Contemporary Psychoanalytic Practices

Both the psychoanalytic and behavioral traditions have evolved a great deal over the past century, both in response to scientific developments and in response to clinical issues that proved resistant to previous forms of treatment. Contemporary therapeutic approaches that are offshoots of the psychoanalytic tradition are often referred to as ‘psychodynamic’ and/or ‘relational’ therapies; for simplicity’s sake I hereafter use the term psychodynamic to refer to these approaches. I want to differentiate between psychodynamic therapy and psychoanalysis proper. The following descriptions are not a commentary on the latter, which due to both the intensive frequency of treatment--typically three or more sessions per week--as well as the specific techniques employed, is often considered as categorically different from psychodynamic psychotherapy (i.e. patients are referred to as being in ‘analysis’ rather than as being in ‘therapy’).

Similar to early psychoanalysis, contemporary psychodynamic therapeutic approaches place an emphasis on the role of unconscious conflict in psychological experience, but the focus of what causes that conflict has shifted. Whereas Freud and early psychoanalysts focused on sexual and aggressive impulses as the main drivers of conflict, subsequent theorists and researchers have emphasized interpersonal needs as the largest driver. In particular, the fundamental need for children to attach to their caregivers and what happens when that need is thwarted has become a central component of psychodynamic thinking and intervention. This makes sense from an evolutionary perspective--from the day humans are born they are interdependent with their caregivers. As opposed to say reptiles, who leave their eggs to hatch and their offspring to fend for themselves, a human baby is born into a world in which it is entirely dependent on its caregivers for survival. If those caregivers have no motivation to protect and raise the baby, then it will die; if this were the case for all babies, then the human race would cease to exist, as no newborns would survive into adulthood to reproduce. It is thus paramount that both caregivers and babies have evolutionary programming that allow for newborns to survive--infants are born into the world with innate programming that allows them to learn how to signal caregivers for support and caregivers have complementary programming that motivates them to respond. This complex systems of hormones, neurotransmitters and brain architecture that allows children and caregivers to signal and impact one another has been dubbed the ‘attachment system’ (Bowlby, 2005).

In an ideal world, caregivers are able to sensitively respond to the needs of their children and nurture them as they grow into subsequent phases of development where they can become progressively more capable of functioning independently, ending in their transition to adulthood. For a variety of reasons, caregivers are not always able to respond sensitively to the needs of their children, and if they are in high distress themselves, they may even respond in ways that feel threatening to the child. When this is the case, children must necessarily adapt to try and maintain the relationships with their caregivers that they are dependent upon. For example, if a child has a stressed out caregiver that yells at and/or blames them when they cry, they may come to associate crying with further emotional pain. Consequently the child’s brain may adapt on an unconscious level by both cutting off the feeling of sadness and its behavioral expression, crying. This change is encoded in the child’s brain in a way that will continue to affect them throughout their lives if left unaddressed (Sullivan, 2012). The short-term benefit of the adaptation for this child is clear as it protects them from potentially painful experiences, but the long-term cost is the diminishment of an essential human emotion that allows them to move on from losses and signal to others when they are in need.

Contemporary psychodynamic therapies have developed around how to repair and resolve difficulties that arise out of a person’s attachment experiences with early caregivers. As in classical psychoanalysis, anxiety and other symptoms are viewed as signals that there is an unresolved conflict that needs to be brought into the conscious and addressed. Through the gradual development of a trusting relationship with their therapist, therapy becomes a venue where people can shed previously needed protective mechanisms and access previously warded off emotional experiences such as the need to feel sad or angry, or the need to feel valued by a caregiver. As people are able to do this, their symptoms naturally diminish and they experience the world with greater emotional richness.

One of the crucial implications of psychodynamic thinking is that it highlights that people who have grown up in harsh familial environments will have had their experience of the world colored by those environments from a young age. Because these people will have suffered for their whole lives, they have no way of knowing that it is possible to feel any other way and will experience their painful symptoms as the norm. For these people, childhood is metaphorically like a long winter that leaves them encumbered by the frost and weight of the world in which they develop. For them, therapy can be the thaw through which they are able to shed the weight of their earlier experiences and rise up into their full potential as adults.

References

Bowlby, J. (2005). A secure base: Clinical applications of attachment theory (Vol. 393). Taylor & Francis.

Sullivan, R. M. (2012). The Neurobiology of Attachment to Nurturing and Abusive Caregivers. The Hastings Law Journal, 63(6), 1553–1570.