Psychodynamic Therapy For Trauma

The words trauma, therapy and psychotherapy have been used increasingly in our day-to-day semantics. Some events that occur in our lives affect our mental health, often labelled as being traumatic. But what is trauma? And does therapy work? And how does therapy work? 

Well, if this intrigues you, you are in the right place! Let's delve into trauma and therapy, the two Ts that pervade our conversations.

What is trauma?

Trauma is an overwhelming experience that exceeds one's ability to cope, resulting in a significant impact on an individual's psychological, emotional and, sometimes, physical state of being. It could be a singular event, an accident or assault; or, it could be a prolonged experience such as abuse or prolonged exposure to stressors.¹

Trauma is complex in its manifestations; some are explicit and identifiable while some are subtle and cumulative - rooted in early developmental stages. Some may be evident harm to one's being, while others may be subtle erosions of one's sense of safety and stability.¹

The result of trauma pervades every aspect of an individual's being, with mental health taking the biggest hit in most cases. The symptoms of trauma are complex too: ranging from anxiety, depression, and isolation, to more severe signs such as dissociation and suicidal ideation. Trauma can change the brain, shaping individuals’ cognitive processes, thought patterns, and beliefs about themselves and the world around them.²

Understanding trauma and its unique manifestations in every individual is therefore vital to addressing and managing its repercussions. Trauma-focused psychotherapy is one of the effective treatment modalities due to its focus on exploring the unconscious. As we proceed, we will examine what psychotherapy is, how it works and its limitations in the transformative journey of trauma recovery. 

Psychodynamic therapy: a brief overview

A little bit of history

Sigmund Freud, famously known as the father of psychoanalysis, laid the groundwork for psychotherapy in the late 19^th century. His ideas focused on the unconscious mind, defence mechanisms, and the role of early childhood experiences in shaping an individual's psyche. As the field evolved, his contemporaries further studied and refined psychodynamic concepts. Carl Jung, Alfred Adler, and Melanie Klein were a few names significant in shaping our understanding of psychodynamic theory as practised today.³

The core principles, however, are based on the role of the unconscious mind. Unconscious processes significantly influence thought processes, feelings and behaviours. The goal is for the individual to gain awareness of their deep emotions and the root cause of their symptoms. The process is a collaborative journey of self-discovery; establishing a safe and trusting space for the individual to explore the vulnerable parts of their psyche in therapy.³

The application of these principles in trauma depends on individual experiences. This warrants a strong commitment to address challenges from the individual and the therapist. Some therapeutic techniques for trauma are discussed further.

Uncovering the unconscious: application of psychodynamic therapy to trauma

Exploration of unconscious processes

Traumatic experiences often give rise to thoughts, emotions and behavioural patterns that remain outside the conscious as the individual does not have the bandwidth to deal with them at that moment. Psychodynamic therapy provides a supportive space to explore these vulnerable parts of the psyche.

Techniques such as free association, allow individuals to express thoughts without censorship, allowing the therapist to identify and address patterns of emotions that might stem from a particular traumatic period. These patterns may reveal unconscious narratives that influence current patterns of behaviour and belief systems that profoundly impact an individual’s life.⁴

Role of early experiences in trauma

Therapists often delve into the dynamics of attachment and interpersonal relationships of an individual to understand how any disruptions may contribute to trauma-related symptoms. By unravelling the connections between the past and the present, individuals are empowered to understand the roots of their distress, facilitating recovery. This could also provide a deeper insight into their relationships and experiences that played a crucial role in their lives.⁴

Some specific techniques are mandated to ensure that all these processes occur in a safe space. Some of them are discussed below.

Psychodynamic techniques

Free association

Central to psychodynamic therapy is the technique of free association. An unfiltered discussion in a safe, non-judgmental space where the brain is allowed to wander freely is the cornerstone of understanding patterns in thoughts and emotions. The trained therapist facilitates a deeper discussion about the patterns in the individual’s thought processes allowing them to understand themselves better.⁵

Dream analysis

Psychodynamic theorists believe that dreams are windows to the unconscious psyche. Traumatic events may manifest in dreams as symbolic representations of how they affected the individual during the event. Therapists skilled in dream analysis can decode the language of dreams, unveiling hidden meanings and providing insight into the impact of trauma on an individual’s psyche.⁵

Transference and countertransference

This treatment strategy involves a level of role-play. Individuals project past emotions and experiences onto the therapist as a part of the transference process. Countertransference refers to the therapist’s emotional reactions, providing additional insights into relationship dynamics.

