Psychodynamic Therapy
Psychodynamic Therapy for Neuropsychiatric Disorders
Psychodynamic psychotherapy can be helpful for patients with functional neurological disorders, persistent post-concussive symptoms, traumatic brain injury, chronic pain, and coping with neurological illness. It is a contemporary evidence-based treatment that is influenced by psychoanalysis, attachment theory, and developmental neuroscience.
Principles of Psychodynamic Psychotherapy
Psychodynamic Psychotherapy typically consists of sessions 1-3 times per week. Short term treatment may be from 4-6 months. Long term treatment can last several years. Short term treatment tends to have very specific goals while long-term treatment tends to focus on personal growth and dealing with entrenched patterns of thinking, feeling and being.
In treatment, the therapist focuses on how past events and relationships have been internalized and play out in current interactions. The therapist helps the patient understand how problematic ways of thinking, feeling, and relating to others is related to earlier experiences. Therapy provides a safe place to explore those same thoughts, feelings and ways of being as they emerge in the context of therapy (transference).
The therapist helps the patient to understand how they developed ways to protect themselves from painful thoughts and feelings (defense mechanisms) and how those protective mechanisms may be causing problems for them now. Through this process, individuals become more aware of how their symptoms are affected by their relationships with others, and develop a greater capacity for self-reflection, ability to regulate powerful emotions, and understand others.
The main principles of the psychodynamic approach are:
What’s past is prologue. Past experience shapes our response to subsequent experiences.
Our subjective consciousness is unique and should be respected.
We are less aware of the motivations for our actions than we like to think (behaviors driven by unconscious drives).
Our past relationships play out in clinical relationships (transference).
Our minds have carefully developed methods to ignore what we cannot acknowledge.
Psychodynamic Psychotherapy for Functional Neurological Disorders
A psychodynamic approach to therapy can be very helpful for some people with FND. Therapy will help you to understand how your early experiences and relationships impacted you and how you express emotions. The diagnosis of FND may be confusing. You may worry you have been misdiagnosed. You may be concerned you have a serious or lifethreatening illness. You may feel very alone. You may feel broken, damaged, weak, fear you are going crazy, or that the condition is "all in your head" even though nothing could be further from the truth.
Many people with FND learned it was "better not to feel" and developed special strategies to disconnect from their emotions growing up. You may have also learned to put other people's needs above your own. You may have difficulty being able to express powerful emotions such as anger and rage. You may have difficulty advocating for your own emotional needs even if you are assertive in other ways. Failure to express powerful emotions means the brain never lets go of those emotions, and the emotional centers in the brain like the amygdala "overheat" and short circuit other brain functions leading to FND symptoms.
Psychodynamic techniques can help people with FND explore and express their thoughts and feelings in safe environment and become aware of thoughts and feelings and coping styles they may not know they had. Often there are triggers that bring on or exacerbate symptoms that are beyond awareness. Using psychodynamic techniques, individuals with FND can increase their awareness of triggers, emotional responses, and connection to their FND symptoms. This helps retrain your brain, which rewires and no longer sends signals from the emotional brain to other brain areas incorrectly. Over time, this can lead to a reduction in frequency or severity of symptoms or event complete elimination. In addition, therapy can help individuals improve their capacity for self-reflection, understanding of themselves and others, assert for their own emotional needs, and banish unhelpful ways of coping that may have been adaptive earlier in life, but have outlasted their helpfulness.
Psychodynamic Psychotherapy for Traumatic Brain Injury
Traumatic Brain Injury can impact physical and psychological health, change your personality, alter your identity and sense of self, and strain relationships. Following a TBI you may grieve for the loss of your health and former sense of self. Everything may seem much harder. You may fear you have lost yourself and that things will never get better. You may worry about losing people closest to you. The circumstances that led to your TBI may be traumatic and continue to haunt you.
For many people, time and a safe place to feel heard, express and make sense of confusing thoughts and feelings, and work towards understanding the new you and manage feelings of grief, sadness, loss, fear and anger, may be all that is need to forge a path ahead.
For other people, a TBI may bring up unresolved issues including past traumas. Fears of abandonment, or feelings of defectiveness, shame, or not having your emotional needs met may be stirred up by a TBI. These powerful feelings may overwhelm you and stall recovery. Psychodynamic psychotherapy can help you make sense of confusing and conflicting feelings, help you to understand who you are and what really matters to you. Over time, you will become more confident, feel safer and more secure in yourself and you relationships.
This therapy is not usually appropriate for people who have severe cognitive deficits from TBI. However many other people can benefit. A neuropsychiatrist has the benefit of understanding not only the psychological effects of TBI but also how the brain injury itself can impact emotions, thoughts and behaviors. Dr. Datta is also experienced working with patients who do have some degree of cognitive impairment or language problems and modifies therapy appropriately. However, in the most severe cases, this kind of therapy may not be helpful.
Psychodynamic Psychotherapy for Coping with Neurological Illness
Most people coping with serious neurological illnesses can benefit from supportive psychotherapy interventions. This includes having a safe place to talk about the emotional impact of your diagnosis and what it means to you. Being heard, and receiving empathic validation, reflection, and thoughtful questioning can be very powerful and healing. A good therapist will also provide context for your experiences and emotions and be able to normalize and communicate the universal nature of some of those feelings so you feel less alone.
For some people, the impact of neurological illness is more hard hitting. You may feel very vulnerable, defective, worry your partner will leave you, or experience an existential conflict. You may be overwhelmed by feelings of grief, sadness, worry, panic, shame, anger, or aloneness. Some of this may be related to the traumatic nature of some symptoms (e.g. seizures) or medical procedures. Some of this may be related to how other people have responded to you. And some of it will be related to how you've processed your illness based on your own past experiences. In these cases, psychodynamic therapy can help you make sense of your conflicting feelings and become more aware of your deepest fears and desires. By confronting these, you can begin to conquer overwhelming feelings, make sense of your past, and feel more confident living your best life with a serious or chronic illness.