Psychodynamic Therapy: Clinical Examples


To illustrate how psychodynamic therapy works, below are examples or clinical vignettes of three different individuals with a similar problem, lateness or tardiness.

These vignettes were designed to illustrate the therapeutic process and a similar problem was chosen for each vignette intentionally to highlight the
unique meaning and motivation that a single issue or symptom may hold for each person. The cases are disguised amalgamations to protect client privacy and confidentiality.

Psychodynamic Therapy Vignette 1
A man comes to therapy stating among other issues that he has been late to several recent job interviews though not to other meetings or appointments. He is in the process of attempting to advance his career and being late to interviews is sabotaging his success.

The therapist and client discover that trying to advance his career evoked deep feelings of insecurity and fears of failure. While being late for interviews did effectively sabotage his success, it was easier for him to write this off in his mind as a relatively minor problem around time-management, safeguarding the idea in his mind that he was otherwise capable of and deserving of a promotion. It allowed him to avoid giving his full effort to obtain a promotion and to avoid suffering the associated risks of rejection and failure, which he imagined would be much more devastating than the relatively minor embarrassment of rejection based on his lateness. Once this was brought more into his awareness through therapy, he gradually became better able to recognize and work through his insecurities and confidence issues, which in part had roots in his relationship with his father, freeing him to advance his career.

Psychodynamic Therapy Vignette 2
A woman comes to therapy stating that she is chronically late and has done everything that she can to change this through a variety of organizational tools and methods but to not avail. Her tardiness is interfering with her work and relationships.

The therapist and client discover that being early or even on time put her at risk of waiting for the person that she was meeting. Waiting evoked uncomfortable needful feelings, especially when she was waiting for someone on whom she was reliant. This in part had roots in traumatic experiences in her childhood around being forgotten by her parents and having to wait for them: in those situations she had felt helpless, frightened and dependent. With the help of her therapist, she gradually grew to tolerate her needful and dependent feelings and with that, no longer needed to eliminate these feelings either by being late or through other problematic behaviors.

Psychodynamic Therapy Vignette 3
A man comes to couples therapy with his wife and among other issues reports that over the past few years he has developed a habit of being late specifically when meeting or going places with his wife.

The therapist and clients discover in couples therapy that the couple developed relationship difficulties during the same period that he began to be late when meeting his wife. One way that the relationship problems manifested was in their sex life. His wife had lost interest in sex leading him to feel rejected and angry about waiting helplessly for his wife’s interest to return. He turned his experience with his wife around, quite unconsciously, by developing a habit of lateness with her. This effectively put his wife in his shoes making her feel devalued while longing for and waiting helplessly at the hands of another. As these dynamics were brought into more awareness in the couples therapy, the underlying feelings gradually could be thought about and expressed productively in words instead of problematic actions.

Summary
These three vignettes convey how a common problem of lateness can hold unique unconscious motivation and meaning for different individuals.
Through these examples you might be better able to grasp what psychodynamic therapy is based on and get a sense of how it works. Click here to go back to the overview of psychodynamic therapy.