Often, when people seek therapy, they want help with anxiety, depression, stress, and/ or anger. However, these feelings have typically originated in interpersonal situations and/or are maintained in relationships. Old and familiar approaches to try to solve the problem (e.g., to protect oneself from rejection or abandonment) now seem to result in making things worse. The solution has become the problem. How does this come about? What can be done to fix this?
An interpersonal-psychodynamic approach focuses on identifying and tracking the Cyclical Maladaptive Pattern which has four components as shown in the example below of a fictional client, Anna, who seeks therapy for depression and unsatisfying relationships.
- Acts of self: Anna feels she works hard as an employee, wife, and mother. She would like others to appreciate her efforts and be caring towards her but has difficulty asking for her needs directly.
- Expectations of others: Although hopeful that her work will be noticed, Anna worries that others will take her for granted.
- Perceived acts of others: Anna finds that others are complementary and offer help, but leave her to “do the heavy lifting”.
- Self-image and self-treatment: Anna feels alone and disrespected. She feels resentful and depressed.
How does interpersonal-psychodynamic therapy work? Binder (2004) outlines three main features:
- Interpersonal pattern recognition: Anna learns through therapy that her strong focus on others is also protective in that she doesn’t have to expose her own vulnerabilities when she is helping others. She also fears that she will be rejected and seen as weak if she asks for help. Through therapy, Anna starts to see that she is unwittingly “teaching” others to rely on her for support. She learns from the support of her psychologist that her fears of rejection make sense although she can also be challenged.
- Self-observation: Anna pays closer attention to when she feels a strong urge to be helpful, particularly when she isn’t sure her help is actually needed.
- Reflection-on-action (using self-observation to change behaviour in the moment): Anna takes a risk to “don’t do something, just stand there” and realizes that her relationship doesn’t suffer. Further emboldened, she takes risks to ask more directly for support.
How effective is interpersonal-psychodynamic therapy?
The effectiveness of psychodynamic therapy has been demonstrated over a number of rigorously designed studies, covering a range of conditions and populations (Schedler, 2010) .
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