By navigating these processes, therapists and individuals collaboratively uncover underlying patterns and emotions linked to trauma. This enhances the therapeutic process, fostering a deeper understanding of the individual’s internal world, and contributing to the healing journey. This makes the therapeutic relationship vital.⁵

Therapeutic relationship

Building trust and rapport

Establishing a strong therapeutic relationship is fundamental in psychodynamic therapy for trauma. Trauma survivors may have experienced serious breaches of trust in their past relationships and may rely on the therapeutic relationship for a safe space.

Building trust involves an empathetic approach, active listening, and a genuine commitment to understanding the individual’s unique experiences. Consistently building the relationship empowers individuals to find the courage to confront traumatic memories and lay the groundwork for healing.^4,5

Importance of secure attachment

Traumatic experiences affect individuals’ attachment styles. By providing consistent support and maintaining a healthy therapeutic relationship, therapists help individuals repair and strengthen their interpersonal relationships and establish clear social boundaries. A secure therapeutic allows individuals to challenge their negative belief systems and resilience to growth.^4,5

Critiques of the psychodynamic approach

While psychotherapy has provided positive outcomes in trauma treatment, some critique has been made of its extremely subjective nature. Since the healing process relies heavily on the therapist's understanding of the individual's experiences and the nature of the therapeutic relationship, it may be difficult to ensure a positive outcome in each person's journey.

Individuals may have to change therapists until they form the relationship that is most conducive to their healing. To address this, therapists often consider integrating psychodynamic therapy with other approaches like cognitive behavioural therapy, mindfulness-based intervention, and trauma-focused therapies and medications.⁴

FAQs

Is psychodynamic therapy effective for trauma?

Yes, psychodynamic therapy has shown effectiveness in addressing trauma by exploring unconscious processes, and early experiences, and fostering a therapeutic relationship. Studies have highlighted positive outcomes in treating complex trauma using psychodynamic approaches.⁶

What are the 4 techniques of psychodynamic therapy?

Four key techniques in psychodynamic therapy include free association, dream analysis, transference, and countertransference. These methods help individuals explore unconscious aspects, uncover repressed memories, and understand relational dynamics.

What is the best treatment for complex trauma?

The best treatment for complex trauma often involves an integrative approach. Psychodynamic therapy, alongside evidence-based practices like cognitive-behavioural therapies and trauma-focused interventions, provides comprehensive support.

Who is a good candidate for psychodynamic therapy?

Psychodynamic therapy is suitable for individuals seeking insight into their emotions, relationships, and unresolved issues. It is beneficial for those open to exploring unconscious processes and building a trusting therapeutic relationship.

What questions do psychodynamic therapists ask?

Psychodynamic therapists may ask about emotions, childhood experiences, dreams, and relationships to explore unconscious patterns. Questions aim to uncover deeper meanings and understand how past experiences influence current thoughts and behaviours.

What should you not say to someone suffering from complex trauma?

Avoid minimising or dismissing their experiences. Instead, provide support and encouragement. Saying things like "Just get over it" or "It wasn't that bad" can be invalidating.

What are the 17 symptoms of complex PTSD?

Complex PTSD symptoms may include emotional dysregulation, difficulty forming relationships, self-harm tendencies, dissociation, and distorted self-perception. Symptoms can vary, and a comprehensive assessment is necessary (van der Kolk, 2014).

When not to use psychodynamic therapy?

Psychodynamic therapy may not be suitable for individuals seeking short-term, symptom-focused interventions. It may not be the first choice for those unwilling to explore unconscious aspects or uncomfortable with open-ended therapeutic processes.

Does complex trauma ever go away?

While healing from complex trauma is possible, complete resolution may vary. With appropriate therapeutic interventions and support, individuals can experience significant improvement in symptoms and enhance their overall well-being.

Why is trauma therapy so hard?

Trauma therapy can be challenging due to the emotional intensity of revisiting traumatic experiences. It requires a safe therapeutic relationship, patience, and a willingness to face difficult emotions for effective healing.

Summary

The impact of trauma is complex and involves a unique response from every individual. Psychotherapy for trauma is one of the most effective methods to deal with trauma due to its focus on unconscious processes in the psyche. With techniques focusing on increasing an individual’s self-awareness, the therapist establishes a safe and secure relationship to address problematic emotional patterns.

Individuals may have to change therapists until they find a therapeutic relationship that is most conducive to their circumstances. Advancements in the therapeutic approaches to trauma reveal that a holistic method is often the best way to heal.⁵