What is psychodynamic therapy?

A brief overview of psychodynamic therapy

It is important to understand that the psychodynamic approach is a way of carrying out talking therapy, based on a set of beliefs, and understanding of the human mind and experience. However, it is traditionally less intense than formal psychoanalysis. In psychodynamic therapy, you work collaboratively with your therapist, whereas in psychoanalysis the therapist tells you where they think your issues lie.

As this type of therapy is complex, it often involves longer-term work. It was developed by the Austrian neurologist Sigmund Freud in the late 19th century, who believed that all present issues have their roots in childhood. So, if you are entering psychotherapy, you should be ready to talk about your upbringing and your family in detail.

In this type of therapy there is lots of focus on the relationship between the therapist and the person entering therapy, for example, how learned behaviors from other key relationships play out in the therapy room and how observing this can help a person to grow. ^{[2] [3] [4]}

You will also explore how your mind works, for example, the associations you have with things and how you interpret your own and others’ behaviors and actions. Psychotherapy acknowledges that these associations will come into the therapy room through transference, both for you and your therapist, so it is important to understand how and why this is happening. ^[5]

What is the goal of psychodynamic therapy?

The main aim in psychotherapy is to understand the connection between your unconscious processes and your actions. This involves examining your emotions, your interpersonal relationships, and your thought patterns.

A key goal is also to learn what to do about these connections, as recognizing them alone might not change how you are feeling. You will work with your therapist on your resilience and ways to deal with hard situations in your life in a way that takes these connections into account.

The idea in psychodynamic therapy is that by understanding what is going on in your unconscious mind and achieving greater self-awareness, you will be able to tackle your own emotional discomfort and the situations causing it with greater clarity. A key part of this is examining issues you might have been suppressing or avoiding addressing, so that you can move towards emotional fulfillment. ^[6]

While it might take some time in psychodynamic therapy before you see a difference, you should gradually feel more equipped to tackle emotional discomfort and find that it is less intense and overwhelming. Many people find that they continue to improve even after they complete psychodynamic therapy.

What is psychodynamic therapy used to treat?

Psychodynamic therapy is used to treat a wide range of mental disorders, including depression and anxiety, and is particularly recommended for people who have experienced their symptoms for a long time or not made progress through other treatments.

Psychodynamic therapy can also be a good treatment option for eating disorders, addiction, loneliness, self-esteem issues, unexplained physical health problems that might be rooted in the person’s mental health, sexual difficulties, and relationship problems.

Some experts do not believe psychodynamic therapy can cure mental health problems, it simply helps to provide relief from symptoms and empowers people to understand themselves, change their behaviors and make more informed decisions.

A 2010 study which reviewed evidence from other studies on the effect of psychodynamic therapy on depression, found that it was similarly effective at producing positive outcomes for people with this diagnosis to other talking therapies. It also found that these positive outcomes tended to be longer lasting than with other forms of therapy. ^[7] 

Although this type of therapy and its originator, Sigmund Freud, have occupied a prominent position in the development of talking therapy, many of Freud’s ideas are now discredited and seen as controversial. It is, however, still widely used and understood to be an effective type of therapy especially if combined with other approaches that have been studied at length. ^[8]

What are common psychodynamic techniques?

Most types of talking therapy are based on a set of beliefs or theories about human behavior, which are then tested through different techniques. A key belief in psychodynamic therapy is that many issues are rooted in childhood and the unconscious mind.

Some of the techniques that your therapist might work with you on include:

Transference

In psychodynamic therapy, there is an understanding that both you and your therapist will bring your life experiences and other relationships into the therapy room to some degree. This means that both of you are likely to ‘transfer’ feelings onto the other person that are influenced by things or people outside of the therapy room.

For example, for some people their therapist might come to represent a safe parental figure that they never had, but this means they begin to project their ideas of parenthood onto them. There is nothing wrong with this, but a skilled psychodynamic therapist should be aware of it, address it and use it to look at the person’s understanding of relationships and the world around them.

When the person does this, it is called ‘transference’ and when a therapist does it, it is called ‘countertransference’. Similarly, the therapist should be aware of when their therapeutic relationship with the client is being influenced by things or people outside of the room and seek advice about how to deal with it through clinical supervision. ^[9]

Interpretation

This technique is used in formal psychoanalysis, as well as by therapists using a psychodynamic approach. In it, your therapist will prompt you to explore something you have brought up in greater detail, to help you both understand its meaning. Another way this technique can be used is by the therapist raising a memory from your time working together, to relate it to something you are raising.

