What is Psychodynamic Psychotherapy?

There are many forms of psychotherapy, but I will focus on psychodynamic or psychoanalytic psychotherapy. This long-established tradition has been developing for more than 100 years and is supported by leading universities including UCT, WITS, Rhodes, and UPA.

While most people who undergo this process benefit, sometimes in profound way, there is nothing mystical about it. It looks no different to a conversation, except that the client does most of the talking while the therapist carefully considers what is said to them and speaks as a way of intervening. This is not a procedure that is done to the client, rather, the therapist and client work together. Concentration, energy, motivation and commitment are required from both parties.

This process helps the client become more aware of their actions, feelings, thoughts, and beliefs while reflecting on their meaning in relation to the total context of their life. Conscious and unconscious assumptions about oneself, life and relationships become available for exploration and the effects of the past are felt live in the room. The outcomes of the process vary broadly but many people deepen awareness of who they are, how they participate in their worlds, and why they struggle with what they do.

What Happens in Therapy Sessions?

The first few sessions will be an assessment. This may involve me asking questions about your life and troubles, or I might simply listen to what you have to say. Adolescents and children can find it difficult to express their thoughts and feelings and so I might help the process by asking them to draw something or to describe what they see in a picture.

Once I have a sense of the difficulty, I will share my thoughts and will make a recommendation. The assessment phase also allows you to consider whether you are comfortable working with me. This is important since therapy is based in openness and so your therapist should be someone with whom that you feel comfortable. I am happy to make a referral where the client might prefer to see someone else and I won’t take it personally.

If I recommend individual psychodynamic psychotherapy and you accept, we will establish how often to meet and set up regular meeting times, during office hours. Each meeting will last approximately 50min and regular attendance is vital to success.

The therapy sessions will differ from to the initial assessment sessions. How I approach therapy will depend on my assessment findings but I usually ask the client to begin the session by taking note of their thoughts and putting them into words. This should be as open as possible and without censorship; even if the thoughts seem irrelevant, silly, or unacceptable. This might feel odd at first since most people are used to being given advice or being led when dealing with professionals.

My task will be to listen very carefully, clarify, interpret, point out any associations that may not be obvious; and guide you to recognise and, if appropriate, challenge your patterns. I will refrain from disclosing personal information or making physical contact. This may feel cold and or unfriendly, but this stance has been shown to allow a person’s most important issues and emotions to surface and can reveal how they relate to others most clearly. Because the client and therapist are full partners in this process, we will both participate in making treatment decisions, including the decision to end therapy.

How Long Does Therapy Take?

The length of a therapy depends on the nature of the difficulty, your level of commitment, and the aims that you have in mind. More severe difficulties generally require longer therapies, but this is not the only factor. Short-term therapies can be enough to relieve a clearly defined behaviour or symptom (e.g. fear of flying) or help with the initial shock of a traumatic incident (e.g. hijacking) or loss. They will not properly address diffuse difficulties such as trouble sustaining relationships, ongoing sexual abuse, feelings of emptiness, chronic inhibition or wanting to be more mature in one’s approach to life.

How Often Should I Attend?

Psychotherapy is carried out at a regular frequency of between one and three sessions per week. Psychoanalysis requires four to five sessions per week. Some clients arrive with the intention of entering an intensive psychotherapeutic process and so, where appropriate, begin meeting more than once a week. Many clients start with one session a week and adjust as and if necessary.

Sessions are increased for various reasons. The client may be experiencing emotional turmoil which requires regular contact to contain. Some issues are difficult to reach when meeting only once a week e.g. some clients are unable to discuss intimate issues if they don’t see the therapist regularly. A true psychoanalytic (vs. psychotherapeutic) process generally requires high frequency of meeting to be able to reach the depths that it aims to.
Unfortunately, meeting more frequently does not necessarily mean that the therapy ends in a shorter amount of time. More frequent sessions allow a depth and degree of continuity that is not possible when meeting once weekly. Less session time is taken up discussing the events of the week and it is much easier to look inwards. This can help you to achieved results that may otherwise have not been possible.

Does Therapy Work?

The short answer is… Yes, but this needs to be qualified. Careful research has shown that therapy can help a person overcome significant issues, can reduce and even eliminate symptoms of depression and anxiety, can improve one’s relationships, sense of self, and even work performance, creativity, and motivation. However, psychotherapy is not magic. Therapy does not cure all woes and will not lead to a trouble free and perpetually happy life.

The success of therapy will depend on all the factors involved i.e. the fit between the client and the therapist, the client’s motivation, dedication, and openness, the therapist’s experience, and skill, and external factors such as time, resources, and support. Other important factors include your wish for self-understanding, a willingness to tolerate uncertainty, and your readiness to consider different points of view.

Roth, A. & Fonagy, R. (2004). What Works for Whom? 2nd Edition. Guilford Press.

What Is Therapy Good For?

Psychodynamic and psychoanalytic therapy understands that symptoms (e.g. anxiety) are an expression of an underlying difficulty (e.g. a fear of judgement) and hence the same symptoms can point to different underlying issues in different people. Because of this, psychodynamic psychotherapy is not principally concerned with kinds of symptoms (e.g. depression, anxiety etc.) or specific disorders. Its focus is instead on understanding each person’s different underlying dynamics.

There is good evidence that this approach works well and that it can successfully treat a wide variety of conditions or disorders. It is particularly helpful with clients who have difficulties in their relationships, in handling the pressures of everyday living and with disorders such as depression, anxiety, eating disorders and self-harm. It is also valuable in helping those who may have been affected by psychological, physical or sexual abuse.

How Much Does Therapy Cost?

My rate for an individual session is R980.00. A session is usually just over 50 min. This is in line with most medical aid rates. If the individual rate is unaffordable, remember that group therapy can be as effective as individual therapy and costs far less (R285.00). Many people are frightened by the thought of group therapy, but most find it valuable in the end and are often pleased to have selected this over individual work. You might want to consider contacting me and discussing whether a group would be a suitable approach for you.