Psychodynamic Therapy: The Concept of “The Space Between”

The Space Between
What Even Is Therapy?

My experience with practicing from a psychodynamic perspective started very early on in my psychotherapy career. I was provided with a world class education in psychodynamic therapy from Smith College. I didn’t know Smith’s reputation for training clinicians in psychodynamic therapy, nor how to practice from that lens. Eight years post graduation and I have found a deep appreciation for this therapeutic process. So much so, that it is precisely what the title of my blog is about. I hope that this post translates well to those seeking therapy services and to providers alike. 

What is psychodynamic therapy? 

Psychodynamic therapy is a byproduct of psychoanalysis, (think Freud and Jung) and has wide applications for therapy today. Psychodynamic therapy embraces a client-centered approach allowing the client to explore anything they are experiencing in the moment. We can touch on family dynamics or discuss past experiences all within the same session. Those who interview with a psychodynamic approach embrace flexibility. The goal of this type of therapy is to process areas of internal conflict and repressed or subconscious emotions. Expect a lot of Socratic questions. 

Analyzing past experiences and shedding light on behavioral patterns allow for clients to better understand and adapt their current relationships, behavior patterns, and emotional experience. This way of interviewing allows the therapist to better understand the person they are working with, not just their symptoms. Additionally, it allows the therapist to reflect on their own work and monitor their experiences to attune to the client. 

How Does It Work? 

The psychodynamic approach means that we treat the person as a whole and try to understand someone’s way of “being” in the world. This is done through processing transference and counter-transference within the relationship. Very simply put, transference is the way the client responds to the therapist’s support and attunement. The quality of their prior relationships and attachments in their life influences this. Counter-transference captures the therapist’s own way of being with a client based on past attachments and experiences.

Therapy is very much a two-way process because everyone brings into relationships the way that they have learned to be in the world. Recognizing that the therapeutic relationship is much like any other relationship, where two people co-create their own “space between” them, the therapist is called to attend to the relationship as being of primary importance in itself. The therapist is their own tool in this fashion, not just a facilitator of a manualized way of doing treatment.

Psychodynamic At Heart

Psychodynamic Treatment Vs. The Medical Model

Much of psychotherapeutic treatment has been perverted to just treating client’s symptoms rather than treating the person. This is partially due to pressures from health insurance and evidence-based research pressures. Purely treating symptoms would be akin to me seeing a physician for treatment for tennis elbow and the physician only taught me methods to not move that elbow so that I can cope with the pain.

Me: “It hurts when I go like this.” *extends arm* MD: “So stop going like that.” 

I absolutely find a lot of value in many evidence-based approaches, but know to my clinical core that those are only useful tools if psychodynamic practice is woven into treatment. When treating someone for depression or anxiety, I first need to know who they are and why they are. I got into this profession to understand the “why?” Of human behavior, not the “what?” Of course, appropriately assessing a client’s goals and hopes in treatment will dictate the depth and use of these reflective practices.

Again, the “Space Between” refers to this rich relationship that the therapist and client both lean into together in the murkiness of their transferential relationship. This co-creation is what carries the therapeutic weight and speaks to higher truths of what it means to be human. Every human I have ever worked with suffering from depression, anxiety, life limiting diseases, or relationship issues have all been unique experiences. This is because the space in between us (our relationship) will always be a unique melting pot of both our emotional and behavioral DNA. 

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