Psychodynamic Therapy Techniques for Substance Abuse

Psychodynamic Therapy for addiction treatment

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Psychodynamic therapy is a type of in-depth psychoanalysis in which the focus is on revealing an individual’s unconscious thoughts to alleviate mental tension and modify current behavior. This type of treatment is based on the theory that a person’s past shapes their future. Unconscious personal experiences have a profound effect on present mood and behavior and can potentially contribute to problems with self-esteem, relationships, and addiction.

The relationship between the client and the therapist is of paramount importance in this form of treatment. Techniques of psychodynamic therapy are adapted from psychoanalysis; however, they are less intense in terms of frequency of visits. They are conducted in the individual, group, or family setting as well as at an institutional or organizational level.

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Table of Contents:

What is Psychodynamic Therapy?

Psychodynamic therapy is a process in which the therapist examines the client’s mind in-depth and determines the effect of subconscious thoughts on the person’s current behaviors. It relies on the belief that an individual’s past actions have a direct correlation with their present behaviors. Past actions and the unconscious thought processes related to them can cause a recovering addict to perform harmful activities, which could, in turn, lead to a relapse of drug or alcohol abuse.

Experiences in the client’s past, such as unresolved conflicts or problematic relationships, can manifest in the present without the person consciously realizing it. Psychodynamic therapy is helpful for people battling substance abuse because it identifies the underlying cause of addiction. During the sessions, the therapist works through the recovering addict’s emotions in an effort to reduce the chances of succumbing to alcohol or drugs. Deep-seated reasons for using illicit substances are uncovered. The addict is taught ways to manage the impulses that trigger abuse.

Psychodynamic Therapy: Approaches, Principles, and Techniques

The key principle of psychodynamic therapy is that unconscious maladaptive beliefs (inaccurate and unsupported thoughts) develop due to past experiences and cause behavioral difficulties in daily life. During sessions, the therapist attempts to reveal and resolve the unconscious conflicts that drive the triggers for substance abuse. Some of the techniques used in psychodynamic therapy include:

  • Interpretation: The therapist examines unconscious forces and thoughts and discusses what they might indicate. This helps a recovering addict interpret conscious thoughts and actions and their effect on addiction.
  • Free association: This is a Freudian technique where the client speaks for themselves instead of repeating the therapist’s ideas. A recovering addict is asked to talk about whatever comes to mind and encouraged to discuss issues they feel strongly about. This helps develop trust between the client and therapist.
  • Transference: This involves redirection of unconscious emotions such as anger, shame, sadness, or dependency. Instead of remaining deeply buried in the addict’s psyche, feelings are transferred to the therapist. This is a unique approach that allows the therapist and the addict to analyze and explore emotions together.

Free association and transference help a recovering addict explore internalized problems and conflicts. Once the defense mechanisms are identified, the therapist helps the client work through them and develop insight to cope with triggers. The goal is to open up the individual’s psyche and develop better insight into how current actions are influenced by the past.

One of the key features of psychodynamic treatment is to study the conflict between the conscious and unconscious mind. The idea is to work through difficult memories and built strong alliances. The therapist helps to identify the defenses an individual has developed to avoid the unpleasant effects of this conflict. As the client-therapist relationship matures, past experiences re-emerge and can be analyzed.

Key Features of Psychodynamic Therapy Sessions

Establishment of trust between the client and the therapist is essential to get to the root cause of an addiction. Recovering addicts who are able to develop a deep bond with their therapist usually obtain the best results. This treatment is highly interactive and is conducted over numerous sessions, typically over a long period of time. It takes time for the therapist to discover the addict’s deepest thoughts. For this reason, treatment often takes longer than other types of psychotherapies. It is not unusual for a recovering addict to require up to three psychodynamic therapy sessions per week over a period of several years.

psychodynamic session with a womanThe ultimate aim of each session is to teach the addict a new skill to eliminate the unconscious connection between past experiences and current-day triggers for substance abuse. The therapist delves deep into the client’s psyche to reveal past-present associations. The path to recovery involves both client and therapist working together toward a life which is free from the influence of past conflicts. The goal is to get the addict to a point where they do not feel the need to use alcohol or drugs.

