A New Study Validates a Key Premise of Psychodynamic Therapy

It has long been held that one of the ways psychodynamic therapy works is through the therapeutic relationship. What exactly is curative about the relationship has been a topic of considerable clinical interest over the past several decades.

Some say that the way the therapeutic relationship functions as a mechanism of change is the same across different schools of psychotherapy, or, in other words, that the therapeutic relationship as a mechanism of therapeutic change is what has been labeled a “common factor.”

In the context of a “common factors” model of psychotherapy and psychotherapy research within academic psychology in general, such a relationship is called a “therapeutic alliance.” Some have gone as far as to assert that the therapeutic relationship is the single most predictive-of-outcome factor in psychotherapy. This, in fact, is generally accepted as empirically supported.

Dodo Bird (Not really a dodo bird)

Source: Photo by Daniel Winarick

The Therapeutic Alliance in Psychodynamic Therapy

While psychodynamic therapy certainly relies on the therapeutic alliance as a source of providing good therapy, psychodynamic therapy, unlike every other name brand out there, also views the therapeutic relationship as having salubrious effects apart from this and that these are specific to specific psychodynamic approaches. The working through of emotional conflicts through dynamics between the patient and therapist has long been viewed as a key component of dynamic therapy. Much clinical literature describes enactments as key areas of interest.

More recently, psychotherapy process research has looked at what happens between patient-therapist interpersonally and how this affects therapeutic outcomes. For example, Safran et al. studied one common interpersonal process in therapy, i.e., ruptures and repairs in the therapeutic alliance, seeing conflicts, their discussion, and resolution as a positive prognostic indicator.

In more relationally oriented psychodynamic therapy (aka psychodynamic-interpersonal therapy), the gold standard for an ideal therapeutic relationship is a patient being able to express aggression to their therapist. Their therapist would be able to contain it and survive, show up for the next session, and not reject the patient, such that there is no shadow of a doubt that the therapy will continue next week.

Therapy Office

Source: Photo by Daniel Winarick

As clinicians, we tend to think it's good if the patient is able to express anger at the therapist if it can be tolerated and worked through. When it does, clinicians view this as an indicator of emotional growth, an increase in the capacity for trust, and healthier relationships.

Psychodynamic psychotherapists in general view “catharsis” in session as positive therapeutically as well. To date, no research has evaluated this central tenet of psychodynamic interpersonal therapy and relational psychoanalytic theory. However, new research out of a collaboration between scientists at a University in Canada and a University in Sweden has changed that. In a just-published article in the Journal of Counseling Psychology, they found that patients who expressed anger at their therapist in the session showed greater reductions in symptoms of depression from the psychotherapy.

School of Psychotherapy

Source: Photo by Daniel Winarick

This finding is consistent with clinical literature and provides additional empirical support not only for relational mechanisms of change in psychodynamic psychotherapy but also for specific psychodynamic hypotheses, namely the Freudian view that, albeit oversimplified, goes something like this: Depression is anger turned inward.

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