Chapter 9.Psychodynamic Psychotherapy

Psychoanalytic and psychodynamic theories are fundamental to modern psychiatric practice, including addiction treatment. Although some investigators have argued that psychodynamic treatment has only a minor role in the treatment of substance abuse (Vaillant 2005), others have shown how psychodynamic understanding can add depth to work with individuals and groups, further the rehabilitation process (Dodes and Khantzian 2004; Frances et al. 1989; Khantzian and Albanese 2008), and increase the usefulness of 12-step programs (Dodes 1988). For many patients, self-medication with addictive substances plays a part in the move to dependence. Relapsing patients understand better what affects they are seeking, but alternative approaches to relief from suffering are of help to patients. In a transtheoretical integrated treatment model, understanding of psychodynamic principles can be used by the therapist to help the addicted patient recognize that he or she has a problem and then to identify what might provide effective motivation for that individual to change. This approach helps patients in actualizing their wish to change by helping them move along the continuum from contemplation of a problem, such as smoking, to contemplation of the need for change, to taking action and then maintaining abstinence. In addition, memory and transference from past relationships into the current therapeutic interaction are an inevitable part of the treatment process, and understanding one’s resistance to treatment is a tool for change.