What is Psychodynamic Therapy?

If you find yourself stuck in the same patterns, whether in relationships, work, or your inner life, you’re not alone.

Psychodynamic therapy helps you understand why those patterns exist and how to change them at the root.

Simple Definition

Psychodynamic psychotherapy is a form of talk therapy that focuses on understanding how unconscious processes, early relationships, and past experiences influence our present emotions, thoughts, and behaviors.  Rather than only emphasizing the reduction of symptoms, it addresses the deeper emotional roots of distress to create lasting change.  

Where Psychoanalytic Therapy Comes From

Psychoanalytic or psychodynamic therapy is rooted in the work of neurologist Sigmund Freud.  In case the name Freud has you anxious about lying on a couch and having everything reduced to sex for four sessions a week, know that psychodynamic therapy has evolved from Freud’s early work and psychoanalysis.  

Freud’s contributions are foundational, though some critiques, especially his emphasis on sexuality, are valid.
Since then, many theorists have expanded his ideas in important ways. The key is not to throw out the baby with the bathwater.   

Psychodynamic movements include the object relations of Melanie Klein and D.W. Winnicott, the analytic psychology of Carl Jung, the self-psychology of Heinz Kohut, and the ego psychology of Anna Freud to name a few.  

How Psychodynamic Therapy Works

Role of Understanding Unconscious Processes

Psychoanalytic theory is based on the idea that we develop emotionally over time.  When that development is disrupted (especially in our early relationships), it can lead to unconscious defenses that cause patterned distress later in life.   

Psychodynamic therapy provides a space to explore the unconscious conflicts behind your struggles, so you can better understand them and work through them.

As a therapist, I supportively create a safe space where you can explore your inner world in a way tailored to your needs.  

Psychodynamic therapy views symptoms as signs of a deeper disruption and explores what’s driving them beneath the surface.

For example, instead of simply trying to eliminate depression, we explore what those symptoms may be communicating about your inner world.

Then we work to heal the conflicts beneath the symptoms for more lasting change.  

If you have mold in your home (more common in North Carolina than we would like), you can take medication to manage symptoms or address the mold itself.  Psychodynamic therapy focuses on removing the underlying causes, not just the symptoms.  

If you’re looking to address the underlying, structural foundations of the emotions, thoughts, and behaviors that comprise your personality, psychodynamic therapy may be a great fit for you. 

Defense Mechanisms

The foundations of psychodynamic psychotherapy recognize that we unconsciously protect ourselves from our distresses through the use of defense mechanisms.    

We all need and use defenses for our psychological development.  Problems arise when we overuse them.  Then they become habitual and keep us stuck, negatively impacting our ability to develop and later navigate parts of life and relationships.

Understanding Patterns and Relationships 

We are prone to repetition and psychoanalytic understandings explore the ways we unconsciously repeat our histories in patterned ways (typically in attempts to resolve early conflicts).  

The psychodynamic therapist seeks to understand how our current struggles are often linked to the early conflicts, traumas, and anxieties we experienced in relationship to important others, particularly our early caregivers and parents.  

We are typically unaware of these patterns until we explore them in therapy.  Left unchecked, these mechanisms unconsciously continue to impact our lives, limiting us to autopilot ways of living.

Therapy helps us not just understand our patterns but change how we respond.

What Happens in a Session?

Psychodynamic therapy differs from old-school psychoanalysis in that the therapist and client sit face-to-face and meet less frequently.  In my therapy practice in Raleigh, NC, I typically meet with clients weekly, sometimes twice a week.  

The psychodynamic process involves the use of the relationship between the therapist and the client to provide insight into the client’s inner world and particular use of defenses.  

A psychodynamic therapist asks curious questions and uses interpretations to collaborate with clients so the therapist can better understand the client’s experiences, fears, pains, and styles of protecting against them.  

The way we relate with our therapist can reveal important and deep insights about our attachment styles, our patterned reactions to our anxieties and pains, and our underlying wounds, desires, and dreams in life.  

The hope of the psychodynamic approach is that our clients will develop trust in the therapy so they can grow to become fuller versions of themselves.  

What You Can Expect

In psychodynamic therapy, sessions are conversational and reflective.

Instead of giving you worksheets or quick fixes, we focus on understanding your inner world, your relationships, and the patterns shaping your life.

Over time, this leads to deeper insight, emotional growth, and lasting change.

