Why is it that when most Cognitive Behavioral Therapists seek therapy, they seek a psychodynamic therapist?

• Isn’t Psychodynamic therapy archaic and stuck in the early 20th century?

• How effective is Psychodynamic therapy compared to CBT therapy?

Modern Neuroscience confirms Freud’s suppositions.

Many of my patients first come to therapy having heard the unconscious described in vaguely mythical sounding nonsense. This could not be further from the truth.

Rather, the unconscious is understood today to be implicit memory. (Schore 2019) Making sense of our day to day lives is often hard enough. Can you imagine having to constantly make sense out of the way the world works? Here, is where implicit memory comes in.

What is Implicit Memory?

I defer here to Dr Schore of UCLA Medicine, who says it better than I can, “Implicit Memory is where the emotional, affective, sometimes traumatic-presymbolic and preverbal experiences of the primary mother-infant relations are stored.”

Newborns are hardwired to develop expectations.

To be more specific, The nervous system of a newborn is hardwired to learn what to expect from the world. Some children seem to find the world pleasant and appealing while others seem reactive and easily stressed. Nervous systems react and begin to anticipate the world.

Early experiences matter. Quality and regularity of food, repeated patterns of positive exciting contact with the outside world followed by self soothing and calming eventually leading to a feeling of safety as one falls asleep and retreats from the world. As we have all experienced, life is significantly more complicated than this.

Adolescence changes everything

Something strange happens during adolescence, the raw sensory experience of childhood is converted to deeply abstracted meaning. Concrete physical experiences now carry symbolic weight referring to the past, present and future.

The double edged sword of our nature is that we are malleable. When enough good things happen to us, we do better. When bad things happen to us, we do worse.

Psychodynamic therapy works because it changes how you experience & react to the world. Pain is woven into the fabric of our lives. In the context of reporting on your private thoughts over time, you will begin to form a clinical relationship with me. You will then do things in the context of that relationship that you do in other relationships.

Rather than you telling me your problems and me coming up with a contrived answer, We experience your fears, desires, and behaviors in the context of an ongoing clinical relationship. The more you encounter yourself as you are the more you will notice your world becoming richer. You will notice that your relationships become more fulfilling. You will also untangle actions and behaviors that seem to lead to feeling anxious and depressed.

Wait, I thought I, “had” Depression?

Depression is a description not a disease. Our healthcare system has produced a Diagnostic and Statistical Manual of Mental Disorders (DSM-5) which has become a standardized universal in mental healthcare. Unfortunately, standardized lists fail to capture complex human experiences. (McWilliams)

In our current healthcare system, my patients often report having experienced a system that prioritizes profits over developing a deep understanding of who they are. Insurance based systems would like for you to believe that short term therapy & worksheets can remove the patterns, assumptions and maladaptive means of self regulation that you have developed over a lifetime.

In short, CBT therapists seek out psychodynamic therapy because it works. When it comes to evidence based research, effect size measures how effective an intervention is to a population compared to a population that never received treatment. When it comes to reducing anxiety and depression:

• CBT routinely scores between .8 and 1.0

• SSRI’s have an effect size of .35 (Khan)

• Psychodynamic therapy? 1.51. (De Maat)

Frequently Asked Questions:

• Is therapy quick?

  Psychodynamic therapy is an evolving relationship. An average course of treatment can take between two to three years. However, the study outlined above drew its conclusions from 21 sessions or 5 months of weekly therapy.

• How much is this going to cost me?

  People buy expensive trucks, seek out plastic surgery and often spend thousands to find a balance of peace and satisfaction. Unlike these surface level responses, Psychodynamic therapy can change your life.