Cognitive behavioural and psychodynamic approaches to therapy seem to offer contrasting modes of treatment for psychological difficulties, largely due to the fact that they originate from very different theoretical and philosophical frameworks. It seems likely, therefore, that treatment for a woman experiencing depression, anxiety and feelings of inadequacy will proceed along very different lines according to each approach. There do appear to be some features, however, which are common to all effective ‘talking’ therapies, notably rooted in the therapeutic relationship itself and in the qualities and skills of the therapist, whatever their persuasion.
Psychodynamic therapy, as Jacobs (2004) notes, incorporates many different strands, originating from Freudian psychoanalytic theory, and is generally understood to focus upon the unconscious activity of the psyche. The internal aspects, or ‘states’, of the psyche are seen as taking shape during the years of a child’s development and constitute elements of the child’s relationship with significant others, notably mother and father. Consequently, all psychodynamic therapies pay particular attention to “the importance of the child’s early environment as promoting the foundation of later personality strengths or areas of vulnerability” (Jacobs, 2004, p.10). At times of stress we can be driven back to more primitive, or infantile, ways of thinking, feeling and behaving in accordance with our perceptions of those early relationships.
A psychodynamic therapist working with a woman who expresses feelings of depression, anxiety and inadequacy, therefore, will be concerned to attend to various indicators of unconscious psychic activity in the way the woman talks about events and situations, past and present, and her associated feelings. The woman may, for example, speak of disrupted relationships with particular loved family members, through death or separation, or of traumatic or abusive experiences. The therapy is likely to move constantly between past and present, with the client being encouraged to make connections between her perceptions about her past personal history and what she is experiencing, and feeling, in the present. For example, this woman’s present feelings of inadequacy may be interpreted as linked to earlier experiences of never quite being able to live up to her mother’s high expectations of her.
A distinctive feature of psychodynamic therapies is the key hypothetical process of transference. Relationship is central to the therapy in that the client’s personal history is seen as significant for the relationship between client and therapist (Jacobs, 1986; 2004). The client is said to unconsciously ‘transfer’ unacceptable, repressed, elements of her past into her relationship with the therapist. Thus, using our earlier example, the therapist may have noted certain remarks made by the woman suggesting that she may not be able to meet the therapist’s expectations. This would then prompt questions in the therapist’s mind about the woman’s past ‘failures’ to live up to expectations. The task, then, is to identify and work with this transference of feelings of inadequacy, in an attempt to uncover and resolve those earlier conflicted experiences. The client, having gained insight into the origins of her problematic feelings, and brought them to consciousness, is now enabled, through therapy, to resolve those feelings as they impact upon her in the here and now.
The psychodynamic therapist is essentially anonymous in terms of his/her own views, adopting a passive and detached stance. Nelson-Jones (2001), in his review of this approach, comments upon the great power held by therapists of this orientation in relation to their clients since they (the therapists) are the interpreters of the client’s ‘material’ and they get to decide how and when, for example, the client might be resisting, or denying, their underlying difficulties.
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