Abnormal Psychology

Foundations of Treatment 119

Methods of Psychodynamic Therapy

Freud and his followers developed a variety of techniques to allow the analyst

and patient to glimpse the workings of the patient’s unconscious and to pro-

mote insight.

The Therapeutic Alliance

Both psychoanalysis and psychodynamic therapy emphasize the importance of a

therapeutic alliance, the positive relationship between the therapist and the patient

(Greenberg & Mitchell, 1983; Klein, 1932; Kohut, 1977; Sullivan, 1953; Winnicott,

1958). This patient-therapist collaboration, a social factor, provides the trust and

good will needed to undertake the challenging work of the therapy. The therapeutic

alliance also can supply patients with a corrective emotional experience, an oppor-

tunity to work through past unresolved experiences in a safe environment with the

therapist (Alexander & French, 1946). This experience can lead to improvements in

symptoms, personality, and behavior.

Free Association

One method that Freud developed in order to determine patients’ unconscious

confl icts is free association, in which patients report aloud their train of thought,

uncensored. Psychodynamic therapists believe that the content and pattern of

patients’ unedited thoughts reveal unconscious urges and responses to those urges.

Interpretation

Free association is usually used in conjunction withinterpretation, in which the

therapist infers the unconscious meaning or motivation behind a patient’s words

and behaviors and shares this inference with the patient. Thus, the therapist

might fi rst note a patient’s thought pattern during free association and then point

out possible unconscious meaning in the patient’s associations. The therapist also

uses interpretation when a patient makes a speech error, such as saying “father”

instead of “bother”; such errors are thought to be laden with meaning and are

often called Freudian slips. According to Freud, interpretation should help the

patient become aware of his or her unconscious confl icts. The patient’s own in-

terpretations are not generally considered as accurate as the therapist’s because

the patient’s unconscious urges and confl icts are presumed to make him or her

less objective.

Dream Analysis

Another method that Freud developed to plumb a patient’s unconscious is dream

analysis, in which the therapist interprets the content of a patient’s dreams. Freud

P S

N

Therapeutic alliance

The positive relationship between the

therapist and the patient.

Free association

The psychodynamic technique in which

patients report aloud their train of thought,

uncensored.

Interpretation

The psychodynamic technique in which the

therapist infers the unconscious meaning

or motivation behind a patient’s words and

behaviors and shares these inferences with

the patient.

Dream analysis

The psychodynamic technique in which the

therapist interprets the content of a patient’s

dreams.

Table 4.2 • Differences Between Psychoanalysis and Psychodynamic Therapy

Psychoanalysis Psychodynamic Therapy

Frequency Four or fi ve times a week Usually not more than twice a week

Duration Years, or indefi nitely A few years or less

Seating Arrangements Patient lies on a couch;

the analyst sits behind

the patient, off to the

side, out of the patient’s

view.

Patient and therapist both sit on chairs,

facing each other.

Emphasis More emphasis on

sexual and aggressive

urges and childhood

experiences

Less emphasis on sexual and aggressive

urges; more emphasis on current—rather

than past—experiences

David Young-Wolff/Photo Edit