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How Psychotherapy Works and How to Benefit

Why Psychodyamic Therapy Works

When people search for high quality, effective psychotherapy, they are often disappointed. Instead of having their life problems and emotional pain treated with an incisive and deep approach by an experienced guide, they often encounter a therapist who merely listens, offers superficial tips or explanations, does not educate you about how your healing is likely to unfold.  

That approach is what I call Therapy-lite. It is commonly offered by practitioners who lack the deeper training, framework and knowledge used by a psychodynamic therapist. I am not making the claim that only people with higher degrees can deliver effective therapy. I am only making the case -- based on ample feedback from my patients -- that many therapists do not have a very transformative approach to therapy. Patients know when they feel they are receiving in-depth knowledge, accurate insights and high emotional attunement. They sense when their problems and feelings are being understood superficially or not. They sense that when the therapist is too eager to be liked by them, or to believe that the therapist's kind, caring attitude alone will create transformation. 

Psychodynamic therapy, by contrast, refers generally to the traditional focus on "Depth, Insight and Relationship" that evolved out of the psychoanalytic tradition. Psychodynamic therapy is what most people think therapy is or should be. Research shows that effective therapists practice the basic principles that came from traditional therapy:


  • Attending to the relationship dynamics between therapist and patient as a source of insight and healing;

  • attending to the unconscious or hidden and repressed aspects of patients' experience;

  • Helping the patient develop insight into their inner lives.  


Q: Isn't it proven that cognitive-behavioral therapy are the most effective or "evidence-based"?

The attempt to show that some therapies are "evidence-based" and that others lack evidence is fraught with the difficulty of measuring a) what various therapists are really doing during sessions, b) differing levels of therapist skill and competence; and c) the effect on patients over the short to long term.

 the notion that the most effective or "evidence-based therapy" is Cognitive-Behaviorial (CBT) is largely a myth, if not a scam, foisted on the public to suit the needs of the medical-insurance industry to push short-term, symptom-reducing therapy on the public.


CBT suggests that poeple's complex emotional and life issues are best understood solely as the result of negative, dysfunctional thoughts that can be changed into positive ones. This is a shallow analysis and therefore produces limited, short-term results.

The cognitive view of human suffering takes little account of the impact of early childhood trauma, attachment style, relational patterns and defense mechanisms in a person's psyche. These factors make it very difficult to address their emotional suffering through direct, rational arguments such as "You say that you often hate yourself and feel ashamed, but look, your friends and family really love you."

Most people know that there is something irrational about their feelings. Recognizing that various thoughts, feelings and habits are irrational, obsessive, compulsive and unhelpful does not diminish their power. 

Research shows that most people instinctively know that their inner struggles and problems are not merely the result of negative thinking. Thoughts are only the surface phenomena of deeper, "structural" distortions in our character, our emotional habits and ways of understanding life. We refer to the self as having a structure because our inner development is based on the fundamental 

Sometimes we find it easier to think positively and sometimes not. The problems in our self-esteem, relationships and work lives are not solved by merely looking to change our thoughts. In recent decades, various spiritual and new-age teachings also sell the lie that "all human suffering comes from our thoughts." The question is, where do our thoughts come from? They come from the Self. They come from the self-structure within the unconscious psyche that is shaped by many factors.


That is why our constant efforts to change our thoughts -- and to embody higher, spiritual qualities -- is incredibly difficult. What is needed is that we face our emotional wounds -- and indeed the intractable pain of being human -- with deep compassion and curiosity. Surely this is what most spiritual and religious wisdom would encourage, yet today's new-age and pop-buddhism adopts the atomistic, shallow notion that a human being is merely a collection of random thoughts coursing through their mind. 

The prevailing truth is that what most people need - and say they want - is in-depth, relational psychotherapy (aka Psychodynamic Therapy). 

Working from a broad understanding of human development, I can quickly and intuitively grasp a patient's inner and outer life -- and help set the foundation for real transformation. One of the keys to Psychodynamic therapy is that we understand and listen to what is unconscious and hidden. For example, sometimes a person is traumatized and very doubtful about themselves - and also about therapy. We can't just reason them out of their doubt. We have to listen to the dreams they have at night that may signify new energy and a shift toward healing. 

Therapy-lite only addresses the conscious, rational mind. They ask you to "recognize the irrational thoughts." The problem is you have already done that. You know various thoughts or feelings are irrational -- the question is how to change them. That deeper change has to come from a shift in your overall attitude and understanding of your life. It doesn't come from merely trying to be rational and making a decision to "love yourself."


The experience of greater love, lightness, and creative flow in life only comes from a deeper shift in your psyche -- we can even call it an awakening of spirit. Usually that shift comes from exposing and feeling aspects of your psyche that have long been repressed or neglected. To reach into this level takes a psychotherapist who knows what to listen and look for.

Just "believing in you" and "supporting you" is not enough. There has to be some real experience and wisdom at grasping the hidden threads of a person's life and sometimes, firmly challenging them to reorient their outlook and try new ways of being. It doesn't work to merely kill our patients with kindness. We have to have a working model of the deep psyche -- a familiarity with the paradoxical, existential and spiritual themes human existence. 

The problem with that approach is that  

Traditional (i.e. depth, psychodynamic) therapy is relational, insightful, and treats the human being as a complex, conscious being with many layers -- both conscious and unconscious. It is not just about discussing the past, but it is about understanding where a person has been and where they are going. It should be practical and down-to-earth while also allowing for emotional release, new insights and higher consciousness.

The evidence is that the traditional, depth approach creates lasting, positive changes in our feelings, relationships and sense of meaning and fulfillment. We have a choice between a psychotherapy that honors the complexity of human nature - or one that pretends we are more like thinking machines whose thoughts just need to be "reprogrammed" by short-term therapy or medication that suits the pharmaceutical and health insurance companies.

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