Emerald’s approach has roots in psychoanalysis…what does this mean?

If you’ve read this far into Emerald’s website, you’ve seen the words psychoanalysis and psychodynamic thrown around. If you are wondering what exactly these words mean, you’re not alone.

Psychoanalysis was first conceptualized by psychiatrist Sigmund Freud in the early 1900s as both a theory of how the mind works and a method for exploring the subconscious. At the core of psychoanalysis is the belief that all behavior and thought is driven by unconscious thoughts, feelings, drives, desires, and memories. In the 1950s, John Bowlby and Melanie Klein expanded on this belief by adding that these unconscious processes are heavily influenced by our early childhood experiences, particularly the mother-infant relationship. Through several groundbreaking research studies in human behavior over the last century, pioneers in psychology, therapy, and neuroscience have contributed to a collective understanding that our past is always present and is a driving force of our adult functioning. Psychodynamic therapy is a way of exploring all of the moving parts that create who we are. 

Pop culture and media have represented therapy by showing patients laying across a couch while a therapist sits silently in the corner taking notes. While this is slightly more aligned with how traditional psychoanalysis is conducted (no, you don’t have to lay down), psychodynamic therapy is more interactive and utilizes the relationship created between therapist and client to understand and help the client. This requires the therapist to be present and use their presence with the client as a therapeutic tool. l I frequently check in with my clients about how they’re feeling about me and our relationship and, sometimes, they are brave enough to tell me when something’s not working for them -- which I so appreciate. Often, their feelings about our therapeutic relationship parallel their thoughts and feelings about their relationships outside of therapy. Through open communication, honesty and vulnerability — facilitated largely by the security and safety of a client-therapist alliance — we can work through these thoughts and feelings together. The end goal of this process is for the client to eventually apply this experience to their life outside of therapy, tolerating and navigating relationships in healthier and more authentic ways. 

In the last twenty years or so psychodynamic work has sadly taken a backseat to the widely used Cognitive Behavioral Therapy (CBT) but not because it’s any less effective. There is a vast amount of research and studies demonstrating the effectiveness of psychodynamic and psychoanalytic work. The only reason it’s been downplayed in recent years is due, in part, to Big Pharma. In the 1980s and 90s, insurance companies looked to evidence-based techniques and medication to justify the reimbursement of therapy services. Essentially, if there wasn’t clear data that showed direct correlation between short term therapy and patient progress, they weren’t going to pay for it. This is a sad injustice not only to the countless clinicians and researchers who have dedicated their life’s work to the field, but also the general public and consumers of mental health services.

Humans aren’t a straight arrow and CBT skills aren’t a one-size-fits-all intervention. In fact, studies have concluded that CBT and short term therapies, while evidence-based and effective, do not last over a long period of time. This means that if the CBT skills aren’t reinforced after a client ends therapy, they’ll most likely fade away and symptoms can resurface. In contrast, psychodynamic therapy integrates skills and relational work that supports the client long-term. I’m a big proponent of CBT, and I find that it is most effective when used in conjunction with a psychodynamic approach. The long-term nature of this work isn’t in Big Pharma’s financial interest, but it’s at our expense when insurance giants skew the public perception of what works by denying reimbursement for a century old practice that is indeed evidence-based.