What is psychodynamic therapy?

With roots in traditional psychological theories by Melanie Klein and Sigmund Freud, psychodynamic therapy draws on the principles of object relations, self-psychology, and ego psychology. The psychodynamic approach to talk therapy was initially developed as an alternative treatment to psychoanalysis. It was designed to be less time-intensive, with a shorter duration and fewer sessions.

Psychodynamic therapy is similar to psychoanalytic theory in that it is an in-depth form of therapy to guide people to better understand themselves and what is going on under the surface. Psychoanalysis, which happens 4-5 times a week, tends to focus strongly on the fine details of how people relate to their therapist, others, and themselves. While it does that too, psychodynamic therapy does this to a lesser degree.

As a form of psychotherapy or talk therapy, psychodynamic therapy aims to address the foundation and formation of psychological processes and emotional distress. With the help of psychodynamic treatment, clients can improve mental health symptoms, navigate interpersonal problems, focus on their strengths and goals, and live more fulfilling lives.

Core Principles of Psychodynamic Therapy

In psychodynamic therapy, therapists help clients gain insight into their daily lives and present-day mental health concerns. Psychodynamic therapy focuses on the psychological roots of emotional suffering. It helps clients engage in self-reflection and self-examination.

Essentially, the patient-therapist relationship, or therapeutic alliance, encourages patients to dive into problematic relationship patterns, behaviors, and beliefs in their life. During therapy sessions, psychodynamic therapists evaluate thinking and behavioral patterns that clients have developed over time. Although the structure of psychodynamic therapy will vary depending on the psychotherapist, most psychodynamic approaches involve:

• Focusing on the affect and expression of emotions. With the help of open-ended questions, transference, and free association, the psychotherapist helps the patient explore and discuss the full range of their feelings, unconscious conflicts, and conscious thoughts. The therapist helps the patient put words to feelings, including feelings that are difficult to acknowledge.
• Exploring attempts to avoid distressing thoughts and feelings. Knowingly and unknowingly, patients develop defense mechanisms and unconscious processes to avoid painful thoughts and feelings. Psychodynamic therapists actively explore these attempts.
• Identifying recurring themes and patterns. Psychodynamic therapists work to identify recurring themes in patients’ life experiences, interpersonal relationships, thoughts, and feelings. Sometimes, a patient may be aware that these patterns and unconscious thoughts are self-defeating but feel unable to overcome them. In other cases, the patient may be unaware of these patterns until the therapist brings them to light.
• Discussing past experiences. Therapists explore early-life experiences, the relationship between the past and present, and how past experiences may shape the patient’s current feelings, thoughts, and beliefs. Ultimately, psychodynamic therapists aim to help patients overcome these past experiences and live in the present.

What should you expect during psychodynamic therapy?

Psychodynamic therapy sessions involve a collaborative approach between you and your therapist. During your first session, your therapist will ask about your medical and mental health history, whether you’ve attended therapy before, and what you’re looking to achieve in psychotherapy.

With help from your psychotherapist, you’ll feel encouraged to speak openly about anything that comes to mind, including current mental health issues, fears, dreams, and urges.

The goal of psychodynamic therapy is to help clients increase self-esteem, recognize their abilities, gain self-awareness, and communicate more effectively with their significant others. Psychodynamic theory assumes that chronic problems are rooted in the unconscious mind, and patients must bring these problems to light to experience relief. Thus, the client’s self-awareness is integral to discovering these unconscious patterns of thought and understanding how past experiences shaped them.

In many cases, clients may experience ongoing improvements after psychodynamic treatment has ended. Although brief psychodynamic therapy is sufficient for some individuals, others may find that long-lasting benefits come from long-term psychodynamic therapy.

Who can benefit from psychodynamic therapy?

Even if you’re not living with a mental health condition, you can still benefit from psychodynamic therapy. It is used to treat anxiety, mood disorders, including depressive symptoms and bipolar disorder, relationship problems, and work and career problems. It is also used to treat other serious mental health conditions, especially among individuals who have lost meaning and experience difficulty maintaining interpersonal relationships.

Research has shown that psychodynamic therapy can effectively treat substance abuse and addiction problems, social anxiety disorder, eating disorders, and post-traumatic stress disorder (PTSD). Psychodynamic therapy can also help clients cope with painful feelings, low self-esteem, and unresolved conflicts by exploring past experiences.

Is psychodynamic therapy effective?

According to extensive research, psychodynamic psychotherapy is an effective treatment for a wide range of psychological disorders, including anxiety disorders, depression, substance abuse, and stress. Even in brief-form psychodynamic therapy, the benefits of it continue to grow after treatment ends, according to new research published by the American Psychological Association.

In the study, American psychologist Jonathan Shedler, Ph.D., reviewed eight meta-analyses comprising 160 studies of psychodynamic therapy, as well as nine meta-analyses of other therapeutic approaches and medications, to demonstrate the efficacy of psychodynamic therapy. Dr. Shedler focused on effect size, which measures the amount of change produced by each type of treatment.

In one major meta-analysis of psychodynamic therapy, 1,431 patients with a range of mental health conditions demonstrated an effect size of 0.97 of overall symptom improvement. When researchers re-evaluated patients nine months after treatment ended, the effect size increased by 50 percent, reaching 1.51.

In his research, Dr. Shedler also noted that previous studies have not adequately captured the benefits that psychodynamic therapy aims to achieve. “It is easy to measure change in acute symptoms, harder to measure deeper personality changes. But it can be done.” Dr. Shedler concluded that when other types of therapy, such as cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT), are effective, it may be due to unacknowledged elements of psychodynamic theory.

In sum, Dr. Shedler’s research finds strong evidence that psychodynamic therapy is highly effective, and its benefits keep building over time, even after treatment has stopped.

How To Find a Psychodynamic Therapist

A psychodynamic therapist is a licensed mental health professional with advanced training in psychodynamic perspectives, Freudian psychology, and psychoanalytic theory.

Some psychotherapists take different approaches to utilize psychodynamic theory, for example, by combining elements of psychodynamic therapy with other types of psychotherapy. Alongside the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), some therapists also use the Psychodynamic Diagnostic Manual (PDM), rooted in psychodynamic theory, to assess mental health.

In addition to finding a mental health professional with training in psychodynamic therapy, it’s essential to search for someone you feel comfortable opening up to. Therapy is an intimate experience, and finding the right psychotherapist can make all the difference. According to the American Psychological Association, forming a therapeutic relationship can boost the success of your treatment, leading to better long-term psychological outcomes.

To find the right fit, reach out to a psychodynamic therapist through the Therapy Group of DC. Whether you’re living with painful feelings or looking to improve your interpersonal relationships, we’ll connect you to a mental health professional you feel comfortable with, in keeping with your personal preferences and requirements.

We know that reaching out for help can feel daunting, and we offer guidance every step of the way. One of our compassionate counselors, psychologists, or therapists will help you gain insight into your mental health and live a more fulfilling life.