Inspired by Sigmund Freud, these are intensive, insight-oriented therapies for clients who are motivated to make major personality changes. There have been many advances in these therapies since Freud's day. No longer are all psychodynamic therapists merely passive listeners to the client's words, making infrequent interpretations. Many are active participants, providing feedback, helping clients to become aware of how they avoid important feelings or thoughts, helping them to understand the past events that led to the current problems in living and exploring options for improving their lives.
The therapist provides a safe, accepting setting in which clients become gradually freer to explore important themes and reveal, both to the therapist and themselves, innermost thoughts, feelings and conflicts. The therapist provides well-timed interpretations, which are designed to help the client realize why he or she behaves in detrimental ways. The psychodynamic therapist is particularly skillful at relating patterns of maladaptive behavior that had to be learned during childhood so as to maintain needed ties to the parents, but are self-defeating in adulthood.
An example is the girl who had to learn to be docile and self-effacing with a rigid, authoritarian father and a passive mother, but as an adult has a great deal of difficulty asserting herself. Instead, she allows herself to be "walked on" by others. She doesn't understand why and is unable to change this way of relating even though she very much wants to. By gaining insight into why and how she learned this way of relating to authority figures, and her suppressed emotions of hurt, fear and anger, she can change her behavior and behave more appropriately with them.
The psychodynamic therapist also helps the client to become aware when he or she is attributing ("transferring") attitudes, feelings and beliefs to the therapist that were true of important people in the past but are not really true of the therapist.
For example, the client who had the authoritarian father may view the therapist as potentially authoritarian and punitive and not express negative feelings to him or her, fearing the same outburst of anger that she got from her father. A skilled psychodynamic therapist will be alert to subtle signs of this type of transference belief and will be able to help the client become aware of it and help her to work it through. The result is an increase in inner strength, the ability to assert herself with people in general and to actively pursue her goals.
The client in this type of therapy talks about important issues that cause him or her pain, fear and conflict. The therapist mostly listens and comments on the client's communications. If the therapist is an accredited psychoanalyst, and the client is in a full-scale analysis, the sessions are usually frequent, at least three times a week. The client may lie down during the sessions, the analyst sitting behind, which enables the client to talk freely, without self-consciousness, as might be the case were he or she to face the therapist. Most psychodynamic therapists, however, see clients less frequently, once or twice a week, are more active in the sessions, and still are able to help their clients accomplish significant changes.
Some of the newer, more effective types of psychodynamic therapies are Self Psychology, Object Relations theory, Relational Analysis and Robert Stolorow’s Intersubjectivity.
Robert Stolorow is a well-known psychoanalyst who is one of the founders of the Institute of Contemporary Psychoanalysis in Los Angeles. He has written a number of books describing his modification of Self Psychology to make it more scientifically rigorous. In so doing, he has eliminated the non-process aspects of Self Psychology, The theory is quite similar to Relational Gestalt Therapy.