I worked for years in treatment settings where therapy was short-term, goal-oriented, and focused on teaching patients “tools” and “coping strategies” to use immediately. This approach to treatment is primarily associated with cognitive-behavioral therapy. I have been trained in this and similar approaches — Dialectical Behavioral Therapy, Acceptance and Commitment Therapy, and Pain Reprocessing Therapy, to name a few. You may have encountered this kind of therapy in the past, or have heard that it’s the most “scientific” and “evidence based” of available psychotherapies.

I was offering this kind of treatment, but I didn’t entirely believe in it.

For one thing, I believe that people are more than a collection of symptoms to be diminished. I believe that the form that our suffering takes has meaning, and that it is important to not rush into “getting rid” of our suffering. Often, the efforts we make to “get rid” of our symptoms can cause more problems than our actual distress — for instance, drinking alcohol every night to deal with anxiety. Rather than helping people to “get rid” of their suffering, which seemed like an impossible task, I wanted to help people live better, even when they were suffering.

For another, my patients rarely had cookie-cutter problems that we could resolve with just a few handouts or thought-challenging techniques. Many of my patients were coming to me with problems that, at first glance, seemed highly irrational and self-defeating, such as eating disorders and substance use problems. I found that it wasn’t enough with these problems to just “change one’s thoughts” or logic oneself out of self-sabotage. The fact of the matter is, many of us act in ways that go against our self-interest, and even knowing that, we continue to act in these ways! Cognitive and behavioral approaches seemed to me to deal too much with the logical and rational part of the brain — the part that was being sabotaged to begin with — whereas more and more I was convinced that we are not entirely rational beings. We are also emotional, ambivalent, embodied, divided, paradoxical creatures. I wanted to be able to address those sides of our selves in therapy too — not just our rational brains.

Finally, when looking for my own therapist, I never sought out cognitive-behavioral therapy for myself. Neither did most of the other therapists that I knew. We knew that it was unlikely that we could significantly change ourselves with just a few simple tools (or we would have done it already, after all). We wanted therapy that was deep, effective, and long-lasting, where we could learn more about ourselves and how we functioned in the world, at work, and in our relationships with others. We were looking for psychodynamic psychotherapy.

Psychodynamic psychotherapy draws from psychoanalysis — think Sigmund Freud, think Woody Allen, think therapy patients lying on a couch. While I don’t ask my patients to lie on the couch, and I’m not trained as a psychoanalyst, I use an approach to therapy that emphasizes how past experiences and relationships shape our present reality. Psychodynamic psychotherapy is characterized by a stance of curiosity and exploration, not by dogmatism or the therapist knowing the one right way to approach a problem. Psychodynamic psychotherapy is highly individualized, and I spend a lot of time trying to get to know and understand my patients deeply before suggesting anything to them. I see my role as helping a person develop greater curiosity into their own experience, so that the narrative that they tell about themselves is richer and more complex than when they entered treatment. Often, this kind of therapy is associated not only with a reduction in what we would consider “symptoms,” but also in an expanded ability to tolerate a wider range of emotional experiences — to bear what was previously believed to be unbearable.

Contrary to what you may have read about or heard from other therapists or doctors, cognitive-behavioral therapies are not the only evidence-based therapies! There is ample and growing evidence that psychodynamic psychotherapy is effective for a wide variety of patients presenting with a wide variety of concerns.

It remains to be said that I adjust my work based on the patient. Some of my patients come to me using substances that are dangerous for them, or altering their bodies through eating disorders, or with frequent thoughts of suicide. I address any risky behaviors early and frequently in our work together, and have ample training in risk assessment, harm reduction, and safety planning. I do not hesitate to switch to a more behavioral approach to treatment when people’s lives or well-being are seriously at risk. I will often recommend complementary care, such as collaboration with a psychiatrist, primary care physician, or dietician, in addition to our work together.

If my approach sounds like a good fit for you, or if you want to learn more, please get in touch.