Psychodynamic Psychiatry

Psychodynamic Psychiatry is a mode of outpatient psychiatric care that attempts to understand, in a mutually collaborative manner, the deeper meaning underlying a particular patient’s presenting problems. Psychodynamic psychiatrists do not believe in panaceas or magic cures. We understand that the symptoms people tell us about are “over-determined” and “multiply complex.” That means that there is no single explanation for any particular psychiatric illness, and hence, likely, no single treatment. It means that one must look at the hidden causes, often rooted in unconscious cognition and the psychosocial milieu, of manifest symptoms. It means that although medications can often help, they are rarely the only solution. There are often psychological and psychosocial reasons for failure to respond to medications, and sometimes combinations of medicines added out of frustration and prescriber anxiety can do more harm than good. And finally, it means that each individual’s presentation is defined by their unique life narrative, their distinctive childhoods, their idiosyncratic developmental histories, medical histories, family histories, genetic predispositions, and the pattern of their relationships both past and present that are laid down in neural circuitry. A psychodynamic psychiatrist must hold this complexity in mind, rather than selectively focusing on only one aspect of the patient when creating an individualized treatment plan unique to a particular patient.
What makes us unique is the combination of memories, early life experiences, relational patterns, dreams, and imagination stored in our brains. For years, neuroscientists thought that these pathways in our brains were set in stone after we matured. But now it has become clear that these roads are under constant construction throughout our lives. Our neural pathways adjust themselves constantly to record and adapt to new experiences. Who we are depends on where we have been, who we have loved and who we have lost; and how we have processed those experiences, consciously and unconsciously. For some of us painful memories can linger like an open wound, affect our relationships and hinder us from becoming who we want to become. But through a psychodynamic therapeutic process, a psychiatrist can help a patient access and modify some of those memories and problematic patterns in a way that they can reclaim their lives and transform their sense of self. This is not an easy process and requires both the patient and the therapist to work hard together. It requires an earnest and honest commitment to the work of therapy.

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