Psychodynamic therapy is an approach that involves facilitation a deeper understanding of one’s emotions and other mental processes. It works to help people gain greater insight into how they feel and think.
By improving this understanding, people can then make better choices about their lives. They can also work on improving their relationships with other people and work toward achieving the goals that will bring them greater happiness and satisfaction.
Psychodynamic therapy is rooted in psychoanalytic theory but is often a less intensive and lengthy process than traditional psychoanalysis. While psychoanalysis tends to focus a great deal on the patient and therapist relationship, psychodynamic therapy also places a great deal of emphasis on a patient’s relationships with other people in the outside world.
What Is Psychodynamic Therapy?
Psychodynamic therapy is a form of talk therapy. It is based on the idea that talking to a professional about problems people are facing can help them find relief and reach solutions.
Through working with a psychodynamic therapist, people are able to better understand the thoughts, feelings, and conflicts that contribute to their behaviors. This approach to therapy also works to help people better understand some of the unconscious motivations that sometimes influence how people think, feel, and act.
This approach to psychotherapy can be helpful for dealing with mental or emotional distress. It can help promote self-reflection, insight, and emotional growth.
By better understanding your emotional patterns and their roots, you are better equipped to manage your problems and develop coping techniques that will help you both now and in the future.
Uses
While it is similar to psychoanalysis in many respects, it is often less frequent and shorter in duration. Like other forms of therapy, it can be used to treat a variety of mental health problems.
- Anxiety
- Depression
- Eating disorders
- Interpersonal problems
- Personality disorders
- Psychological distress
- Post-traumatic stress disorder
- Social anxiety disorder
- Substance use disorders
Factors that may impact what type of treatment is used include cost-effectiveness, availability, patient preferences, and the severity of the symptoms the person is experiencing. While cognitive-behavioral therapy (CBT) is a popular and effective approach, evidence suggests that psychodynamic therapy can be just as effective for many conditions.
Online therapy is another option that you might consider. Some research also suggests that online psychodynamic therapy may be as effective as online CBT.
How It Works
Psychodynamic therapy helps people recognize repressed emotions and unconscious influences that may be affecting their current behavior. Sometimes people act in certain ways or respond to others for reasons that they don’t really understand.
Psychodynamic therapy helps people learn to acknowledge, bear, and put into perspective their emotional lives. It also helps people learn how to express their emotions in more adaptive and healthier ways.
Important Characteristics
Some important aspects of psychodynamic therapy include:
- Identifying patterns: Psychodynamic therapy helps people learn to recognize patterns in behavior and relationships. People often develop characteristic ways of responding to problems without really being aware of these tendencies. Learning to spot them, however, can help people find new approaches to coping with problems.
- Understanding emotions: Research has found that psychodynamic therapy is useful for exploring and understanding emotions. Through gaining insight into emotional experiences, people are better able to recognize patterns that have contributed to dysfunction and then make changes more readily.
- Improving relationships: Relationships with others are a key focus of psychodynamic therapy. In working with a therapist, people are able to understand how they often respond to others.
The therapeutic relationship itself can serve as a way to look into the relationships a person has with other people through a process known as transference. This gives people an immediate “in vivo” way to explore and then change their pattern of responses in order to improve their relationships.
How Effective Is It?
How effective is psychodynamic therapy and how does it compare to other forms of treatment?
Assessing the efficacy of psychodynamic therapy presents some challenges, but research does suggest that it can be useful in the treatment of a variety of psychological problems.
One reason that it may be difficult to assess the full efficacy of psychodynamic therapy is that many of the changes it produces can be tough to measure.
While it is relatively easy to measure changes in specific acute symptoms, it is much more difficult to measure underlying personality changes, noted researcher Jonathan Shedler in a press release by the American Psychological Association (APA).
Despite this difficulty, research supports the efficacy and use of psychodynamic therapy to treat a variety of conditions.
- One notable review published in the journal American Psychologist concluded that the evidence supports the efficacy of psychodynamic therapy.
- Another study found that psychodynamic therapy could be at least as effective as cognitive-behavioral therapy (CBT).
- A 2017 review published in the American Journal of Psychiatry concluded that psychodynamic therapy was as effective as other established treatments. However, the authors of the study suggested that further research was needed to determine who benefited the most from this type of treatment.
What You Can Expect
If you decide to try psychodynamic therapy, you may meet with your therapist weekly to a few time each week. Each session typically lasts for around 45 minutes and you will continue to see your therapist for several months. In some cases, you may keep having sessions for a year or longer.
During psychodynamic therapy, people are often encouraged to talk about anything that might be on their minds. This might include things they are currently experiencing or memories of things that have happened in the past.
