By KAISA PUHAKKA, professor in the Clinical Psychology Department at CIIS
Psychodynamic practice is making a comeback thanks to a recent surge in empirical research supporting it (see for example Jonathan Shedler's 2010 article in APA's The American Psychologist). But far-reaching developments in the field have been quietly happening long before they caught the public eye.
Psychodynamic therapy today is indeed very different from what it was in Freud's time. In a forthcoming book, "That Was Then, This is Now: An Introduction to Contemporary Psychodynamic Therapy," Shedler details recent changes in the field. To me the most fascinating developments are the active presence of the “unconscious” and the shift from authoritarian delivery of interpretations by therapist to patient to a more collaborative work between the two as practiced in contemporary relational psychodynamic approaches. These developments open a meeting ground for psychodynamic and other holistic approaches such as existential and phenomenological psychotherapies, which rejected the Freudian theory of the unconscious. They also open the door for exchanges with spiritual traditions such as Buddhism and its sophisticated meditative techniques for deepening access to the unconscious.
Now what is it that psychodynamic therapists do? Freud used to call ours an “impossible profession,” and certainly it is impossible to answer this question briefly. Just for starters, they do a lot of deep listening, which is an extraordinary skill that's being honed throughout the training of psychodynamic therapists and usually keeps developing in depth and refinement even after formal training. It takes more than the ordinary ear to listen deeply, which is why Theodore Reik long ago named it “listening with the third ear.” Deep listening tunes not just into what the person knows about themselves but also what they don't know and perhaps don't want to know about themselves. The latter especially is important because very likely nobody ever listened to it before. It may be communicated by words not intended, by gestures and body language, and by something even more subtle and difficult to name that therapists sense to the extent that they are open to sensing it.
This takes me back to the importance of training and cultivation of the extraordinary skill of listening. For this skill to deepen, the therapists in training need to turn their “third ear” toward their own interior to learn to sense in the moment what otherwise would pass unnoticed in their response to the patient. In contemporary psychodynamic therapy, the boundary between the conscious and the unconscious is permeable, and some of what happens in the process between therapist and patient is communicated directly without conscious verbal mediation. Buddhist meditative practices, such as mindfulness-based stress-reduction, have been adapted as simple techniques for the benefit of patients in mainstream symptom reduction approaches. In psychodynamic therapy, it is first and foremost the therapists who benefit from Buddhist meditation in deepening their attunement to their own as well as the patient's interior processes.