[herethennow]

T and pdoc looking into moving from CBT to psychodynamic therapy.. anyone done this before?

Though I hate the structure that CBT has, I kind of like the fact that everything was written and I didn't have to talk much. That, I believe, would be different when it comes to psychodynamic.

Anyone tried it to some degree of success? What does it really entail? I'm not one who likes to talk much.. and would really like someone else to lead me (like what CBT does) but I'm not too sure.

Thanks in advance!

I personally hate CBT, DBT, etc. They seem like band-aids to me.

Psychodynamic is a type of therapy that explores the past and its influence on the present AND utilizes the transference that develops to understand patterns, etc. It focuses on the unconscious and what is behind feelings and emotions.
It is an insight type therapy, where you come to a realization with your therapist's help.

It involves lots of talking, although sometimes it takes time to trust and it is ok if there is silence. Silence is there to reflect and think. There is usually no direction and the client takes the lead. NO homework and no "do this" or skills learning.

It is talk therapy, focusing alot on the relationship between you and the T.

In more traditional psychodynamic therapy the therapist does not share much personal information with the client, so that the transference develops and the client can work through it with the therapist.

Many people go more than once a week. I think 2 times is common.

Some people call psychodynamic therapy "psycho-analytic light" (less intense).

Although very draining, I find it the most interesting.

Many T's will take a more eclectic, combination approach that works quite well. It doesn't have to be all one or the other.

[critterlady]

My T is mostly psychodynamic. We tend to look for patterns in what I do and how I think about or react to things. We look for the origins of the patterns, to help me understand how what I do now may be more of a reaction to something from 40 years ago than it is to anything current. Recognizing that helps me react more appropriately to current things.

We don't spend a lot of time discussing our relationship, but it's definitely part of the equation. I have more of a paternal transference going on with him. My own parents weren't/aren't particularly good at caring for me and T is awesome at it. He's helping me understand just how lacking my parents were by showing me how it could have been done.

Anyway, it's not a quick fix, like CBT and DBT purport to be. It's a longer term therapy. But I think it has longer term results, too, since you're not just changing the top layer of a problem, you're getting to the root of it. It's hard work, can be painful and can sometimes feel a lot worse before it feels better, but I think it's worth it.

[stopdog]

The ones I see bill themselves as psychodynamic and also list other things (eclectic, etc). Once a week is the norm around here - I only go twice a week because I see two different ones.

[doyoutrustme]

I think a good therapist will blend the right techniques for each patients needs. Therapy is not a prescription that needs to be "tried" one at a time.

[herethennow]

Thanks for the replies everyone!

Looking at the response, this means I would have to talk more Not really a fan of talking... even if it does get to the root of my illness. But my T decided to extend our CBT, so I have some more time to think about psychodynamic.

My T is all psychodynamic. It's a unstructured gentle approach. But yes, it's mainly all talking and about the past and how it connects to issues in present day. It's also a longer term therapy-well, for some anyway. Healing also happens through the therapeutic relationship.

[ultramar]

I'm in psychodynamic therapy and it's been very helpful. As someone said, I think it gets to the root of the problems and there are studies showing that although it is often equally as effective as some CBT therapies in the short-term, it can have more lasting results. But this is always going to depend on the therapy-therapist-patient, so it's very hard to make generalizations.

I'll add that I think many contemporary/modern psychodynamic therapies are not so 'insight-oriented' as psychoanalysis used to be back in the day. In relational psychodynamic therapy (or even if it's not called that) I think the healing is in the *experience* (visceral, deep, not necessarily conscious) of the therapy relationship. So, whereas you may have some light bulb moments when talking about things on a more cognitive/intellectual level, the healing lies in the experience of the therapy itself, not even just how you feel about the therapist or how you relate to them, there's more to it than that, I think, but I'm going around in circles and am not good at explaining this!

Also, although CBT I think is billed as very here and now, and psychodynamic has the reputation of being very 'let's talk about your childhood' I don't think either is so limited. I've seen people here in CBT talk a lot about the past, and a lot of psychodynamic therapy can take place in the here and now.

It's usually once a week. I think psychoanalysis (which is really different in important ways) is up to 5 days a week.

In any case, I think a good therapist, no matter their preferred orientation, will gear the therapy towards the needs of a patient at any given time (which may change as the therapy progresses). Also, people can come in with all kinds of different issues, so you may need a relational approach, combined with addressing cognitive distortions, periods of trauma processing, some psychoeducation, etc.

Originally Posted by ultramar

I'll add that I think many contemporary/modern psychodynamic therapies are not so 'insight-oriented' as psychoanalysis used to be back in the day. In relational psychodynamic therapy (or even if it's not called that) I think the healing is in the *experience* (visceral, deep, not necessarily conscious) of the therapy relationship. So, whereas you may have some light bulb moments when talking about things on a more cognitive/intellectual level, the healing lies in the experience of the therapy itself, not even just how you feel about the therapist or how you relate to them, there's more to it than that, I think, but I'm going around in circles and am not good at explaining this!

I believe what you are trying to say is that psychodynamic therapy affects the "right-side" of the brain. The experience of the therapist through transference basically creates new pathways in the brain, which then result in a client's growth and a different way of being. Studies have shown that the "corrective emotional experience" from misattunement with the T (usually over transference) can indeed alter the right brain. This goes on all unconsciously.

However, I would disagree with the lack of focus on "insight." The insight comes from recognizing patterns in our lives that are interfering with life. So the insight can be along the lines of "I'm terrified of being abandoned, so I let my friends walk all over me, which has its roots in my childhood where my father left and I had to cater towards my mother." Something like that. That insight allows for reflection on our behavioral patterns with life outside the T office.

I think it is a combination of both that make this type of therapy so powerful; both right-brain work and left-brain work.

I would also tend to disagree with you regarding the number of sessions per week a client goes. In psychodynamic it is usually 1-2. Ignoring budget, there are reasons a psychodynamic T would asks a client to come 2 times a week; for example, attachment style that T can recognize would make it harder to work 1 time a week, severe symptoms, etc. Some psychodynamic T's may do 3 times a week (M-W-F). Yes, traditional psychoanalysis is 4-5 times a week, but that can be done 2-3 as well. I think T's make judgements about session frequency and need based on the client.

This article gives a great overview for everyone.

www.apsa.org/portals/1/docs/news/jonathanshedlerstudy20100202.pdf