During a session, the therapist sits facing the recovering addict and guides them through the recovery process. The conversation involves stepping into the client’s past and determining which unconscious thoughts are affecting current behavior. A key component of the sessions is building a solid relationship in which the recovering addict is relaxed and comfortable and able to share their deepest thoughts.

Does Psychodynamic Therapy Work for Addiction Treatment?

Psychodynamic therapy is effective for people with substance abuse issues for a number of reasons. Recovering addicts get in touch with unconscious feelings and emotions they are unaware of. The therapist uncovers feelings that are buried deep in the addict’s subconscious. The addict and the therapist work through the pain these feelings bring about. The therapist teaches the addict skills to tolerate and cope with this pain.

This type of psychotherapy seeks answers to an addict’s current behaviors by delving into the past. The underlying principle is that whether we are aware of it or not, the past influences the present. By discovering the links between the past and the present, the therapist and client gain new insight into why certain behaviors occur at the present time.

In terms of substance abuse, psychodynamic therapy provides motivation to stop drug-seeking behaviors. It helps a recovering addict develop a better understanding of the unconscious thoughts that trigger harmful activities. It teaches coping mechanisms for a healthier drug- or alcohol-free lifestyle. Several studies have shown that psychodynamic therapy is a valid and effective treatment for addiction with good outcomes compared to other therapies or no treatment.

Benefits and Criticisms of Psychodynamic Therapy


  • Discovers links between the client’s past and present
  • Gives a better understanding of the reason for present-day behaviors
  • Provides motivation to stop substance abuse
  • Allows individuals to understand the root cause of their addiction
  • Available through inpatient and outpatient rehab programs
  • Teaches lifelong skills for staying sober and leading a fulfilling life


  • It is a long-term treatment and it may take years for the effects to manifest
  • Standard insurance policies may not cover this form of psychotherapy, making it unaffordable for many substance abusers
  • Some individuals are not comfortable with the deeply personal nature of the treatment
  • It does not treat current symptoms, rather it focuses on the underlying reasons for drug or alcohol abuse
  • It does not eliminate immediate risks that an addict may be putting themselves or those around them in

What Does Psychodynamic Therapy Treat?

What is psychodynamic therapy used to treat? By teaching the addict to face underlying emotions, this form of therapy lowers the chances of relapse from addiction recovery. In addition to all types of addiction, it is also useful in treating adjustment disorders, personality disorders, post-traumatic stress disorder (PTSD), anxiety, depression, and panic disorder.

During psychodynamic therapy, the focus is on developing self-awareness by probing the inner psyche. The effects of the therapy can be felt even after the formal sessions have been discontinued. This is because recovering clients learn skills to evaluate their thoughts, look into their mind, and identify the reasons for current behaviors. This skill is useful in preventing substance abuse and relapse and also in leading a generally happier and healthier life.

Attributes of a Good Psychodynamic Therapist

Trust is essential to the success of psychodynamic therapy. A good therapist is able to develop a close relationship with a recovering addict. This helps to discover unconscious feelings and their association with present-day actions. A therapist must ascertain a number of things – the level to which a recovering addict is in touch with their feelings, the unconscious emotions that are buried deep in the subconscious and must be drawn out, the effect of these feelings on the client’s behavior, and the client’s ability to cope with the pain caused by these feelings.

It is important for the therapist to tailor the psychodynamic therapy approach to the addict’s specific needs. The structure of the treatment depends on understanding the psychological thought process of the client in great depth. A strong client-therapist relationship is critical because the treatment is only effective when the client feels comfortable in frankly and honestly sharing deep-seated emotions. This open, honest communication is vital to the success of psychodynamic therapy.

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