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23 Things That Define Mental Health

7. The ability to assert yourself effectively and appropriately.

Psychodynamic psychotherapy, also known as psychoanalytic psychotherapy, is enjoying a renaissance. Founded by Sigmund Freud and crew, psychoanalysis was the dominant form of therapy throughout the 20th century. Its popularity waned over the years as new therapies were developed.

But now, younger therapists as well as academics (critical theory, literature departments) are rediscovering the richness and utility of psychoanalytic thinking. Research is catching up to show that it works very well and has enduring benefit that outlasts the period of therapy because it can alter one's developmental path in life and help to change personality traits and the way an individual approaches and stewards their own life.

What Is Psychoanalysis?

Psychoanalytic therapy is, at heart, simple. Per Freud’s “Fundamental Rule,” the patient (“analysand”) tries to say whatever comes to mind, without editing it—this is called “free association.” The therapist, or analyst, for their part, listens without filtering the data, without imposing a frame for interpretation, trusting unconscious processes and discipline from training and one’s own analysis and supervision.

Therapy doesn’t happen overnight for either party—it takes practice for the patient and years of practice and training for the psychoanalyst—but it creates a nonjudgmental, mindful setting for therapeutic inquiry in which developmental processes can flourish.1 The term "psychodynamic" refers to unconscious psychological and emotional processes to become aware of and make use of in the service of personal growth and well-being.

Over time, given the simplicity of the framework, patterns emerge in the exchange between analyst and analysand that reflect experiences outside of therapy, past and present, to change the future by increasing awareness and options. This is called “transference.” Psychodynamic therapy, though there are variations, essentially makes use of the transference phenomenon to catalyze developmental processes.

As problems from outside of therapy get pulled into the therapy, they can be addressed with a spirit of curiosity, self-exploration, and support. The process puts the brakes on destructive patterns outside of therapy while the work is progressing.

While the terms "psychodynamic" and "psychoanalytic" overlap, psychodynamic therapy tends to be less frequent but usually weekly, traditional psychoanalysis a few to several times per week. Psychoanalytic therapy is perhaps the broadest framework for therapy, covering pretty much everything important for personal development and comprehensive therapy (Shedler, 2010). A focus on the relationship with one's body and physical health is an important element not explicit in the following list, with the recognition that in many cases, clinically significant traumatic experiences may require extra care.

7 Building Blocks of Psychodynamic Therapy

  1. Focus on affect and expression of emotion.
  2. Exploration of attempts to avoid distressing thoughts and feelings.
  3. Identification of recurring themes and patterns
  4. Discussion of past experience (developmental focus).
  5. Focus on interpersonal relations.
  6. Focus on the therapy relationship.
  7. Exploration of fantasy life.

The Pros and Cons of Open-Ended Therapy

Psychodynamic therapy is organic and open-ended, in some ways demanding because there is little direction and guidance from the therapist.2 The pronounced personalization can be a pro and a con, depending on what is needed and by whom.

Psychodynamic therapy generally requires individuals to be inclined to self-reflection, interested in working on meaning, and able to use psychological understanding to see strengths and opportunities in oneself. As a result, many other forms of therapy have been developed that provide more structure and direction3 and have a more circumscribed focus, including CBT, DBT, and EMDR, among others. Psychodynamic therapy does not typically press people to make changes, which can be helpful for some and problematic for others—and always worth exploring.

    Defining Mental Health

    Measuring the outcome of therapy is also challenging, but psychologists Shedler and Weston developed a scale (2007) based on careful examination of therapeutic processes, reflecting what people need in various areas of personal development and how therapists and patients understand successful psychotherapeutic experiences. Based on years of research and development of a consistent rating system, the Shedler-Weston Assessment Procedure (the SWAP-200), identifies 23 elements defining mental health.