Benefits of Psychodynamic Therapy

Increased Self-Awareness and Insight

Psychodynamic therapy explores and helps us understand ours and others’ emotions.  It helps us learn to observe ourselves, reflect, and recognize our tendency to react.

Over time, we gain insight into our reactivity triggers and patterns.  Then we can learn to change and respond in more integrated and effective ways.

Emotional Healing

In a therapeutic relationship with a psychodynamic therapist, we can heal wounds that have long fueled our emotional suffering.  Much of our present day emotional life is undergirded by our early experiences with pain, loss, and frustration.

By entering into our emotions with curiosity and care, we equip ourselves to feel the feelings and resiliently work through problems that have long plagued us.

Psychodynamic therapy helps us understand our wounds so we can heal them in a compassionate relationship of care.

Increased Emotional Intelligence and Improved Relationships

In therapy we discover what shapes perspective, both ours and others, and we begin to see our circumstances with more nuance and complexity.  We then develop more empathy and compassion for others and ourselves.

This growth increases our effectiveness in our work and personal relationships.  Indeed, emotional intelligence is increasingly recognized as essential for being a great leader.

Improved Self-Esteem

Psychodynamic therapy offers a safe space to question our preconceived notions of ourselves.

Through the therapist’s caring curiosity and thought-provoking questions, we realize false narratives we’ve had about ourselves.

In a therapeutic relationship we discover more of our true selves and develop a sturdier sense of who we are below the surface of our personalities.

Improved Agency and Autonomy

Becoming aware of the unconscious processes at play in our lives can equip us to live life with more intention and agency.  

We can empower ourselves to learn to regulate our anxiety and emotions, courageously face our fears, confront our issues, and accept the reality of our wounds.  Until we do so, we will be limited in our ability to heal, grow, and thrive in our lives.  

Increased Meaning and Purpose in Life

Gaining insight into our patterns and tendencies helps us understand how we have covered up our inner knowing of what we want in life.  Through the many layers of distortion and defense we hide from ourselves the keys to what would set us free for a fulfilling life.

In psychodynamic therapy we explore our hidden motivations so we can stop all of the unconscious effort to keep ourselves from addressing the elephant in the room.  Then we can be free from all of the mechanism to live life with more meaning and purpose.

Long-Term Growth

In addition to relieving symptoms, psychodynamic psychotherapy is designed to provide deep, long-lasting growth. Through this kind of therapy clients report feeling freer and living fuller lives.  

Research suggests that the benefits of psychodynamic therapy often continue long after the therapy ends.  A meta-analysis of studies of therapy effectiveness show ongoing improvement from psychodynamic therapy long afterward.  

When surveyed nine months or more after completing various types of therapy, those who engaged in psychodynamic psychotherapy reported experiences of greater continued growth than their counterparts who received different forms of therapy.  

Some studies suggest that the benefits of other therapies may diminish over time, while psychodynamic therapy shows continued growth after treatment ends.

Psychodynamic therapy has staying power because the work is deeper and prepares us to learn how to manage our mental health in an ongoing way.  

It is the proverbial teach-a-person-to-fish type of therapy as opposed to a give-a-person-a-fish type of therapy. With this deeper approach, you can find relief from symptoms while also discovering your own path for growth.  

Psychodynamic therapy is more of an investment in transformation than seeking a quick solution to a singular problem, such as overcoming a newly developed anxiety about driving or getting on an elevator.  

Psychoanalytic approaches to therapy can be a better fit for those looking for deeper, longer-lasting change.  It can be more complex and time-consuming to explore the unconscious than short-term therapy.  

Psychodynamic Therapy vs CBT

Cognitive Behavioral Therapy (CBT) has become popular in our culture, largely due to its short-term, solution-focused approach.  It is a very different approach from psychodynamic psychotherapy.  

CBT is a structured, goal-oriented approach that seeks to manage and reduce the symptoms one is experiencing.  While approaches like CBT can be very effective for reducing specific concerns, I tend to work psychodynamically with clients who are looking for deeper, long-term change.  

Research suggests that psychodynamic therapy and CBT have similar effectiveness, and as stated above, psychodynamic therapy clients have shown continued growth after their therapy has ended.  

As a therapist practicing in Raleigh, NC, I much prefer to work psychodynamically so we can approach your struggles more holistically.  

You can think of it like a polluted river.  You could remove trash from its surface each day, or you could go upstream and stop the source of the pollution.   

