Psychodynamic therapy: What it is, how it works, and who it’s best for

Psychodynamic therapy focuses on helping individuals gain deeper insight into subjective experiences within themselves and their environment. These insights help them to relate more effectively or healthily with themselves, people around them, and their environment.

It aims to help people become more aware of the motivations for their actions as a way to help them become the person they seek to be. It allows someone to take a deep dive into the “why?” of their actions to identify self-defeating behaviors and create new ways of aligning with their ideal.

This form of therapy evolved from and is informed by Sigmund Freud’s psychoanalytic theory. But unlike traditional psychoanalysis, it’s briefer and focuses on the internal self to a lesser degree. 

What is psychodynamic therapy?

Psychodynamic therapy uses self-reflection and self-examination to explore a person’s internal motivations, feelings, desires, and needs and how each influences their behavior. 

It reveals the hidden aspects of the self that may be informing a person’s current state to empower them to take charge of their awareness, make healthier choices, and improve their life to be more enriching in the long term.

This form of therapy emphasizes the client’s perspective to help them identify the root cause of their distress and take proper steps to tackle it effectively. As aptly put in the journal World Psychiatry, psychodynamic therapy spotlights the “extraordinary human potential for dynamic self-alteration and self-correction.”

A review published in the journal American Psychologist identified seven features that make psychodynamic therapy distinct from other types of therapy. They are:

1. Psychodynamic therapy explores a client’s emotions to reach a deeper level of self-knowledge that facilitates behavior change.
2. It actively uncovers aspects of a person’s emotions that may be intentionally or unintentionally repressed because they are distressing or threatening.
3. Psychodynamic therapists collaborate with their clients to identify recurring patterns that they may not be aware of and how these “painful or self-defeating” patterns influence their thoughts, emotions, self-identity, behavior, and experiences.
4. Psychodynamic therapy looks into a person’s past experiences to reveal their impact so the client is better equipped to live more actively and intentionally in the present.
5. Psychodynamic therapy explores a person’s relationships and experiences and how they impact their capacity to respond to to their psychological needs.
6. Psychodynamic therapy uses the client’s relationship with the therapist to better understand recurring patterns or themes in their interactions with others.
7. Psychodynamic therapy encourages clients to freely express their reality and fantasies because it provides therapists with extensive information for developing appropriate interventions.

What does a psychodynamic session look like?

Generally, psychodynamic sessions are collaborative, open-ended, and conversational. The therapist will allow the client to express their internal experiences, desires, dreams, fantasies, thought processes, and fears. In turn, the therapist will ask questions to investigate and better understand the client’s unconscious mind.

The therapist may help the client explore, acknowledge, and describe difficult emotions. They’ll create a safe space that supports the unrestrained expression of the client’s inner world and all the conflicts, troubles, and pain that may be hindering them from living a more fulfilling life. This process gives the therapist information that informs strategies to rework the client’s psyche with them.

The therapist may also explore the client’s early life experiences, emotional responses, and thought patterns and how these shape their current experiences or behavior.

The overarching goal of each session is to improve self-awareness and empower the client to actively and positively participate in their present and lead a healthier life.

How long might psychodynamic therapy last?

Psychodynamic therapy can be thorough, and progress may be more deliberate. It’s not uncommon to be in psychodynamic therapy for over a year, though studies have also explored brief psychodynamic therapy and targeted psychodynamic therapy for conditions like substance use. 

Ultimately, the number of sessions varies by client. And each client’s attitude toward the presenting issue — if they feel they’ve made progress and have greater clarity and catharsis — dictates how long therapy lasts.

What type of person is it best for?

Some experts have called into question the efficacy of psychodynamic therapy, suggesting that there are not enough studies to support its effectiveness as a treatment for mental health conditions. 

Nonetheless, numerous studies suggest that psychodynamic therapy leads to improvements in cases where depression, anxiety, borderline personality disorder, substance abuse, eating disorders, panic disorders, post-traumatic stress disorders (PTSD), and other types of psychological distress are present.

Individuals who aren’t comfortable with long-term therapy or struggle with introspection may find it difficult to engage in psychodynamic therapy, says Alma member Helodia Dastiné, LMSW. Even among people for whom this may be true, a clinician trained in psychodynamic therapy can still help them explore the reasons for their inability to be curious about and explore their inner self, she adds.

Still, psychodynamic therapy is best suited for people who:

1. Have a desire to understand their feelings, beliefs, inner narratives, childhood experiences, and dreams in a more in-depth manner, says Dastiné.
2. Are more likely to solve a problem by first understanding the root cause.
3. Learn new behaviors by discussing and listening rather than doing.
4. Prefer to explore the big picture rather than zoom in on individual details.
5. Are comfortable being — or want to improve their ability to be — self-aware and introspective.
6. Are patient enough to understand that progress in psychodynamic therapy will be gradual and more deliberate.

What’s the difference between psychoanalysis and psychodynamic therapy?

Psychoanalysis and psychodynamic therapy are often used interchangeably, Dastiné says. Psychodynamic therapy is similar to psychoanalysis in that they both work to uncover repressed childhood experiences that may explain an individual’s present difficulties, Dastiné explains. Generally, they share the same goals and principles, like transference and free association, but execute their treatment differently.

Unlike psychodynamic therapy, psychoanalysis is more intensive, time-consuming, and frequent, with multiple sessions each week. In doing so, psychoanalysis creates the opportunity for both the therapist and client to get past the client’s anxieties and open them up to more in-depth processing and exploring, according to Dastiné.

Psychoanalytic therapy also requires that the therapist be a certified psychoanalyst. A therapist conducting a psychodynamic session may only need training in psychoanalysis or psychodynamic therapy. 

The layout of a therapy room is also more intentional in psychoanalytic therapy. Clients often lay on a couch with the analyst behind them, out of their line of sight, or they may sit beside the client, so the client is more comfortable expressing their thoughts, Dastiné says.

What’s the difference between psychodynamic therapy and cognitive behavioral therapy

Cognitive behavioral therapy sessions are close-ended and highly structured. Cognitive behavioral therapy usually requires the client to play a more active role in achieving their goals, whereas psychodynamic therapy focuses more on processing experiences and thoughts.

Cognitive behavioral therapy is also more action-oriented, providing the client with tools and techniques to incorporate into life outside of therapy. Therapists often assign homework and worksheets, allowing clients to practice and implement solutions between sessions.

Cognitive behavioral therapy may also be shorter, ranging from five to 20 sessions, than traditional psychodynamic therapy, which is usually slow-paced and long-term.

Psychodynamic therapy helps people explore the connections in their inner world and how they manifest in their relationship with themselves and the world around them. Although psychodynamic therapy treatment can take more time, it empowers individuals by allowing them to understand the underlying causes for their actions and use that knowledge to make positive behavioral changes.