The true meaning of this insight is then brought
into the patient’s consciousness by the working-
through process. This refers to a careful and repeated
examination of how one’s conflicts and defenses
have operated in many different areas of life. Little
may be accomplished by a simple interpretation that
one’s passivity and helplessness are really an uncon-
scious form of aggression. Once the basis for the
interpretation is firmly laid, it must be repeated
time and time again. The patient must be confronted
with the insight as it applies to relations with a
spouse, a friend, or a supervisor, and yes, even as it
affects reactions to the therapist. Patients must be
helped to work through all aspects of their lives
with this insight. This is not unlike learning a prin-
ciple in a physics class. The principle only begins to
take on real life and importance when one sees that
it applies not just in a laboratory but everywhere—in
automobile engines, house construction, baseball,
and so on. So it is with insight. It comes alive
when it becomes painfully clear in example after
example how it has affected one’s life and relation-
ships. It is due in part to this extensive working-
through period that traditional psychoanalysis takes
so long—three to five therapy sessions per week for
3 to 5 years, and sometimes much longer.
Techniques of Psychodynamic Psychotherapy
The analyst regards the symptoms of neurosis as
signs of conflict among the id, ego, superego, and
the demands of reality. A phobia, an undesirable
character trait, and excessive reliance on defense
mechanisms are all signs of a deeper problem. The
symptom, then, indicates an unconscious problem
that needs resolution. Obviously, if patients could
resolve their problems alone, they would not
need therapy. But the very nature of unconscious
problems and defenses makes self-healing exceed-
ingly difficult. To dissolve defenses and confront
the unconscious in a therapeutic relationship are
the purposes of psychoanalysis. Over the years,
many variations in techniques have been devel-
oped. However, in nearly all these variations, the
basic emphasis is on the dissolution of repressions
through the reanalysis of previous experience. The
fundamental goal remains freedom from the
oppression of the unconscious through insight.
Shedler (2010) identified seven features of psycho-
dynamic therapy that seem to best characterize this
approach (see Table 12-1), although many of these
would characterize other forms of treatment as well.
Below, we highlight some of the specific tech-
niques used in psychodynamic psychotherapy.Free Association
A cardinal rule in psychoanalysis is that the patient
must say anything and everything that comes to
mind. This is not as easy for the patient as it may
appear at first glance. It requires the patient to stop
censoring or screening thoughts that are ridiculous,
aggressive, embarrassing, or sexual. All our lives we
learn to exercise conscious control over such
thoughts to protect both ourselves and others.
According to Freud, however, if the therapist is toT A B L E 12-1 Seven Key Features of Psychodynamic Psychotherapy (Shedler, 2010)
■ Encourages patients to focus on affect and the expression of emotion.
■ Helps people explore their attempts to avoid distressing thoughts and feelings.
■ Identifies and focuses on recurring themes and patterns in patients’thoughts, feelings, and behaviors.
■ Helps patients discuss how past experiences affect their current relationships, feelings, and behavior.
■ Focuses on interpersonal relationships and interpersonal experience.
■ Focuses on the current therapy relationship.
■ Encourages patients to explore fantasy life (e.g., uncensored thoughts, feelings, dreams).
SOURCE: Adapted from“The efficacy of psychodynamic psychotherapy.”American Psychologist, 65, pp. 98–109. Copyright © 2010 by the American Psycholo-
gical Association. Reprinted by permission.
350 CHAPTER 12