Psychodynamic Therapy in the Treatment of PTSD

A number of treatments, including cognitive-behavioral and psychodynamic therapy, have been developed to help people recover from the effects of post-traumatic stress disorder (PTSD).

If you're seeking treatment for PTSD symptoms, it's important to understand the difference between the two forms of therapy. Get the facts on both with this review.

Types of Cognitive-Behavioral Therapy

Cognitive-behavioral therapies for PTSD are based on the idea that problems arise as a result of the way people interpret or evaluate situations, thoughts, and feelings, as well as the problematic ways these evaluations cause people to act (for example, through avoidance).

Examples of cognitive-behavioral therapies for PTSD include:

• Acceptance and commitment therapy
• Behavioral activation treatment
• Cognitive processing therapy
• Exposure therapy
• Stress-inoculation training

Psychodynamic Psychotherapy

Psychodynamic approaches to PTSD focus on a number of different factors that may influence or cause PTSD symptoms, such as:

• Early childhood experiences (particularly our level of attachment to our parents)
• Current relationships and the things people do (often without being aware of it) to protect themselves from upsetting thoughts
• Feelings that are the result of experiencing a traumatic event (these "things" are called "defense mechanisms")

Unlike cognitive-behavioral therapy, psychodynamic psychotherapy places a large emphasis on the unconscious mind, where upsetting feelings, urges, and thoughts that are too painful for us to directly look at are housed. Even though these painful feelings, urges, and thoughts are outside of our awareness, they still influence our behavior.

For example, they may lead you to avoid starting a relationship with someone, because the relationship could bring up some of these painful feelings. Therefore, just as with cognitive-behavioral therapy, psychodynamic therapy also wants to bring about changes in behavior. It is just that the road it takes to get there is different.

How Psychodynamic Therapy Works

Bringing about a change in symptoms or behavior requires getting in touch with and "working through" those painful unconscious feelings. To do this, the psychodynamic therapist will assist the patient in recognizing the defense mechanisms being used, what they are being used for (to avoid painful feelings in the unconscious mind stemming from a traumatic experience), and connecting with and appropriately releasing those feelings and thoughts that were previously being avoided.

For example, over several sessions, a psychodynamic therapist may notice one of the following defense mechanisms:

• Disavowal: When a patient is denying the extent to which a traumatic event has impacted their life. This common defense mechanism may be used to protect people from something that they don't have the ability to cope with.
• Displacement: When a patient is expressing anger and putting blame on family members even though they haven't done anything to deserve it. In this case, the therapist may interpret this behavior as a sign that the patient is actually upset with and blaming herself for the traumatic event. Since this anger and guilt is too difficult to cope with, it is expressed toward others.

In both of these cases, the therapist would interpret the patient's behavior and share this interpretation with the patient.

Studies on Effectiveness of Psychodynamic Psychotherapy

Psychodynamic psychotherapy for PTSD has not been studied as extensively as cognitive-behavioral therapy for PTSD. Of the studies that have been conducted, though, it has been shown that psychodynamic psychotherapy can have a number of benefits.

For example, studies of psychodynamic therapy for PTSD have shown that after therapy, people report improvement in the following:

• Interpersonal relationships
• Fewer feelings of hostility and inadequacy
• More confidence and assertiveness
• Reductions in PTSD symptoms and depression

Which Type of Therapy Should You Use?

The answer to this question is really based on your personal preference. Both cognitive-behavioral therapy and psychodynamic psychotherapy can have benefits for someone with PTSD.

Cognitive-behavioral and psychodynamic therapists, however, take different approaches to the treatment of PTSD, and some people may prefer one approach to the other.

Therapy is going to be the most effective if you buy into the approach and have a good relationship with your therapist. So it is important to shop around and find the best fit for you. You can find PTSD treatment providers in your area through UCompare HealthCare as well as the Anxiety Disorder Association of America.