Yesterday's Men - How Psychodynamic Psychotherapy Uses the Past to Heal the Present

It's a truth long acknowledged, in therapeutic circles, that the things that happen in one's past form the person today. The child, as they say, is father (or mother) to the man (or woman): and the event, or the lifestyle, of our old selves is certainly parent to the he or she we have become. Often, past events, feelings and relationships are inextricably bound in present problems. Psychodynamic psychotherapy offers a practical, long-term way to deconstruct those present problems by delving into their roots, causes planted in the past.

Like most forms of psychoanalysis or therapy, psychodynamic psychotherapy is founded on principles that sound blindingly obvious. But then most things that sound blindingly obvious only do so because they are the end result of a lot of careful thinking: realisations that the rest of us think of as genius. Basically, psychodynamic psychotherapy works by trying to build a complete picture, through regression, discussion and repeated recall sessions, of the architecture of a person's emotional and psychological state. At which point, its weaknesses, or the things that are causing that person to experience problems, can be identified not just for what they are, but for why they are.

In psychotherapy, the question of "why" is often far more important than the question of "what". A physiological illness is usually treated in terms of "what" - so a bacterial infection, for example, is cured with antibiotics. What is it? Bacterial. How, then, does one cure it? Antibiotics. Psychodynamic psychotherapy addresses the more intricate question - the "why" - recognising, implicitly, that curing psychological ills must return to causes rather than effects.

A course of psychodynamic psychotherapy is necessarily a long term endeavour - generally lasting a minimum of six months. It takes time to rebuild a person's psychological history in such a way that their current mental and emotional states can be properly understood: time, and wrong turnings. It's often been said that psychology, and psychotherapy, are not exact sciences - akin to a blind man stumbling around in the dark - and with good reason. The canyons of the mind are strange and limitless and it takes patience, expertise and the ability to retract wrong steps, to navigate them.

Psychodynamic psychotherapy differs from cognitive therapy in that it looks at root causes without trying to change learned behaviours. In other words, it's a form of therapy that embraces the idea of past affecting present for the sake of understanding, rather than the sake of change - a "why" rather than a "what" or "how" therapy. Why does this person act this way? Because of things that happened in his or her psyche through childhood, young adulthood and so on. Psychodynamic psychotherapy is about helping a patient to understand his or her feelings and behaviour - not necessarily to change those feelings and behaviours, but to develop a deeper realisation of where they come from. In effect, that makes this form of therapy an almost stoic "acceptance" cure: by engaging in it, a patient can come to understand his or her self properly. It's in understanding that acceptance lies - and in acceptance that we can find peace.

John Reed, Psychotherapy Chapel Hill