What Is Dynamic Psychiatry?

Dynamic psychiatry (shorthand for “psychodynamic psychiatry,” the two phrases used interchangeably here) is an approach to understanding, diagnosing and treating psychiatric disorders. As with most concepts that apply to mental health and the complexities of dealing with the mind, dynamic psychiatry is difficult to reduce down to a one sentence definition. Psychodynamics is defined in the American Heritage Dictionary as “the interaction of various mental or emotional processes, especially when they are considered as constituents of a system of interrelated forces.” Dynamic psychiatry, then, is an approach to psychiatry in which the understanding and appreciation of those various processes and interrelated forces are considered to be fundamental to effective diagnosis and treatment. Dynamic psychiatry includes an appreciation of biochemical and environmental forces as a part of the overall makeup of a person’s condition and treatment.

Misconceptions and Questions about Psychodynamic Psychiatry

There are many commonly misunderstood aspects of psychodynamic psychiatry and its theoretical foundations within psychoanalysis. These misconceptions and partial truths exist for a variety of reasons; some of the more common notions are mentioned here, with some attempt at corrective clarification.

Misconception:
“Psychodynamic therapists dwell on the past and don’t really help with the present.”

Reality:
While dynamic therapists understand that early relationships and experience are very important in the shaping of the individual, this does not mean that they ‘dwell’ on prior events, or encourage their patients to do so. Dynamic therapy is self-directed by the patient, with the belief that whatever is troubling the patient will surface in the therapy setting. In fact, dynamic therapists could most accurately be seen as drawing primarily on the present, because they focus first and foremost on what is happening in the here-and-now of the therapeutic relationship, and view the understanding derived from that relationship as central to the helpfulness of the therapy.

Misconception:
“Psychodynamic therapists just listen; they are mostly silent and don’t really say anything helpful.”

Reality:
It is true that most psychodynamic therapists place a high priority on active and effective listening, but they also actively express themselves when they feel it will be helpful to the overall process of therapy. These expressions include an emphasis on the relational interaction between therapist and patient, as well as the therapist’s understanding and interpretation of the patient’s behavior and thought content, and the therapist’s reaction to the patient.

Misconception:
“Dynamic therapy focuses almost exclusively on sexuality and unconscious processes: abstractions that may be interesting but generally unhelpful.”

Reality:
While it is true that psychodynamic models utilize an understanding of unconscious processes and innate drives, these are not fairly characterized as the “exclusive” focus. It is more accurate to describe these concepts as a “backdrop” or “framework” within which greater understanding can be achieved.

Psychodynamic and psychoanalytic models do place great importance on the power of innate drives such as sexuality, aggression, and the tendencies to attach to and relate to others. Understanding the roles and influence that these inherent forces play within a person’s individual life situation, development, and symptoms is often an important aspect of improved functioning and symptom relief.

Misconception:
“Psychodynamic psychiatry tends to ignore biological and chemical factors and the potential usefulness of medication.”

Reality:
The vast majority of psychodynamically-oriented psychiatrists do prescribe medications to their patients for symptom relief as part of the overall treatment plan. As noted above, an appreciation of and attention to psychodynamic issues includes the role of neuro-scientific and biochemical aspects of illness and treatment.

Suggested Readings

Engel, GL: The clinical application of the biopsychosocial model. J Med Philos. 1981 May;6(2):101-23.

Erikson, EH: Childhood and Society. New York, W.W. Norton & Company, 1950.

Gabbard, GO: Psychodynamic Psychiatry in Clinical Practice, 4th Edition. Washington, DC, American Psychiatric Publishing, 2005.