    Of course, not all the factors are present for all people, and they aren't intended to set unrealistic expectations. Nevertheless, the majority of the factors will resonate with many readers, though not all elements will be a fit for everyone. A mentally healthy person:

    1. Is able to use their talents, abilities, and energy effectively and productively.
    2. Enjoys challenges; takes pleasure in accomplishing things.
    3. Is capable of sustaining a meaningful love relationship characterized by genuine intimacy and caring.
    4. Finds meaning in belonging and contributing to a larger community (e.g., organization, church, neighborhood).
    5. Is able to find meaning and fulfillment in guiding, mentoring, or nurturing others.
    6. Is empathic; sensitive, and responsive to other people’s needs and feelings.
    7. Is able to assert themself effectively and appropriately when necessary.
    8. Appreciates and responds to humor.
    9. Is capable of hearing information that is emotionally threatening (i.e., that challenges cherished beliefs, perceptions, and self-perceptions) and can use and benefit from it.
    10. Appears to have come to terms with painful experiences from the past; has found meaning in and grown from such experiences.
    11. Is articulate; can express self well in words.
    12. Has an active and satisfying sex life.
    13. Appears comfortable and at ease in social situations.
    14. Generally finds contentment and happiness in life’s activities.
    15. Tends to express affect appropriate in quality and intensity to the situation at hand.
    16. Has the capacity to recognize alternative viewpoints, even in matters that stir up strong feelings.
    17. Has moral and ethical standards and strives to live up to them.
    18. Is creative and able to see things or approach problems in novel ways.
    19. Tends to be conscientious and responsible.
    20. Tends to be energetic and outgoing.
    21. Is psychologically insightful; is able to understand self and others in subtle and sophisticated ways.
    22. Is able to find meaning and satisfaction in the pursuit of long-term goals and ambitions.
    23. Is able to form close and lasting friendships characterized by mutual support and sharing of experiences.

    Seeking Help

    Much depends on fitting the patient with the therapy type and, moreover, seeing which conditions respond to which interventions, and recognizing the critical role of the fit between therapist and patient (the “therapeutic alliance”). In spite of much infighting among different therapy schools, many see the effectiveness of therapy hinging on several "common factors," with additional value accruing from specific areas of focus and ways of working.

    Regardless, it is clear that there is a great unmet need for mental health care, with legislation, public awareness, and the healthcare system lagging behind but beginning to respond with greater vigor. Making sure therapists are well-trained and grounded in sound principles is mission-critical.

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    References

    1. The Flourishing Scale identifies 8 items present in those living fulfilling lives:

    I lead a purposeful and meaningful life.

    My social relationships are supportive and rewarding,

    I am engaged and interested in my daily activities,

    I actively contribute to the happiness and well-being of others,

    I am competent and capable in the activities that are important to me,

    I am a good person and live a good life.

    I am optimistic about my future.

    People respect me.

    2. One of the shortcomings for the field of psychodynamic therapy has been less of a tendency to conduct outcome research. While there is a massive body of literature extending back to the 1800s, the majority of the papers and books are on theory and case examples. In recent years, researchers interested in psychodynamic therapy have been more active, and it is becoming clear that the evidence for psychodynamic therapy is at least on par with other therapies.

    3. Cognitive behavioral therapy (CBT), for example, looks at how thought patterns can be shifted through intentional effort, often using assigned homework. Dialectical behavioral therapy (DBT), initially developed to treat borderline personality Disorder, specifically trains people in mindfulness practice, distress tolerance, emotional regulation, and interpersonal skills, recognizing that getting stuck in either-or thinking impedes progress; it offers a dialectical view instead, one in which polarities can be understood on a continuum and there is room for differing perspectives. There is also acceptance and committment therapy (ACT), EMDR (eye movement desensitization and reprocessing (EMDR), internal family systems (IFS), motivational interviewing (MI), compassion focused therapy) (CFT), and and array of others.

    Citation: Shedler J. The efficacy of psychodynamic psychotherapy. Am Psychol. 2010 Feb-Mar;65(2):98-109. doi: 10.1037/a0018378. PMID: 20141265.

    Shedler, J., & Westen, D. (2007). The Shedler–Westen Assessment Procedure (SWAP): Making personality diagnosis clinically meaningful. Journal of Personality Assessment, 89, 41–55.

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