What Is Psychoanalysis?

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Problem-focused psychodynamic therapy begins by identifying the specific problems a patient wants to change.

A psychodynamic formulation links current problems to stressors, early experiences, conflicts, and defenses.

Patients develop skills for recognizing triggers and conflicts and managing problems more effectively.

Psychodynamic psychotherapy continues to be among the most commonly practiced psychotherapeutic approaches in the United States, despite the development of several other types of therapy (Norcross et al., 2023). It is derived from psychoanalysis as developed by Sigmund Freud and many subsequent psychoanalysts and typically involves one to two sessions per week.

According to psychoanalytic theory, people struggle with conflicts about certain feelings and thoughts, such as angry, dependent, and sexual wishes. Because they anticipate these urges and thoughts may cause damage, people tend to suppress them, and they can become unconscious. However, despite being repressed, they continue to press for expression, triggering anxiety, guilt, or ways of defending against such feelings. For instance, anger can, without necessarily reaching conscious awareness, create guilt or anxiety about possibly causing harm to others. Defenses that are triggered can lead anger to be denied, expressed passive-aggressively, or directed toward oneself, causing intense self-criticism and possibly depression.

These conflicts are usually more difficult to manage and more intense if individuals had negative childhood relationships with caregivers or were exposed to painful or traumatic events. These experiences can cause even more intense feelings and conflicts surrounding anger and dependency. Parental attitudes involving judgment, criticism, or neglect can also lead to negative views of oneself and expectations of others that persist into adulthood and adversely affect mental health. Negative views of oneself and expectations of others get “transferred” from early life to present-day relationships.

The core notion of psychoanalytic treatment is that helping people to become aware of the hidden sources of their problems is a way to gain relief from them. As they become more conscious of their guilty, dependent, or sexual wishes, individuals learn to tolerate and express them more effectively, reducing shame and guilt. These conflicts also emerge with the therapist, in what is known as transference, and, therefore, can be directly demonstrated and addressed in the therapeutic relationship. For example, patients may anticipate that the therapist will be judgmental toward them when the therapist is there to help them. Guilt and shame are eased when conflicted thoughts and feelings are discussed with a therapist who is responsive, empathic, and not judgmental.

Problem-Focused Psychodynamic Psychotherapy

Psychodynamic psychotherapy is an excellent treatment, but there have been problems associated with its use. One is that the concepts have often been described in ways that are highly complex. Potential patients and even mental health students don’t always have a clear notion of what the treatment offers. One goal of my writing has been to make these concepts and clinical interventions more comprehensible and user-friendly. A second problem is that treatment can become quite unfocused; patients and therapists can lose track of what they are working on. In my approach, problem-focused psychodynamic psychotherapy (Busch 2022), the therapist and patient work to define the patient’s specific problems and maintain a focus on them. It’s important that people leave therapy understanding what these problems are and how to address them on their own.

In problem-focused psychodynamic psychotherapy, the therapist and patient work to identify the specific problems (symptoms, behavioral difficulties, personality issues, and relationship conflicts) the individual brings to treatment. The therapist then helps the patient explore the contexts, emotions, and triggers surrounding problems to better identify and address what sets them off or worsens them. The therapist and patient elaborate what is referred to as a psychodynamic formulation, or map, for understanding each area of difficulty. The formulation includes early life experiences, self-assessments, expectations of others, conflicts, and defenses that contribute to problems. This formulation is used as a framework for targeting interventions to ease the various problems and make needed behavioral and relationship changes.

For instance, Jane, a 40-year-old woman, came to therapy describing significant anxiety and depression, which her therapist identified as two major problems that needed to be addressed. On exploring the circumstances and feelings surrounding these symptoms, it became clear that they were triggered by her judgmental and pressuring boss. While some people may have been only moderately affected by comments or demands her boss made, she became deeply affected and preoccupied with them, even outside of work hours. On exploring her early life, it emerged that she grew up with a bullying father who was harsh and critical, making her feel she could never do enough to please him. Recognizing the impact of these childhood experiences helped her to understand why her mood was so affected at work, whereas her colleague Susan, while certainly not liking them, brushed off most of the boss’s comments as “being a boss.”

What Is Psychoanalysis?

Take our Do I Need Therapy?

Find a psychoanalyst near me

Another area identified as part of her formulation was her negative self-views and expectations of others that contributed to her anxiety, depression, and reactions to her boss. Indeed, before getting this job, Jane had seen herself as inadequate and expected others, even friends, to be judgmental of her. It was important to help Jane challenge these views, noting, for example, that she was quite successful professionally and socially. Furthermore, it emerged that Jane felt conflicted about and struggled to recognize her intense anger at her boss’s behavior. She tended to suppress her angry feelings and direct them toward herself. After becoming aware of her anger, she feared she might express it, causing her boss to become more critical in response. Thus, Jane feared telling her boss that she felt overworked. However, she learned from Susan that the boss was responsive when she raised concerns about overwork.

An important place to address these issues was in the relationship with her therapist, anticipating that he would be a harsh and critical authority figure. Indeed, this created an opportunity to point out how she distorted her expectations of the therapist. However, transference doesn’t occur just with therapists: Jane learned that, in general, she expected others to judge her harshly, leading to unnecessary avoidance of close relationships. After three months in therapy, her anxiety and depression were significantly reduced, and she was communicating with her boss about tensions at work.

Developing Psychodynamic Skills

In this therapy, people learn to step back, think about, and address their problems. They develop the capacity to identify contexts and emotions likely to exacerbate their difficulties and take steps to address these triggers. They learn to recognize and address the impact of their early history on their problems. They develop the capacity to identify and confront negative views and expectations they have of themselves and others. They gain the ability to recognize and manage feelings and fantasies that cause conflict and exacerbate problems. Finally, the treatment helps develop the capacity to try new forms of behavior and better manage interpersonal conflict. I refer to these abilities as psychodynamic skills.

Busch, F.N. Problem Focused Psychodynamic Psychotherapy. Arlington, VA, American Psychiatric Press, 2022.

Norcross, J. C., Pfund, R. A., & Prochaska, J. O. (2023). Psychologists conducting psychotherapy in 2022: Current practices and historical trends. Professional Psychology: Research and Practice.

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