HMN 2024: How Psychodynamic Therapy Can Help You Heal from Trauma

Written by guest author and SelfWorks psychologist Nina Bakoyiannis

Trauma refers to experiences that threaten your safety in the world. They are distinct from everyday conflict because they evoke a deep sense of terror and helplessness, fear of bodily harm, or worry for survival. This can include surviving a natural disaster, car accident, or sexual assault.

Complex trauma refers not to isolated incidents, but traumatic experiences that build across the lifespan and often involve caregivers. According to recent statistics, roughly 1 to 8 percent of the population has complex post-traumatic stress disorder (PTSD) (Maercker et al, 2022).

There has been a push to utilize evidence-based psychotherapies (EBPs) for treating trauma. EBPs are time-limited, manualized treatment protocols that are aimed at changing the maladaptive thoughts or behaviors that arise from trauma.

Such treatments, such as prolonged exposure therapy and cognitive processing therapy, gain the title “evidence-based” because they go through randomized control trials. These research studies compare a group of individuals who go through an EBP program to a group that receives no treatment to highlight that the therapy group produced greater PTSD symptom relief.

However, creating the label “evidence-based” for only these therapies can give a false impression to the public that other types of therapy, such as psychodynamic therapy, do not have evidence or efficacy. Psychodynamic therapy may be more challenging to fit into an RCT study since it does not follow a manual and is not time-limited. Yet many have studied the efficacy of psychodynamic therapy through comparable measures and find it to be highly effective for the treatment of trauma (Lampe et al., 2014: Britvi? et al., 2006; Levi et al., 2015).

Here are 5 ways psychodynamic therapy can uniquely help with trauma:

1. The value of the therapeutic relationship

The first step of psychodynamic therapy is establishing safety. A persistent sense of dread and mistrust can linger following trauma, making it difficult to feel safe in the world. For example, a person raised in an explosive household may learn to scan for signs of danger in everyday interactions, leading to a feeling of hypervigilance.

This type of therapy uses the therapeutic relationship, or the relationship that develops between client and therapist, as a vehicle for change. The empathy and security you feel with your therapist can allow you to internalize the deeper sense of safety within yourself that allows the therapy to unfold.

2. Studying what is readily available and what is unconscious

A hallmark of psychodynamic therapy is bringing to light what is unconscious. Everyone is driven by thoughts, impulses, and desires that do not immediately show themselves. By naming this unconscious material in therapy, you are freeing yourself from being ruled by patterns and impulses that you previously did not have language to describe.

Among the most natural reactions to trauma is a desire to avoid thinking of or being reminded of the experience. However, trauma can still impact the way you feel about yourself, others, and the world around you. Avoiding does not stop trauma from haunting us; it only disguises the impact. With your therapist’s help, you can look more closely at your unconscious experiences of trauma and how they affect your behavior.

3. Understanding how the past unconsciously influences current behaviors

We all use past experiences to gauge future outcomes. If your past includes trauma, it can feel impossible to imagine things turning out differently. You may start behaving or thinking in ways to respond to past traumas instead of the current moment, without even recognizing you are doing so.

As an example, a person who experienced neglect as a child might unconsciously sabotage their schoolwork or career by procrastinating, repeating a narrative of failure they internalized years ago. While these traumatic past memories live on in hazy fragments, they still inform behavior.

Psychodynamic therapy prioritizes safely and gently facing these memories. Through this, you can begin to understand how the past may inform your present actions in order to take control of your narrative.

4. Improving relationships with understanding and change

As you begin to feel closer to your therapist, themes in your relationships with others may emerge in the therapeutic space. If your upbringing was filled with others who have inflicted harm, you may then start to expect your therapist to behave similarly to the critical, demanding, or abusive figures in your life. Someone who felt abandoned by a parent may unconsciously expect the therapist to abandon them too, and start to act in ways that test the therapist’s commitment. Psychodynamic theory calls this transference.

The therapist’s calm and supportive demeanor in response to the client can reshape their expectations. This is called a reparative emotional experience. Psychodynamic therapy provides an opportunity to work through these relational challenges in vivo. By doing so, you gain insight that encourages greater flexibility in interpersonal relationships.

5. Integrating repressed emotions and self-states

If you were exposed to trauma as a child, it can impact your sense of self in adulthood. As an example, abused children sometimes push away parts of themselves in an attempt to cope with threatening situations and maintain some sense of safety.

If expressing needs, sadness, or dependence was met with ridicule or harm, for example, expressing such in adulthood can feel dangerous or shameful. Pushing away parts of yourself that were unacceptable to caregivers in order to survive is the defense mechanism of repression. As such, you may now experience yourself as fragmented, you may have difficulty accessing these emotions, or even regard yourself as helpless, out of control, or “broken.”

The reparative emotional experiences in therapy can heal these parts of yourself. You can begin to internalize the therapist’s voice to replace your inner critical voice learned from caregivers long ago. You can recognize and nurture all the various parts of yourself that once remained hidden, and integrate them into a more unified sense of self.

Conclusions: Creating Meaning and Fulfillment

Psychodynamic therapy goes beyond symptom reduction (Shedler, 2010). It teaches you how to truly know yourself and hold space for the complexities of the human condition, by unlocking unconscious, untapped material that was previously unknown. It can provide insight into all the helpful or unhelpful ways your experiences have shaped you in order to create meaningful and lasting change.

Psychodynamic therapy is an opportunity to be witnessed, seen, and understood by another person so that you can be more comfortable sitting with yourself. It can allow you to process these traumatic experiences, so you no longer block them out or allow them to rule over your life entirely. Trauma becomes simply part of a larger memoir that you will continue to write.