The synonyms originate from the psychoanalytic theory developed by Sigmund Freud and Josef Breuer in the 19th century.
In some parts of the world psychodynamic and psychoanalytic psychotherapy are considered synonymous, since both have their roots in the psychoanalytic theory developed by Sigmund Freud and Josef Breuer in the 19th century. In Slovenia, psychoanalytic psychotherapy has often been considered to be synonymous with psychoanalysis.
The key theoretical framework for understanding personality in psychoanalytic theory is Freud’s structural model. The structural model is concerned with the three systems of an individual’s personality – the id, the ego and the superego, which typically undergo five developmental stages – oral, anal, phallic, latent and genital. This model is based on Freud’s motivation theory, according to which the personality is determined by our drives, especially libido and aggression. Both can be viewed as forms of psychological energy and represent a quasi-physiological entity or link between the physical and the psychological (Praper, 1999). This dual-drive theory forms the core of the motivational and psychodynamic theory of personality, and is the first of four paradigms central to the understanding of personality in psychodynamic and psychoanalytic psychotherapy. (Motivational and psychodynamic theory is just one of the major theories of personality: others include structural, functional, biological, behavioural, social, humanistic and cognitive.) The dual-drive theory also underlies the second important theory, Heinz Hartmann’s ego psychology, which emerged in 1962 and extended Freud’s structural theory by shifting the focus from the id to the ego. Unlike Freud, Hartmann argued that the ego develops autonomously, independently of conflict. The third important theory is object relations theory, which claims that our early childhood experiences with significant others have a decisive influence on all our subsequent relationships. According to this, all our mental structures bear the imprint of our early object experiences (Kernberg in Woller and Kruse, 2005). The fourth important paradigm is self psychology, founded by Heinz Kohut in 1979. This theory developed the concept of the self-object function, which claims that the way we experience the self is invariably co-determined by how we experience the responsiveness of the other towards us (Kotnik, 2003). Contemporary psychoanalytic theory was also greatly influenced by infant and toddler observation (Stern, Lichtenberg, Dornes), attachment theory (Peter Fonagy, 1960; John Bowlby, 1969) and neurobiological research. Infant and toddler observation is primarily concerned with the discovery of the importance of the mutual emotional attunement between mother and child, which has an important impact on the child’s emotional development. Attachment theory and neurobiological research have presented related findings. Attachment theory argues that the child begins to form inner models of attachment in their relationships with relational figures in the preverbal stage of development; that these internal models affect all their later relationships (Bowlby, 1969); and that safe attachment in childhood is a prerequisite for healthy personality development (Fonagy, 2004). Meanwhile, neurobiological research has confirmed that early mother-child interactions have a profound influence on the regulatory processes in the brain, especially the regulation of emotion (Woeller and Kruse, 2005). Hans Krens (1995) also merits a mention here. He located the conditions for healthy personality development in the prenatal period, contending that child development begins at conception and that traumatic experiences in the womb have an important influence on personality development after birth.
However, even though in many countries the psychoanalytic and psychodynamic approaches are considered synonymous, in Slovenia they differ significantly. Unlike the psychoanalytic approach, the psychodynamic approach also uses touch or other forms of body work (with or without touch). Conventional psychoanalysis rejects the touch aspect, unlike contemporary psychoanalysis, if I may call it that, which permits or even encourages it in some cases. Depending on the nature and extent of the client’s issues, I may combine psychoanalytic work (with the client either lying down or sitting) with body work (either with or without touch). In cases of neurotic personality organisation, in which the identity is clear, the defence mechanisms more mature and the degree of reality control high (to draw on Kernberg’s classification), the client should lie down where they cannot see the psychotherapist. Touch may still be helpful in such cases but is not essential, since the repressed content is more accessible to the conscious mind when the client is lying down. However, psychotic clients, or clients with borderline personality disorder, should sit somewhere they can have eye contact with the therapist. This gives them a greater sense of control, which in turn reduces the risk of regression, which can result in a psychotic state. The focus here is on grounding and stabilisation. In major ego deficits, lying down may lead to malignant regression. Touch can be essential for such patients, however, or those with trauma, as it may be their first ever experience of this kind of contact, i.e. touch based on safety and trust; emotional touch. Sometimes this may require many hours of purely analytic work.
