Breaking Bad News

The Essentials of Psychodynamic Psychotherapy

Jerald Kay, M.D.

Abstract: Psychodynamic psychotherapy, in all its forms, is the psychotherapy most frequently provided by psychiatrists. Psychodynamic therapy is useful in long-term, short-term, supportive, crisis intervention, and group/family

CLINICAL SYNTHESIS

therapies, with patients of all ages. Patients hospitalized in psychiatric as well as medical-surgical services can also benefit from a clinician’s psychodynamic orientation. The effectiveness and efficacy of psychodynamic psychotherapy are supported by a growing literature. This article describes and discusses the clinically useful tenets of the psychodynamic view and the attractive explanatory power the approach offers regarding behavior, motivation, and adaptation. Central psychodynamic techniques, such as constructing useful interpretive interventions and ensuring a patient’s emotional and physical safety by establishing professional boundaries, are reviewed. Psychodynamic psychotherapy incorporates many principles of psychoanalysis. Despite the inherent challenges of developing a full understanding of psychoanalytic theory, central treatment guidelines may be distilled to provide the nonanalyst with a comprehensive system for appreciating conflict, symptoms, psychic pain, personality development, and the intricacies and power of the doctor-patient relationship. This article provides a distillation of the more useful attributes of psychoanalytic theory. Readers who are interested in an immersion in psychoanalytic theories, classical as well as more recent, such as post-Freudian ego psychology, object relations, self psychology, and interpersonal/intersubjective psychology, may consult any of numerous sources (1–5). predicated on the physician’s ability to provide a safe forum for examining psychological problems, feelings, and behaviors by maintaining an open, nonjudgmental, and empathic rapport with the patient. • The past experiences of both...