One form of psychodynamic therapy known as brief psychodynamic therapy is designed to produce results more rapidly, often in 25 to 30 sessions. In this shorter-term form of treatment, people may initially determine a particularly emotional area where they want to focus on.
Long-term psychodynamic therapy may take a year or longer and involve 50 or more therapy sessions.
A Word From Verywell
If you are experiencing symptoms of a mental health condition, talk to your doctor or mental health professional. They can make a diagnosis and recommend treatment options that may be best for your individual needs. Psychodynamic psychotherapy may be a good fit for you.
What Techniques Are Used in Psychodynamic Therapy?
At the core of psychodynamic therapy is making the unconscious become conscious. This process is encouraged in a client through a variety of tools and techniques that the therapist uses depending on the client’s specific needs.
Free Association
Psychodynamic therapy often involves free association. This is when the patient is encouraged to discuss whatever is on their mind, including the events of the week, past conflicts with others, fears and desires, dreams and nightmares, or anything they want to disclose about themselves and their experiences.2 Psychodynamic therapy involves listening to the different levels of expressed communication, both from the person’s conscious and from their unconscious that, in a sense, is trying to get out.
Content vs. Process
Understanding patient communication at various levels is sometimes described as content versus process. The content is what the patient is communicating at the conscious level and is mostly limited to what is understood by the patient. The process of communicating is how the information is presented, which may provide certain clues to the unconscious and represents what the person is trying to communicate outside of immediate awareness. The psychodynamic therapist listens to content, but also observes non-verbal cues, certain errors in speech, how topics can change suddenly, and anything that may contradict or emotionally charge the content that is being expressed. That is an important part of the therapy process.
An example of this is a patient who says early in therapy, “My boss is always looking over my shoulder at work. I’m not the kind of person who needs to be treated like a child.” In turn the therapist may say, “Your relationship with your boss is obviously frustrating for you. I understand it’s important for us to address that problem. But I also believe you’re letting me know something about the way you want to be treated in therapy. I want to make sure you’re always treated with the respect of a capable adult.”
In the first part of the statement, the therapist addresses the conscious content of the patient’s difficulty with the boss. The second part intends to address what is likely a part of the unconscious process—how it is important for the patient to feel the same about the therapist or the therapy process. These references to what the patient is presenting at different communication levels help promote insight and trust in the therapeutic alliance.
Transference
In addition to observing the nuances of communication, psychodynamic therapists understand that patients often unconsciously place feelings, desires, fears, and resentments they may have for real people in their life history onto the therapist. This phenomenon is known as transference because people transfer their feelings from the original person onto the therapist as an object of those feelings. Patients do not always recognize transference when it occurs, but when it does happen, the psychodynamic therapist can make the connection, thus helping the patient locate the actual source of those emotions. They often involve people that represent unresolved conflicts in that person’s life, and even reveal misplaced guilt or shame they experienced in these relationships.
Countertransference
Conversely, therapists may have unconscious feelings toward their patients at any given time in therapy because therapists are human, too. Psychodynamic therapy recognizes this important phenomenon as countertransference. Therapists are trained to understand their own issues to reduce the undue influence of those issues in therapy. As a result, countertransference can be used as a tool for the therapist to better understand the patient’s experience and have a more prepared approach as those issues arise.
Clarification & Interpretation
While the psychodynamic therapist observes and assesses both the content and process of communication from the patient, the therapist responds in either two essential ways: clarification or interpretation. The therapist clarifies through feedback and elucidating questions for both patient and therapist to better understand what is being discussed at the conscious level. Interpretation is the therapist’s direct response to something emerging from the unconscious that reveals repressed emotions and memories that influences conscious life.
Here’s an example of how a psychodynamic therapist may interpret transference in a patient who suffered the trauma of parental abandonment. If previous discussion included that the patient has a history of undermining relationships through anger and emotional withdrawal, the therapist would understand this to manifest in the therapy at some point.
The therapist has worked to clarify the patient’s anger in relationships outside of therapy, but as trust builds through the therapeutic alliance, the patient becomes increasingly afraid of getting emotionally injured by the therapist. In response, the patient starts to transfer anger and emotional withdrawal towards the therapist. When it appears to be the appropriate moment, the therapist can say something like, “I believe you’re worried I will abandon you, just as your father did to you.”