In psychodynamic therapy, you might also explore and interpret the content of your dreams with your therapist, as they are often the easiest way to access any concerns in your unconscious mind. ^[10]

Free association

In this technique, you work with your therapist to talk about whatever comes into your mind, following your stream of consciousness rather than any set structure for the conversation. The idea is that this will help you to access unconscious associations and talk in a way that you might have done as a child, without any concern about how your free flow of conversation is being received.

Whichever techniques your therapist uses with you, the key underlying goal will be to understand the links in your unconscious mind and how this impacts the way you view things and your relationships.

Through applying these techniques, you should begin to approach people and situations differently, with greater knowledge of where your feelings about them are coming from.

What should you expect in a psychodynamic therapy session?

In psychodynamic therapy sessions, the person entering them should expect to lead to some extent, raising whatever they want to talk about or anything that has come to mind since their last session. Anything that has been on your mind, however mundane, might help your therapist to work with you to uncover connections in your unconscious or suppressed preoccupations. 

Psychodynamic therapists also believe that the roots of many feelings and behaviors come from the unconscious mind. A significant tool that is commonly used to access this is through dreams, so you might talk about pre-occupations or themes that come up regularly in your dreams.

You should also expect your therapist to make links between your present experiences and your childhood, so they might ask you if things that happen remind you of similar experiences or relationships in your upbringing. You might work with your therapist to see if the way you felt or behaved in a recent situation has its roots in something earlier in your life.

The key aim in sessions is for you and your therapist to work together to understand your feelings, responses, and patterns of thought.

First session

In your first session with your therapist, they will ask you what has brought you to therapy, whether you are engaging in any other support such as taking medication or attending a group for people going through similar experiences to you. You might also briefly cover your upbringing and where you are at in life now. 

They will go through a working agreement with you, which might include how often you will meet, where and when, how you will pay for the sessions, how much notice you need to give to cancel a session and in what circumstances your therapist is entitled to break confidentiality. You might also agree how many sessions you will do together before reviewing how they are going.

If you have previously experienced a mental health crisis, you might work together to agree a crisis plan that covers who you will call when this happens and any coping mechanisms you can employ.

Therapy settings

Therapy also now takes place in a variety of settings, and there is a greater diversity of therapists available. Psychodynamic therapy is often associated with an old-fashioned view of therapy, in which a person lies on a couch while another, older expert interprets your thoughts and behaviors. However, this is now a rarity; many people now engage in therapy through apps, video calls, over the phone or in their office.

How do I know if psychodynamic therapy is right for me?

It is important to understand before entering psychodynamic therapy that it is a long-term type of talking therapy and is often very intense because of its emphasis on exploring past experiences. This can lead to difficult feelings about yourself and your family, which your therapist will support you with.

Psychodynamic therapy can also be expensive, because of the length of treatment and due to the level of training and expertise needed to deliver it. Most therapists using a psychodynamic approach will suggest meeting regularly, and formal psychoanalysis can involve meeting multiple times a week.

Psychodynamic therapy focuses on talking more than doing, so it’s important to think about whether that will suit you. ^[11] If you feel ready to unpack your past experiences and believe that the root of your issues lies in them, then psychodynamic therapy could be right for you.

Many people enter psychodynamic therapy because they want to gain a better general understanding of themselves, rather than to learn how to manage a specific issue or struggle. It can still take some time to see the effects of psychodynamic therapy and some people feel things get harder before they begin to feel better, so it is important to consider this before you make a decision about whether or not it’s right for you.

What to think about before starting psychodynamic therapy

Before entering this type of therapy, it is important to consider your mental health and which type of therapy best fits what you are trying to achieve. If you have a specific diagnosis, you might want to try a type of therapy commonly used to treat it, for example, psychodynamic therapy has been proven to be particularly effective with people with persistent depression.

As you will need to be able to trust your therapist enough to open up about your childhood experiences, the role of the relationship with your therapist is important in psychodynamic therapy. Therefore, you need to ensure your therapist is a right fit for you and your needs. Many therapists offer short, informal discussions before committing to working together, which can be helpful in working out whether you feel comfortable with them.

Depending on whether you have a mental health problem and, on its severity, you might need to take medication alongside doing this type of therapy. If your therapist is not sure you can make the progress you want to with psychodynamic therapy or with them, they should recommend that you work with somebody else or try a different approach.