How Psychodynamic Therapy Works

aka “psychoanalytic” therapy

So what is psychodynamic therapy?

Psychoanalytic or psychodynamic therapy are often used interchangeably.

Psychodynamic therapy has its roots in traditional psychoanalysis, and draws theories and concepts from object relations, ego psychology, and self psychology. This National Library of Medicine paper by Opland and Torrico (2024) provides a neat academic explanation (for those of us who can’t sleep at night).

Essentially, Psychodynamic therapy is a form of evidence-based talk therapy that focuses on how unconscious processes and early life experiences influence current thoughts, emotions, and relationships.

How does psychodynamic work?

Psychodynamic therapy assumes that psychological symptoms, such as depression, anxiety, low self-esteem, and relationship difficulties, are driven by unresolved emotional conflicts and patterns formed in early life. These patterns often operate outside our conscious awareness. People may recognise recurring problems in their lives yet struggle to understand why they repeat them. Psychodynamic therapy aims to make these unconscious patterns conscious.

The work involves exploring formative relationships, attachment experiences, and habitual coping mechanisms, including defence mechanisms that once served a protective function but may now limit growth. By identifying these patterns, clients develop insight into how past experiences shape present reactions. This increased self-awareness reduces emotional reactivity and supports more adaptive choices.

The therapeutic relationship itself is central. Patterns of relating often emerge within the therapy space, offering real-time opportunities to understand interpersonal dynamics. This process, sometimes referred to as transference, allows clients to examine relational expectations and emotional responses in a contained and reflective environment.

What is the goal of psychodynamic psychotherapy?

Psychodynamic psychotherapy seeks to increase an individual’s self-awareness and understanding by way of uncovering the links and providing continuity between past and present; in particular exploring aspects of the self not completely known to oneself.

Utilising the analogy of an iceberg, the tip of the iceberg represents the conscious mind consisting of known thoughts and perceptions. The further or deeper the iceberg goes, the less conscious awareness becomes accessible to the individual; information in the preconscious or subconscious level may manifest in the forms of dreams and memories. Finally, the unconscious holds unacceptable feelings, desires and urges, and therefore tend to be associated with anxiety, pain, and shame.

Psychodynamic often regards the therapeutic relationship as key as it allows for recurring interactional and behavioural patterns to emerge through transference and countertransference, and subsequently be brought to the attention of the patient. Dynamically oriented clinicians recognise an individual’s early life experiences in shaping one’s personality and inner world, and they assist patients in making sense of their intra- and inter- psychic conflicts, while identifying and working through their defences to resolve the underlying difficulties.

Psychodynamic therapy may be short-term and focused, or longer-term and exploratory, depending on clinical need. It is commonly used to treat mood disorders, anxiety disorders, trauma-related difficulties, and personality disorders. Research supports its effectiveness, particularly for individuals seeking not only symptom reduction but deeper, sustained psychological change.

Unlike symptom-focused approaches that prioritise immediate behavioural strategies, psychodynamic therapy targets the underlying emotional drivers of distress. The goal is structural change: improved emotional regulation, stronger identity, healthier relationships, and greater resilience over time.

In essence, psychodynamic therapy is about understanding the “why” behind persistent patterns. When insight deepens, change becomes more durable.

Psychodynamic v CBT

Researchers have identified seven features that distinguished dynamic from cognitive-behavioural therapies, as follows:

Ψ Focus on affect and expression of emotions;
Ψ Exploration of attempts to avoid difficult or distressing topics, activities, thoughts, and feelings;
Ψ Identifying recurring themes and patterns;
Ψ Exploration of past experiences;
Ψ Focus on interpersonal experiences;
Ψ Emphasis on the therapeutic relationship;
Ψ Exploration of one’s wishes, dreams, or fantasies

Taken together, psychodynamic psychotherapy involves a therapy experience that extends beyond symptom remission. Successful psychodynamic psychotherapy not only provides symptom relief, but also develops in the individual a stronger sense of self and psychological resources including, but not limited to the capacity for more fulfilling relationships, ability to experience a wider range of affects, better understanding of the self in more sophisticated and multidimensional ways, and to enable greater flexibility when faced with challenges in life.