What is “Psychodynamic Psychiatry”?

Psychodynamic psychiatry is a new discipline that has emerged from a fusion of psychoanalytic and extra-psychoanalytic psychology, neuroscience, and academic psychiatry. This new discipline is trying to take root in a difficult intellectual environment. Neither organized psychiatry nor organized psychology presently advocates for the usefulness of paradigms that integrate biological, psychological, and social influences on behavior. Psychodynamic psychiatry does precisely that.

In the consulting room, practitioners of psychodynamic psychiatry are attentive to the discourse of the patient, considering how the stream of thought and affect reveal meanings and inner conflicts of which the patient may have little or no awareness. Yet these meanings and conflicts influence symptom formation and character (unconscious process). The psychodynamic psychiatrist wishes to learn what influences from the past result in foundational attitudes observed in the patient's relationship with others, including the psychiatrist (transference). How does the patient ward off painful affects (defensive structures)? Does the patient idealize or devalue aspects of self or others? How does the patient wrongfully endow others, or feel endowed by others, with positive or negative attributes (projective mechanisms)? Can dreams, slips of the tongue, boundary crossings and administrative entanglements be explored fruitfully? How does the psychiatrist feel about the patient (countertransference)—and how can that experience be turned to the patient's benefit? These and other questions and concerns integrated with an appreciation of biological and cultural influences form the prism through which the psychodynamic psychiatrist regards the patient, always with an eye to symptom relief and, often, to a beneficial revision of the patient's personal narrative and sense of self.

Psychodynamic treatments are based on assessment which is carried out from a developmental perspective. Particular attention is paid