Why choose dynamic psychotherapy?

Psychoanalysis was invented well over a century ago.  Saying whatever comes to mind for an hour, several times a week, may have worked back in victorian Vienna, but it seems quaint now — awkwardly out of step with our fast-paced lives.  A less intense derivative called psychodynamic (or just "dynamic") psychotherapy decreases the sessions to once or twice a week and does away with the analytic couch.  But the flavor is the same: a leisurely, not obviously goal-directed exploration of thoughts and feelings that seems to ignore the concrete complaints that brought the patient in the door.  In an age of symptom-relieving, pragmatic cognitive-behavioral therapy (CBT), medications approved by the FDA to normalize our moods and thoughts, myriad self-help books, videos, apps, and 24/7 counseling by text message and tweets... is there still a role for this dinosaur?

Yes.  The simple answer is that nothing has replaced it. Medication cannot alter self-defeating interpersonal behavior or poor self-esteem. Cognitive therapy and CBT improve mood symptoms but don’t address long-term personality issues or unconscious patterns of dysfunction. In contrast, dynamic psychotherapy (and psychoanalysis) help relieve the very problems many people struggle with: long term patterns of self-defeating attitudes and behavior that "make no sense," yet are hard to shake without help. It's an approach that sees you as an individual, not merely a member of a diagnostic category. It's the ultimate in customized treatment; everyone's therapy is one of a kind.

Dynamic psychotherapy, and related therapies based on depth, insight, and the healing power of the therapeutic relationship, are losing ground to symptomatic treatment, mainly CBT and psychiatric medications. These latter treatments can be delivered in algorithmic, even automated fashion (as in an app or bot). Like Henry Ford with his assembly line, it’s industrially efficient to treat patients — and therapists — as interchangeable widgets who follow a defined protocol. That is, more “care” can be delivered rapidly and at relatively low cost. But commodity mental health care is dehumanizing. And it often fails to address, much less treat, the real problem.

Measuring concrete symptoms and noting their change over time is simple conceptually and relatively easy to study. Largely for this reason, a huge amount of published research shows that symptomatic treatments such as medication and CBT do, in fact, relieve symptoms. These therapies wear the label “evidence based” as a selling point.

This label is true but misleading, as it implies other types of therapy lack supportive research evidence. But here’s a secret: dynamic therapy is also evidence based. The number of studies of dynamic psychotherapy is smaller, but the amount of symptomatic improvement (the statistical “effect size”) is often larger, and these benefits are often more enduring as well. Moreover, the evidence for dynamic therapy extends not just to concrete symptom improvement, but to more global changes such as enhanced satisfaction with work and personal relationships.

You have many choices for help with emotional issues. There are self-help books, CBT apps, prescription drugs, structured protocols and homework assigned by a therapist, text-based counseling, and so forth. Many of these are less expensive and more convenient than one-on-one therapy with a professional who listens carefully to the subtlety of your feelings, attempts to understand you as deeply as possible, and gives you all the time you need. Consider what really goes to the root of your problems, and what that is worth to you.