THE TRUTH ABOUT THERAPY: IT’S ALL GOOD (AND WHY I PRACTICE PSYCHODYNAMICALLY)

CBT, EMDR, ACT, MTOU*… Trying to choose between different kinds of therapy can feel like drowning in alphabet soup. Each one claims to be effective – sometimes even the most effective – and is backed by passionate practitioners (and nowadays, its share of TikToks).

If you’re considering therapy, you might be wondering:

-          Do I need a specific type of therapy for my particular problems?

-          Which type of therapy is the best one for me?

-          What if I pick the wrong type of therapy?

These are all valid questions.  And analysis paralysis is a thing!  We’re afraid of missing out on the “best” when it comes to tacos, the quickest route to work... so why not where it comes to our therapy?

Luckily for us, it turns out that basically all types of therapy work about equally well (Wampold, et al., 1997).  This finding is so well-known in psychology that it has its own name: the “Dodo Bird Verdict.”** What seems to matter most is the relationship between therapist and client; when people feel understood, respected, and supported by their therapist, their work together is more likely to succeed – regardless of what kind of therapy is used (Horvath & Symonds, 1991; Flückiger, et al., 2018). 

This may be disappointing for fierce adherents to a particular approach, but it’s great news for the client!  Or at least, it allows us to stop wondering “which therapy is best” and focus on “How do I find a great therapist?”***

 

WHEN YOU SAY ONE THING BUT MEAN YOUR MOTHER

Connection matters most, but the approach used needs to click for both as well. Here's why I choose to practice psychodynamically.

As a kid, I loved asking “why?” Of all the approaches, Psychodynamic theory is the one most interested in finding answers to my favorite question.  It’s aimed at helping us understand the deeper “why” behind our actions and patterns, as opposed to focusing solely on symptoms or on the present.  Don’t get me wrong: if you’re suffering, alleviating distress is key!  And being present is important!  It’s why a good therapist knows how to aim for both understanding and symptom reduction.  But if you have a leak in your ceiling, putting down a bucket will only work for so long; you need to figure out why the leak is there in the first place and fix it.  More on that later.

Research shows that psychodynamic therapy works (Shedler, 2010), leads to lasting change (de Maat, et al., 2009) and even promotes continued improvement after therapy ends (Leichsenring & Rabung, 2008).  So if you’re someone who thinks “why bother cleaning this corner of my room when I don’t have time to clean the whole thing” or if being criticized by a teacher or a boss instantly triggers rage and defiance in you, and you wonder why am I like this?  …Psychodynamic therapy might be a good fit for you. 

At its heart, Psychodynamic therapy works through four Big Ideas:

1) Our unconscious mind influences us in powerful ways.

Your mind is like a computer with too many tabs open in the background – some from weeks ago, some playing audio from a video you can’t even find.  You’ve forgotten about most of them, but they’re constantly draining your battery and slowing everything down. Our goal is to close the unnecessary ones by bringing them into our awareness – by “making the unconscious conscious” – so your mind runs smoother and you can focus on what actually matters.

 

2) Our early experiences shape who we are in the present.

Ever have a big reaction to something minor and think, why did that get to me so much?  Often, it’s because the situation poked at something old – something that started way before this moment. The way you connect with others, your emotional triggers, the stuff that makes you anxious for no obvious reason… these often trace back to earlier feelings and experiences. Understanding these origins helps you stop ghostwriting your past into your present so you can respond in the now with more awareness and choice.

 

3) You keep having the same relationships over and over again. 

Do you keep dating the same person, having the same fights, or feeling the same frustrations with friends, and romantic partners? It’s not a coincidence.  Your early experiences – how your parents responded to you, what you learned about expressing emotions, how conflict was handled in your home – created a blueprint you (consciously and unconsciously) continue to follow in all your relationships.  Including the one with your therapist! When they emerge during a session, we have a unique opportunity to pause and look at it together in real time – like breaking the fourth wall of your own life.

 

4) Your defenses are outdated survival tactics.

You push people away before they can leave you.  You refuse to ask for help because you’re fine, really. You drive uncomfortable emotions so deep you barely feel them anymore.  These strategies once protected you in tough situations, but now they just keep you stuck, limiting your growth or damaging your relationships.  By recognizing them for what they are, you can stop fighting battles that ended long ago, or exchange old, worn-out tools for new ones.

 

YOU DON’T WANT THE BOOBY PRIZE

Understanding ourselves is powerful… but it’s not always enough. Recognizing your past patterns is one thing; actually changing them is another. This is why in Maybe You Should Talk to Someone, Lori Gottlieb called insight the “booby prize of therapy.” Insight without action doesn’t do much – change is the real goal.

Psychodynamic theory offers tools for this, as well.  While Freud focused on understanding the past, his colleague, Alfred Adler, believed we didn’t have to be its prisoner. Instead of stopping with “why do I do this?” Adler also asked, “Why do I keep choosing to do this?  What purpose does this behavior serve now?”

One of my clients, Aubrey,**** struggled with procrastination as a screenwriter.  Through our work together, we traced this back to criticism from her mom about her childhood writing (“if that’s good enough for you, I guess it’s fine”). But more importantly, we explored how her procrastination was serving her in the present: if she never wrote, her work could never be criticized and she could never fail (it could never be praised, or be a success, either).  Once Aubrey saw this, she was able to start making the conscious choice to take risks and put her work out there where it belonged – being read by others.

This is why many modern therapists, myself included, don't stick rigidly to just one approach. A Cognitive Behavioral Therapist (CBT) might help someone with anxiety challenge their thoughts; an Acceptance and Commitment Therapist (ACT) might encourage accepting the anxiety while focusing on meaningful activities; a psychodynamic therapist might explore how anxiety relates to past experiences and relationships.  But an effective therapist knows when to mix and match strategies to create the most effective plan – like a chef who knows the classical technique but isn't afraid to blend styles to create the best dish for each diner.

 

SO WHAT’S THE BEST MODALITY?

By now, I hope you have the answer: it’s the one that makes sense to both you and your therapist, helping you to build that essential therapeutic connection. If you’re intrigued by exploring your past to change your future, and curious about the deeper patterns in your life, psychodynamic therapy might be a great fit. But whatever approach you choose, make sure you feel comfortable with your therapist and their style. That combination - more than any specific technique - is what makes therapy work.

 

TO LEARN MORE ABOUT THE MOST COMMON THERAPY MODALITIES, view the glossary on my FAQ page (https://www.sethwagermanphd.com//s/f/most-common-types-of)

FOR FURTHER READING on psychodynamic and Adlerian therapy, read “Maybe You Should Talk to Someone” (Gottlieb, 2019) and “The Courage to Be Disliked” (Kishimi and Koga, 2013). 

*MTOU: Made This One Up!

**In Alice in Wonderland, the Dodo bird declares everyone has won and deserves prizes. So as well for therapy, it seems.

***...Remind me to write this sometime.

****"Aubrey” is a composite example with identifying details changed to protect client confidentiality.