Psychodynamic therapy sees people as complex, not just a collection of symptoms, and helps you heal at the source.

Common Concerns About Therapy

It is completely understandable to feel hesitant about starting therapy.  Our culture has historically been more resistant to addressing our mental pains than our physical ones, and we are continuing to grow in our mental health awareness and education.  

You may be thinking you are afraid to unearth emotions, fears, pains, etc. that you buried long ago.  You may be concerned that therapy will only cause you to feel unrelenting pain.  This is a common concern people have about starting therapy, and they generally find themselves relieved of the concern while in therapy.   

If you were in a car accident in which you sustained a high degree of road rash and had gravel in your body, you would not likely tell the emergency department doctors not to remove it and to just gauze up the wound because it would be too painful to remove the gravel.   

You know that would lead to infection and more serious problems later.   So why do we treat mental health differently? 

A psychodynamic approach is more akin to a process of removing what has invaded and disrupted the psyche.  It seeks to get to the root cause of the distress rather than finding ways to mask it.  

In other words, you can use techniques to try to manage your anxiety and you can also psychodynamically seek to explore the anxiety in such a way that you learn to overcome it by working through the underlying fears and causes of the anxiety.  

Limitations of Psychodynamic Therapy

Psychodynamic psychotherapy is not a guaranteed path to cure, and like all therapies available, it is not going to appeal to everyone.  

Not ideal for: 

•  People wanting quick symptom relief 
•  Highly structured, problem-specific goals
•  Severe OCD
•  Severe substance use issues

May be a good fit for people who:

•  Want long-term growth
•  Are insight-oriented
•  Feel stuck in patterns
•  Want to understand themselves deeply
•  Struggle with relationships or identity

For a description of Psychodynamic Therapy in an abstract from The National Library of Medicine 

Who Is Psychodynamic Therapy For?

Psychodynamic therapy may be a good fit if you:

• Want to understand yourself at a deeper level
• Are open to exploring your inner world
• Feel stuck in repeating patterns in your life and relationships
• Want more lasting change 
• Want more agency and fulfillment in your life

Work With a Psychodynamic Therapist in Raleigh, NC

Finding the right therapist and approach matters.  If this way of working resonates with you, the next step is simply starting a conversation.  

If you’re feeling stuck in patterns, struggling in relationships, or wanting deeper, fuller, lasting change, psychodynamic therapy may be a good fit for you.  

I offer in-person therapy in Raleigh and work with clients across North Carolina via telehealth.    

You can schedule a free 15-minute consultation to see if this approach feels like a good fit for you.

Frequently Asked Questions

How Long Does Psychodynamic Therapy Take?

As a psychodynamic therapy client, you determine the length of the therapy.  Some therapies have a prescribed amount of time, but psychodynamic therapy gives the client the autonomy to decide when it is time for the therapy to end.  

You can expect psychodynamic therapists to explore with you your decision to end therapy.  They will wonder whether you might be unconsciously avoiding working through some unresolved pattern(s), but you will ultimately decide.

Some stay in therapy for years as they continue to seek self-awareness and growth beyond addressing the initial problem that brought them to therapy in the first place.  Many enjoy the added growth they experience and make inner growth a part of their continued wellness.  

Is Psychodynamic Therapy Evidence-Based?

Yes, research and meta-analyses show that psychodynamic therapy is evidence-based.  Here are some articles if you would like to read some results: 

https://pmc.ncbi.nlm.nih.gov/articles/PMC10168167/

https://pmc.ncbi.nlm.nih.gov/articles/PMC4471961/

https://www.apa.org/pubs/journals/releases/amp-65-2-98.pdf 

How is it Different from CBT?

 

CBT:	Psychodynamic therapy:
– Focuses on reducing symptoms	– Focuses on reducing cause of symptoms
– More universally applied to symptoms	– More individualized to client’s unconscious
– Sessions more structured	– Sessions more exploratory
– Uses worksheets and homework more	– Uses therapist-client relationship more
– More focused on the presenting problem	– More focused on interconnections between presenting problem, the past, and the future

 

Is it helpful for Anxiety and Depression?

Yes, studies show it to be effective for anxiety and depression.  It can be very enlightening to discover through psychodynamic therapy our patterned ways of dealing with anxiety and depression.  

Knowing why and how we have unconsciously reacted to our anxiety and depression can equip us to make helpful changes toward working through these challenges.