For some clients, the therapeutic effect is enhanced when the two approaches are combined . Again, it all depends on the individual, their ego deficits, when the disorder arose, and the client-therapist relationship.
You can find out more about body-oriented psychodynamic psychotherapy in “Body and Touch in Psychodynamic Psychotherapy” (Slovenian only).
We are talking about dealing with the psychodynamics of the current conflict, which is the result of an unresolved basic, unconscious conflict from the past.
The first person to use the term psychodynamics was Sigmund Freud, who used it to describe the emergence of intrapsychic conflict. We use it in therapy to denote a current conflict resulting from an underlying, unresolved, unconscious conflict from the past. This unconscious conflict is the result of conflicting tendencies in early childhood, which made it impossible for the individual to develop normally. The current conflict is thus a symbol of the past and encompasses a range of behaviours that typically contain elements of which the individual is unaware. For instance, at the conscious level they may long to feel less depressed but be unaware of their unconscious fear that an improvement in their psychological state might lead them to uncontrolled outbursts of aggression, which, in turn, might justify a hostile response from others. In this way, their depression is also a kind of shield. In order to resolve the current conflict, it is first necessary to resolve the client’s other conflicts on the emotional level.
As previously mentioned, the concept of intrapsychic, unconscious conflict was first put forward by Freud in the context of his psychodynamic theory, which was based on his studies of the functioning of an individual’s psychic apparatus and the factors that may lead to the development of mental disorders in later life. Freud contended that our instinctual drives (the id) begin to encounter resistance and opposing demands from our environment soon after our birth, mostly in the form of our significant others (parents). The child’s instinctual impulses must give in to these demands, otherwise the child may suffer punishment or loss of affection, which would in turn threaten its existence. Thus, from this unconscious drive a new structure – the ego – begins to emerge. Upbringing and socialisation later result in the emergence of a third entity – the superego – which involves internalised moral requirements, norms and ideals, and constitutes our conscience. This conscience leads us to feel guilt, shame and the tendency to punish ourselves, so we begin to repress the instinctual drives rejected by the ego and the superego. The ideal ego (what we ideally want to be, regardless of whether we can achieve it or not) results in approval, pride and satisfaction. Two parts of the personality begin to develop: consciousness and the unconscious. The personality is caught in a constant interplay between the id and the superego, each exerting its own pressure on the ego. If the pressure is too great, the ego develops certain defence mechanisms and, even though some of these may be healthy, this eventually results in unconscious conflict which, in turn, prevents healthy personal development.
Freud’s psychodynamic theory has undergone many corrections and refinements over the years, but the relevance of unconscious conflict has remained unchanged.
Example: A client sought help in psychotherapy when his girlfriend of 11 years left him and he no longer felt his life had any meaning. This was his current conflict. As a result of her departure, he experienced sleep disorders, an inability to be alone, a total loss of appetite, a lack of personal hygiene, nightmares and unbearable sadness. I experienced him as a vulnerable, tender and attention-seeking little boy who was prepared to make any number of compromises (in this case, to accept his girlfriend’s passive, dismissive attitude towards him) in order to have someone around. This emotional malnutrition was the result of his inner conflict (emotional symbiosis with his mother), for which he compensated at the intellectual level (emotional polarity) with an intolerance of authority. On the unconscious level he was telling himself,“I depend on my mother, so I won’t depend on anyone else.” But all his action was conditioned by the action of the other,so in the absence of the other there was no meaning, no motivation. It was as if he himself did not exist. Thus, his current conflict (his relationship dependence) was a consequence of a conflict at the unconscious level, itself resulting from his emotional dependence on his mother. The underlying issue that needed to be resolved was a separation conflict.
Psychodynamics is what happens inside the client. It is the dynamic relationship between the self, the ego and the superego, and reality. It is the dynamic between the conscious and the unconscious.
