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In years past a lot of stress-related illness was treated with psychoanalysis. It is used much less today. This therapy often involved seeing a therapist several times a week and was a very thorough exploration of everything in the patient’s life and psyche, sometimes taking years to be completed. We mostly don’t have the time or resources for this nowadays, life being as rushed as it is. But if your problems originate very clearly from early on in your life and fail to respond to briefer interventions, you may be recommended this form of therapy, in somewhat more streamlined form. This is called brief focal therapy, which summarizes it pretty well, as it focuses primarily on the aspects of your experience and current mental functioning that underpin your problems.

Psychodynamic therapists tend to be less active and directive than cognitive therapists. They see their role as helping you to find your own recovery rather than delivering it to your door. Metaphorically, if your mind is a dark forest and you are lost in the middle of it, a cognitive therapist will lead you out by the shortest route, while the psychodynamic therapist will merely suggest some interesting directions to take, holding your hand as you start to walk in that direction and pointing out landmarks along the way.

CBT gets you out quicker, but exploratory therapy gives you a more thorough understanding of the forest.

The tools used include working through; that is, looking at and re-experiencing events and their attendant feelings. The key to this is repetition. The therapist will take you over the same ground time and again, looking at it from up and down and this way and that. Thus the bottled-up feelings are released and understood. Transference refers to the powerful feelings that the client will tend to develop towards his therapist, which tend to reflect feelings that have been engendered in him by other pivotal people in his life. These can then be looked at, explored and worked through, freeing him from the vulnerability that he has to situations and people that resurrect these feelings. This is the phenomenon of resonance: the way in which any experience that isn’t worked through at the time is stored up and then added to any experience in the future that your mind links to it, because they are either similar or symbolically similar to each other.

From your point of view, what is needed is honesty and openness with your therapist and avoidance of acting out. This is the opposite of talking in (therapy). For example, if you have problems with anger which lead you to be referred to a therapist, you could road rage on your way to the session, driving on the bumper of the car in front, shouting, beeping your horn, making rude gestures and generally being a pest. By the time you get to your session, your anger will have dissipated and there will be nothing real to work on, except in theory. If, on the other hand, you don’t road rage, you’ll arrive at your session with green smoke pouring out of your ears owing to the silliness of your fellow road users. Now, there is real live emotion, in the session, fuel for the therapy to work on.

Talk in; don’t act out. Insight into your issues, their origins and the defence mechanisms which you have used to get by, but which now are harming you, are also important elements of this type of therapy, but it is not an end in itself. Understanding your issues doesn’t make them go away unless you have also worked them through.

While the evidence for the effectiveness of this type of therapy for stress-related conditions isn’t as strong as that for CBT, it can be a powerful tool for change in some.