysis, this approach can generally be planned to cover a more structured and more limited duration. The frequency and duration of application are determined by the expert according to the person's needs; therefore, the flow of the process may vary slightly for each client.
In initial interviews, information is generally gathered about the person's reason for applying, life story, and current living conditions. This initial evaluation phase helps the therapist get to know the client holistically and establish a framework regarding which issues can be focused on in subsequent sessions. As the process progresses, in addition to the topics initially addressed, new themes that emerge spontaneously during sessions can be included in the work. This flexibility ensures that the approach is shaped in a person-specific manner.
What is expected from the client during the Psychodynamic Psychotherapy process is to be open to sharing everything that comes to mind, without censoring his thoughts. This openness may occasionally lead the person to confront emotions and thoughts he has never expressed before; this situation is accepted as a natural and expected part of the process.
What Topics Can Be Addressed in Psychodynamic Psychotherapy?
The topics that can be addressed during this therapy process span a very wide range depending on the person's life story and current difficulties. While some clients apply with a specific symptom or problem, as the process progresses, it can be seen that other themes connected to this problem also come to light. Some of the frequently discussed headings are:
- Recurring relationship problems and attachment patterns
- Feelings of anxiety, restlessness, and inner tension
- Low self-confidence and difficulties regarding self-perception
- Emotional burdens originating from past experiences
- Coping processes with grief, loss, and major life transitions
- Questions regarding the search for identity and the search for personal meaning
- Recurring conflict patterns in work, family, or social life
- Difficulties experienced in expressing oneself or setting boundaries
The topics addressed in this process may be related to different clinical pictures such as Depression, Anxiety Disorders, Personality Disorders, and Post-Traumatic Stress Disorder. In such situations, whether this approach will be included in the treatment plan is decided as a result of the clinical evaluation performed.
It is important to state that the scope of this approach is not limited only to a specific diagnostic group. Individuals who do not have a prominent clinical picture but want to know themselves better, understand recurring patterns in their lives, or contribute to their personal development can also consider benefiting from this method. The determining factor at this point is the person's curiosity and desire to explore his own inner world.
What is the Difference Between Psychodynamic Psychotherapy and Psychoanalysis?
This therapy method is an approach whose roots are based on psychoanalysis but which has diverged over time. The main differences between the two methods can be summarized as follows:
- While psychoanalysis generally covers a process spanning several times a week and extending over many years, this approach can be applied at a more limited frequency and duration
- In classical psychoanalysis, the client usually performs free association while lying on a couch, whereas in this method, sessions are mostly conducted face-to-face and sitting up
- While psychoanalysis focuses on examining unconscious processes in a deeper and unstructured manner, in this therapy the therapist may assume a more active and guiding role
- This approach can approach current life problems in a more focused manner compared to psychoanalysis
- While the goal in psychoanalysis is generally a more comprehensive transformation in personality structure, the goal in this therapy is mostly the understanding of specific patterns and difficulties
Both approaches place importance on unconscious processes and past experiences; however, they differ from each other in terms of application style, duration, and intensity.
Differences Between Psychodynamic Psychotherapy and Cognitive Behavioral Therapy
Psychodynamic Psychotherapy and Cognitive Behavioral Therapy (CBT) are two different methods frequently compared in the field of psychotherapy. Clients often wonder which approach will be more suitable for them; the answer to this question varies according to the person's needs, goals, and the nature of the difficulties he experiences. Both approaches can yield effective results; however, they bear distinct differences in terms of the points they focus on, the techniques they use, and their process structures. The table below summarizes the main differences between the psychodynamic approach, psychoanalysis, and CBT:
| Feature | Psychodynamic Psychotherapy | Psychoanalysis | Cognitive Behavioral Therapy (CBT) |
|---|---|---|---|
| Focus Point | Unconscious processes, past experiences, relationship patterns | In-depth examination of unconscious conflicts | Current thought and behavior patterns |
| Duration | Medium to long-term (can vary between months and years) | Generally long-term (can span years) | Generally short to medium-term (weeks to months) |
| Session Frequency | 1-2 times a week | Several times a week | 1 time a week |
| Feature | Psychodynamic Psychotherapy | Psychoanalysis | Cognitive Behavioral Therapy (CBT) |
|---|---|---|---|
| Therapist Role | Guiding and exploratory | Less guiding, open to free association | Active, structured, guiding |
| Core Method | Free expression, pattern analysis | Free association, dream analysis | Thought records, behavioral homework |
| Goal | Gaining insight, understanding oneself | In-depth exploration of the unconscious | Symptom-focused change, skill acquisition |
This comparison provides a general framework; which approach will be appropriate is determined based on the person's needs, the nature of the difficulties he experiences, and the result of the clinical evaluation. In some cases, different approaches can also be evaluated together or a transition can be made from one method to another during the process.