Catharsis
When interpretations are accurate, patients will typically react with a noticeable shift in behavior. These actions can include increased emotional expression (e.g., tears, laughter, anger, blushing, etc.), sudden silence, or the immediate articulation of a recent or distant memory. These behaviors often point to the release of a repressed emotion, known as catharsis.3
In catharsis, the patient may also experience some relief of anxiety, anger, or shame, along with an increase in trust. But the experience may also intensify the challenges of going deeper into the person’s unconscious and essentially further into the conflicts of early life as unresolved issues are exposed. This can become especially difficult when ego defenses are reduced, and the therapy patient is faced with the reality of painful life losses towards grief and acceptance. But the increased level of trust in the therapeutic alliance helps carry the process along with greater confidence.
Working-Through
Ultimately, the psychodynamic process can reveal these unresolved conflicts and provide an emotionally safe place to resolve them, sometimes referred to as working-through. When patients in psychodynamic therapy become acquainted with their compulsions to repeat dysfunctional patterns and early-life roles, they can take control of their own choices and behaviors.
Psychodynamic Therapy for Relationships
Psychodynamic theory can also be applied to therapies that involve more than one participant. In relationship therapy with two individuals, conflicts from earlier in their respective life histories are important in understanding how each responds to emotional and communication needs.
Relationships with parents, siblings, and others in childhood, along with how parents had interacted with each other, become points of reference for how people relate to each other in their adult relationships. Because unconscious fears and desires are not limited to childhood issues, prior adult relationships, trauma and loss, and other significant life events can also have a significant influence on present conflicts.
The psychodynamic relationship therapist helps the couple clarify past issues and how they impact the current communication and emotional dysfunctions that impair mutual understanding and conflict resolution. With a deeper awareness of fears, desires, and expectations shared in relationship therapy, a couple can better develop techniques for respectful and effective interactions to meet the needs of the couple’s life together.
Psychodynamic Theory in Family Therapy
Similarly, family therapy seeks to uncover deeper and often unspoken conflicts and issues within the family system. This is often where perceived and assigned roles are explored and challenged to develop healthier and more productive interactions. The overarching goal is to achieve a functional balance in the family system that can tolerate open communication and changes to the family dynamics as the family evolves over time.
Even in dysfunctional family systems, there is a sense of balance among family members, but this type of balance is often precarious and reliant on unspoken fears and needs. These are often referred to as taboos.
An example of this involves a family member, such as the scapegoated child, who acts out in some obviously unhealthy or even dangerous way, while one of the parents harbors a serious substance abuse problem. In psychodynamics, the child may be referred to as the identified patient and would require treatment for any apparent mental health condition. At the same time, the child’s improvement in treatment changes the dynamics of the family, and thus, creates an imbalance in the family system. As a result, more attention is given to notice the parent’s substance problem, which has been previously taboo, but now can be appropriately identified and treated.
Child & Adolescent Therapy
The psychodynamic model can be useful for children in helping to identify emotions and experiences that are repressed or unexpressed, while assisting in their personal development. Significant emotional conflicts, such as those resulting from trauma and losses, can impede psychological growth and reduce the child’s ability to form adaptive coping methods and healthy emotional release. Psychodynamic therapy focuses on creating safe places for young people to find healthy emotional expression towards relieving psychological distress, promoting psychological development, and establishing healthy self-esteem.
Adolescents
For adolescents, psychodynamic therapy emphases the essential need for the young patient to trust the therapist. Although the young person’s ego is not fully formed, many of the same techniques, including interpretation through observing content versus process can be useful in improving trust.
Therapy can assist the patient in the common conflicts of teenage life, including self-image, social and sexual development, and fears involving future life goals. Understanding family dynamics is also an important aspect for adolescent psychodynamic therapy. But adolescents are also influenced by peer relationships and expectations within the group. Therapy helps the young person to sort out these complex relationships towards identifying their own sense of values and self-identity. This development process is known as individuation.
Young Children
Sometimes young children are not thought of as having a rich mental life, but in fact, they can experience feelings that lead to behaviors revealing deeper, underlying problems.4 Psychodynamic therapy for young children often involves different techniques to help promote emotional expression and working-through. Since children have not developed adequate verbal tools, therapists may use play therapy or art therapy, or other kinds of creative expression.
One example involves the therapist encouraging the child to draw pictures of themselves individually or themselves with their families. The therapist observes this process, along with how the picture is organized and how the characters are portrayed in the picture to form a therapeutic discussion with the child, which in turn helps the child develop an emotional connection with whatever conflicts they may be experiencing.
Final Thoughts on Psychodynamic Therapy
There are many specific aspects of psychodynamic theory and its application in therapy that have been developed and refined for more than 100 years. But at its most basic core, the main purpose of psychodynamic therapy is to make the unconscious become conscious for better relationships with self and others.