Psychodynamics, then, is the mechanism by which normal and abnormal psychological phenomena and processes emerge and develop. It is the events that take place within the individual, and can be understood as the dynamic relationship between the id, the ego and the superego on the one side, and reality on the other; or even as the dynamics between the conscious and the unconscious. . Psychodynamics is therefore the dynamics within the psyche; it is about what happens within ourselves as opposed to the dynamics in our relationships (relational dynamics).
According to Ingo Klimkus, who played a central role in the development of the psychodynamic approach in Slovenia, the personality is defined by the structure of its inner dynamics, which are always active (Klimkus, 2010). (Psycho)structure and (psycho)dynamics are therefore two sides of the same coin, since dynamics produce a structure that is later stabilised by means of ego functions, defence mechanisms, superego functions, the self, society, etc. (Klimkus, 2008). Klimkus takes the view that structure and dynamics should form the basis for arriving at a basic diagnosis in the psychotherapeutic process and thereby understanding the client’s personality. Dynamics always create structure (see figure below).
Using the psychodynamic structure diagnostic system with a client:
Using cushions, I create a space with 4 points representing proximity, distance, permanence and change – see diagram below. Step 1: The client intuitively chooses a starting position between any two of these opposing points (marked 1 on the diagram) and observes themself in it, paying close attention to their feelings, thoughts and physical sensations. They then share their observations with me. Step 2: The client then moves outside the space to another position (marked 2 on the diagram), and observes themself from the outside, as if they were still in position 1 (“How do you see that person over there?”) Step 3: The client stands opposite the spot they chose in step 1 (marked 3 on the diagram) and, just as in step 1, observes and describes their feelings, thoughts and physical sensations. Step 4: The client again moves outside the space to another position (marked 4 on the diagram) and, just as in step 2, observes themself as if they were standing in position 1. Step 5: The client stands in position 1, then moves to position 2, then 3, then 4. Step 6: The client stands in position 1, then moves to position 3 without leaving the circle. Step 7: When they are standing in the final position (3), the client takes time to bring this position inside themself, trying to feel it, experience it and be aware of it. Finally, the space is broken up and we discuss what happened in the exercise.
The purpose of this exercise is to establish a spatio-temporal continuum within the client. This helps them become aware of where they are right now and where they are going (e.g. from position 1 to position 3). As the therapist, I observe the differences in the client in positions 1 and 3 in terms of posture, facial expressions, emotions, space perception and self-perception. It is quite common for someone to have no personal space, or not to be aware of it.
Hohage (in Woeller and Kruse, 2005) distinguishes between the substantive nature of structure and the formal or functional nature of structure. When defining structural properties in terms of substance, he means the way the patient describes themself and others, how they react to certain events and stressful situations, their expectations with regard to other people, and the way in which they are driven by their norms, worldviews and fantasies about relationships. All this makes up the individual’s character. Hohage distinguishes between narcissistic, schizoid, depressive, anankastic and histrionic character structures.
Understanding the client’s character structure helps the therapist see the world from their perspective and to understand the conflictual nature of their real situation. When defining structural properties in terms of function, Hohage means the fulfilment of ego functions. The structural level is a consequence of reality. Hohage divides it into pre-oedipal ego, oedipal ego, differentiated ego and non-differentiated ego. The client’s structural level can be assessed on the basis of a number of factors: their current relationship with the therapist; how they describe their past object relations; and how they manage critical situations. As a therapist, I need to pay close attention to their characteristic defence mechanisms; the quality of their object relations and object perception; differentiation between affectivity and the experience of self; self-regulation and integration of the superego; the client’s communication and attachment styles; and my own countertransference feelings.
Thus, the psychotherapeutic process is centred on working on the individual’s resistances, defences, transference or psychodynamics, and on the therapist’s understanding of the individual’s personality structure, inner dynamics and intrapsychic conflict. The aim of psychotherapy is to help the individual make contact with themself, improve their interpersonal relationships and, as a result, lead a life that makes them happy.
