Psychodynamic therapy (PDT) is founded in psychoanalytic theory (Eagle, 2022, Fisher and Greenberg, 1996, Gabbard, 2000) PDT includes a family of psychotherapeutic approaches which have in common that they focus on identifying recurring patterns of relating to the self and others including the therapeutic relationship, exploration of defensive (avoidance) patterns, expression of emotion, and discussion of past experiences that have an impact on the patient’s present experiences (Gabbard, 2004b). The inclusion of unconscious processes is unique to psychodynamic theory and therapy. PDT, especially its short-term variants, includes the identification of a focus based on an assessment of a patient's unconscious conflicts, internalized object relations (i.e. patterns to relating to self and others),  structural impairments (i.e. the level of personality functioning) or  traumatic experiences related to the patient´s symptoms or problems (American  Psychiatric Association, 2013, Kernberg, 1981, Luborsky, 1984).  Psychodynamic operate on a supportive-interpretive (supportive-expressive)  continuum (Gabbard, 2004b), ranging from affirmation at the supportive pole over clarification and confrontation and other interventions to interpretation at the expressive pole. The prototypic insight-enhancing intervention is interpretation by which unconscious wishes, impulses or defense mechanisms are made conscious. Supportive interventions aim to strengthen abilities (‘ego functions’) that are temporarily not accessible to a patient due to acute stress (e.g. traumatic events) or that have not been sufficiently developed (e.g. impulse control in borderline personality disorder). Thus, supportive interventions aim at maintaining or building ego functions (Wallerstein, 1989). Supportive interventions include, for example, fostering a therapeutic alliance, setting goals or strengthening ego functions such as affect regulation or reality testing.(Luborsky, 1984) The use of more supportive or more interpretive (insight-enhancing) interventions depends on the patient’s needs (Luborsky, 1984, Wallerstein, 1989). The more severely disturbed a patient is, or the more acute his or her problems are, the more supportive and the less interpretive interventions are required  and vice versa (Luborsky, 1984, Wallerstein, 1989). Borderline patients, as well as healthy subjects in an acute crisis or after a traumatic event, may need more supportive interventions (e.g. stabilization, providing a safe and supportive environment). As a consequence, a broad spectrum of mental problems and disorders can be treated with PDT, ranging from milder adjustment disorders or stress reactions to severe personality disorders such as borderline personality disorder or psychotic conditions (Luborsky, 1984).

 

Specific psychodynamic techniques for child analysis were first developed in the 1920s (Freud, 1927, Hug-Hellmuth, 1921, Klein, 1932). In the past century, this approach has experienced significant growth, expansion, and evolution, and now incorporates ideas from several disciplines, including developmental psychology, attachment and mentalization theory, and neuroscience (Music, 2009, Steele and Steele, 2018)

 

Gabbard (2004a) has suggested  regarding therapies of more than 24 sessions or lasting longer than six months as long-term. On this website, the definition of short-term or long-term psychodynamic psychotherapy (STPP) given by Gabbard (2004a) will be applied. With regard to STPP, different models have been developed, which were reviewed, for example, by Messer and Warren (1995).For long-term psychodynamic psychotherapy (LTPP) Gabbard’s definition will be used as the working model (Gabbard, 2004a):  “ ... a therapy that involves careful attention to the therapist-patient interaction, with thoughtfully timed interpretation of transference and resistance embedded in a sophisticated appreciation of the therapist´s contribution to the two-person field.”

 

Modern variants of PDT are manual-guided and specifically tailored to the respective disorder.(Leichsenring et al., 2015a) For common mental disorders, psychodynamic treatment manuals are available. (Leichsenring et al., 2015a, Leichsenring et al., 2015b)

 

A diagnostic framework to assess both conflicts and structural deficits which is also useful for therapy planning and the application of adequate interventions has been  provided, for example, by the Operationalized Psychodynamic Diagnosis system(OPD Task Force, 2013) or the Psychodynamic Diagnostic Manual.(Lingiardi et al., 2017)

PDT fulfils the criteria proposed by the American Psychological Association (APA) for defining a psychological treatment (Tolin, D. F., Grasso, D., Boness, C. L., Beck, J. G., Keane, T. M., Leichsenring, F., Olatunji, B. O., Otto, M. W., & Weinand, J. (in press):

 

Psychological treatment is an intervention consisting of

(a) specific actions between a person or persons and a mental health professional or designee,

(b) with the intent of engaging cognitive, emotional, behavioral, or interpersonal processes,

(c) in the service of modifying health or functional outcomes, and

(d) whose core assumptions about its procedures and mechanisms of change are founded in psychological science and consistent with scientific understanding.