Along with cognitive behavioral therapy (CBT), psychodynamic therapy is one of the two most used therapies to treat phobias. Psychodynamic therapy and CBT appear very similar on the surface. Both therapies rely on sessions with trained therapists and the connection that forms between patient and therapist over the course of the therapy. Moreover, both types of therapies are talk based therapies that traditionally require numerous sessions to address and treat the phobia. The main difference between the two lies in what the therapist talks with the patient about.
In psychodynamic therapy, therapists work off the Freudian assumption that the cause of phobias are repressed painful memories that are centered around the root of the phobia. For example, if a person has acrophobia (fear of heights), a psychodynamic therapist would use dream analysis and free association to recall a painful memory associated with heights that likely occurred in childhood and has since been forgotten.
Dream analysis is one tool that psychodynamic therapists use to bring repressed memories from the subconscious mind to the conscious mind. In dream analysis, a patient gives a detailed account of a recurring dream or a particularly peculiar dream they had. The therapist listens to this account and interprets the symbols from the dream to give the patient an idea about their painful memory. Psychodynamic therapists rely heavily on dream analysis as they see it as a window into the subconscious mind.
The other main tool that psychodynamic therapists use to recall repressed memories is free association. In free association, the therapist shows the patient a series of indefinite images and asks the patient to say the very first word that comes to their mind. Again, the therapist interprets the patient’s responses to the images to help the patient get an idea about their painful memory.
Many people feel that psychodynamic therapy is ineffective if the patient does not have a painful repressed memory associated with a current phobia. But psychodynamic therapists believe that all phobias stem from a repressed memory that can be a real experience that happened or simply a misunderstanding of an event or situation that the patient saw or experienced as a child. Still, not therapy is effective for all patients and in some cases, psychodynamic therapists are never able to break past a patient’s defense mechanisms to see what is causing their fear.
Psychodynamic therapists believe that once a patient fully understands the root causes of their fears, they can release these feelings safely in a process called “catharsis.” To reach catharsis, a patient typically requires about six months of treatment from a psychodynamic therapist. This time length is, in many cases, shorter than the time required for CBT and studies show that psychodynamic therapies are just as effective as CBT. One disadvantage of psychodynamic therapy is that it is newer than CBT and its effectiveness is still being tested. But recent studies suggest that the benefits of psychodynamic therapy increase with time, even after treatment has ended. This implies that the knowledge and insights gained during therapy may help patients learn psychological skills that they can master with time.