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  • Chapter 8 - The Overall Structure of Psychodynamic Therapy

  • from Part 2: - The Model of Psychodynamic Psychotherapy into Practice
  • Adam Polnay, The State Hospital, Carstairs and Royal Edinburgh Hospital, Edinburgh, Rhiannon Pugh, Victoria Barker, East London NHS Foundation Trust, London, David Bell, British Psychoanalytic Society, Allan Beveridge, Royal College of Psychiatrists, London, Adam Burley, Rivers Centre, Edinburgh, Allyson Lumsden, NHS Greater Glasgow and Clyde, C. Susan Mizen, Devon and Exeter NHS Foundation Trust, Exeter, Lauren Wilson, Royal Edinburgh Hospital, Edinburgh
  • Foreword by Nancy McWilliams
  • Book:
    Cambridge Guide to Psychodynamic Psychotherapy
    Published online:
    25 August 2023
    Print publication:
    10 August 2023, pp 128-150

  • Summary

    It is one of the remarkable but also unsettling characteristics of psychodynamic psychotherapy that its course is not rigidly predetermined; this allows things to emerge in therapy that neither the therapist nor patient could have anticipated. What focus the work takes and what therapeutic approaches are most useful for each patient need to be found out along the way. This does not however mean it is impossible to give direction or that there is no structure to therapy. In this chapter, we aim to provide orientation to clinicians who are embarking on their first courses of therapy. We integrate theory and technique to offer a longitudinal perspective on how matters can play out over a course of therapy. Firstly, we discuss the formation of the therapeutic alliance and the development of a psychodynamic formulation. The central part of this chapter looks at the therapeutic relationship as a vehicle for change. Finally, we discuss the late phase of therapy and the dynamics of separation from the therapist, and how this can be both a challenging but productive period.