For example, while CBT may seem more suitable for a person who wants to quickly alleviate a current symptom, the psychodynamic approach may offer a more meaningful framework for a person who wants to understand a long-standing relationship pattern underlying the symptom. This preference should be evaluated together with the person's goals, time, and motivation status.
How Long Does Psychodynamic Psychotherapy Last?
The duration of this therapy method varies according to the person's needs, the complexity of the topics addressed, and the therapy goals. General information regarding duration can be listed as follows:
- Short-term applications can be planned to be completed within approximately a few months
- More comprehensive and in-depth work can take months or years
- Session frequency is generally determined to be once or twice a week
- The progress of the process is regularly reviewed together with the therapist
- As therapy goals are reached, session frequency can be reduced and the process concluded
It is not accurate to give a definitive timeline regarding this process; the duration is evaluated by the expert clinician according to the person's condition and can be re-examined when needed during the process.
Why is the Relationship with the Therapist Important in Psychodynamic Psychotherapy?
In this therapeutic approach, the relationship between the therapist and the client is accepted as one of the central elements of the process. Some points regarding the importance of this relationship are:
- The therapeutic relationship can provide a safe space where the person can observe patterns in his other relationships
- Emotions and reactions developed by the client toward the therapist (transference) may carry clues about past relationships
- A safe and consistent therapeutic relationship can contribute to the person expressing himself more comfortably
- The therapist takes care to preserve the reliability of the process with a neutral and supportive attitude
- The sense of trust developing over time can allow the client to share topics he previously had difficulty voicing
Therefore, in the therapy process in question, the nature of the relationship established with the therapist holds an important place in terms of the functioning of the process. This relationship established by the client with his therapist can function as a laboratory of trust over time; the person can carry the feeling of openness, acceptance, and being understood that he experiences here into his other relationships in daily life.
Who Applies Psychodynamic Psychotherapy?
This method is applied by experts who have received training and gained experience in the relevant field. These experts may include:
- Psychiatry specialists who have received training in this approach
- Clinical psychologists who have completed advanced training and supervision processes for this method
- Mental health professionals who have received certification from psychotherapy institutes
For the therapy process to proceed safely and effectively, it is important to work with an expert who is competent and experienced in his field. When deemed necessary, a holistic treatment plan can be established in cooperation with a psychiatry specialist. This cooperation allows for the evaluation of both psychotherapeutic and, if necessary, pharmacological support together.
Some points that can be paid attention to when choosing an expert are:
- The training and supervision process the expert has received regarding this approach
- The duration of his clinical experience in the field of mental health
- Whether the client feels comfortable and safe
- Whether the therapist's communication style matches the client's expectations
These elements are important in terms of the therapeutic relationship progressing on a healthy ground.
How is Confidentiality Protected During the Psychodynamic Psychotherapy Process?
Confidentiality is one of the cornerstone elements of the relationship of trust in psychotherapy processes. Some fundamental principles regarding the protection of confidentiality in this process are:
- Information shared in sessions is kept confidential within the framework of professional ethical principles
- The client's identity and process information are not shared with third parties except for legal obligations
- Recording and filing processes within the institution are carried out in a way to protect patient privacy
- The limits of confidentiality (for example, exceptional situations such as the risk of the person harming himself or others) are clearly notified to the client at the beginning of therapy
- The client's questions regarding the process are answered in a transparent manner at every stage
The principle of confidentiality is of great importance in terms of the client feeling safe and being able to share openly and honestly in the process, and it lays the groundwork for the healthy progression of the therapeutic relationship. The consistent implementation of these principles in an environment providing institutional health services is of great significance both for the protection of patient rights and compliance with professional ethical standards. Clients can direct all kinds of questions regarding confidentiality to their therapists throughout the process and obtain clear information on the subject.
The Psychodynamic Psychotherapy Approach at NPİSTANBUL
In the work carried out in the field of mental health at NPİSTANBUL Hospital, the holistic evaluation of the person is taken as a basis. Clients thought to need this method are first subjected to a comprehensive clinical evaluation process. As a result of this evaluation, an effort is made to determine the approach most suitable for the person's needs.
Some points paid attention to throughout the process are:
- The evaluation is carried out by experienced psychiatry and psychology experts in their field
- The therapy plan is shaped according to the individual needs of the person
- When deemed necessary, cooperation can be made with experts from different disciplines
- Confidentiality and professional ethical principles are meticulously complied with throughout the process
- Care is taken to inform the client about the process and answer his questions
Individuals who want to receive support on any subject related to mental health can first consult an expert to plan the most appropriate evaluation and referral process for themselves. Taking into consideration the nature, duration, and severity of the difficulties the person experiences, different therapy approaches or additional support methods can also be included in the evaluation process if necessary. The aim is to create a sustainable, safe, and person-specific support process for each client.