Approaches Psychodynamic therapy
Psychodynamic therapy is one of the oldest talking therapies, and it has changed considerably over the past century. It looks at the patterns that shape how people feel and relate to one another, including some that operate outside conscious awareness.
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Where psychodynamic therapy comes from
Psychodynamic therapy grew out of psychoanalysis, which Sigmund Freud developed in Vienna in the late 1800s and early 1900s. Central to his work was the idea that feelings and memories outside our awareness still influence how we think and behave. Classical psychoanalysis often meant several sessions a week for many years, with the client lying on a couch. Few people have therapy that way now, and later clinicians questioned or set aside many of Freud's specific theories.
In the mid-twentieth century, the British psychiatrist and psychoanalyst John Bowlby developed attachment theory, which describes how early bonds with caregivers influence later relationships. David Malan and colleagues at the Tavistock Clinic in London were among those who studied briefer, more focused forms. From the 1980s, relational psychoanalysts in the United States, including Stephen Mitchell, emphasised the two-way relationship between client and therapist. Today the therapy is usually a conversation in person or by telehealth, and may be short-term with a set number of sessions or open-ended.
Key ideas
Psychodynamic therapy at a glance
- Past relationships
- Early relationships with parents, carers and siblings can shape what you expect from closeness and trust. Therapy looks at these without blame, with interest in what they taught you about yourself and others.
- Current relationships
- Earlier patterns can show up with partners, friends or colleagues, such as bracing for criticism at work or feeling responsible for a friend's mood. Therapy often starts with a recurring reaction like this.
- The therapy relationship
- Patterns can also surface with the therapist, such as worrying about being a burden or holding back disagreement. You and the therapist can explore these moments together as they arise.
The main ideas
A central idea is that people tend to repeat patterns in relationships, such as pulling away when someone gets close. These patterns usually made sense at an earlier point, as a way of coping or staying connected. Modern therapists use Freud's term, the unconscious, more loosely than he did, for feelings and expectations that shape behaviour without our noticing. This is one reason patterns can be hard to change through willpower alone. Defences are the often automatic ways the mind protects us from painful feelings, such as keeping busy or joking when something hurts. Everyone uses them, and therapy looks at when a defence still helps and when it gets in the way.
Old patterns can also appear in the therapy relationship, for example feeling sure the therapist is disappointed in you. Therapists call this transference, because feelings from earlier relationships carry over into a new one. Discussing it openly lets you examine a pattern as it happens, with someone whose role is to stay steady and interested. The American psychoanalyst Karl Menninger described the links between past, current and therapy relationships as a triangle of insight.
What sessions involve
Sessions are more open-ended than in structured therapies such as CBT, usually without a set agenda or worksheets. You might bring something from the past week, a memory or a feeling that is hard to put into words, and say what comes to mind without editing it first (sometimes called free association). The therapist listens closely, allows for pauses, and may point out a recurring theme or ask what you are noticing in the room. Understanding tends to build gradually, as observations from different sessions link up.
What the research says
Psychodynamic therapy has been studied less than CBT, partly because open-ended therapy is harder to test in trials, although the research base has grown in recent decades. Several systematic reviews have found that short-term psychodynamic therapy can reduce symptoms of depression. The UK's 2022 NICE guideline on depression in adults includes it among several psychological options and places therapies such as CBT and behavioural activation higher on its list.
The evidence for anxiety is more limited, with some positive trial results for panic disorder and social anxiety. Across many kinds of therapy, a good working relationship between client and therapist is linked with how helpful people find it.
Alongside more structured approaches
CBT and DBT skills offer practical strategies for managing worry or strong emotions in the present, while psychodynamic thinking can help explain why a particular situation keeps setting off the same reaction. Many psychologists draw on both. Schema Therapy, developed by the American psychologist Jeffrey Young, draws on cognitive behavioural therapy, attachment theory and psychodynamic ideas, with close attention to childhood needs and long-standing patterns.
Something to try
Noticing a familiar pattern
This journaling exercise looks at one pattern that tends to repeat in your relationships. Approach what you notice with curiosity, and stop at any point.
This exercise is general information only and is not a substitute for individual care from a qualified health professional.
- Find a quiet moment and something to write on.
- Recall a recent, mild interaction that stayed with you, such as a friend cancelling plans, and write a few lines about what happened, how you felt and what you did (perhaps smoothing things over).
- List one or two other times you have responded this way, keeping to recent or light examples. If a painful memory surfaces, note that it is there and leave it for now.
- Read back over what you wrote. If a thread runs through it, such as keeping the peace, put it into a sentence and consider how it may once have helped you.
- Put the page away and do something calming. If the exercise stirs up strong feelings, talk with someone you trust or call Lifeline on 13 11 14 at any time.
How Jess uses Psychodynamic therapy
Psychodynamic ideas may stay in the background, shaping Jess's understanding of how a difficulty developed. They come to the foreground when an older pattern shows up in a current relationship or in sessions with her. Alongside more structured approaches, they can help explain why a skill is sometimes hard to use.
Often used for
- Depression and low mood
- Some forms of anxiety
- Repeating relationship patterns
- Difficulties with self-esteem
- Making sense of past experiences
Questions about Psychodynamic therapy
Do I have to talk about my childhood?
Most people start with a current concern, such as a recent argument or a worry about work, and earlier memories tend to come up when they seem linked to it. You decide how much to share and when, and the therapist can slow the pace if a topic becomes too much.
How is psychodynamic therapy different from CBT?
CBT is more structured and focuses on practical skills for changing thoughts and behaviour, often with tasks between sessions. Psychodynamic therapy is more open-ended and looks at patterns in feelings and relationships, including links between past and present. Both have research support for some difficulties.
How long does psychodynamic therapy take?
Short-term psychodynamic therapy is planned around a set number of sessions. The UK's NICE guideline on depression describes it as usually 8 to 16 regular sessions for less severe depression and 16 for more severe depression, or about two to four months of weekly appointments. Longer-term therapy can continue for a year or more. The length depends on your goals and progress, and is reviewed with Jess as part of your treatment plan.
Other approaches Jess uses
Where Jess sees people
In Rosanna, the clinic offers online booking and early morning and early evening appointments. In Warrandyte, sessions can be held outdoors in the clinic's backyard by the Yarra River. Jess also sees people by telehealth, and appointments can be made with or without a referral.
Rosanna
Mind Your Health Centre
47 Greville Road, Rosanna VIC 3084
Jess is here Wednesday 1pm to 7pm, Thursday 7am to 1pm
- Phone
- (03) 9965 8903
Warrandyte
Mullum Road Clinic
71 Yarra Street, Warrandyte VIC 3113
Jess is here Monday and Tuesday 9am to 6pm
- Phone
- (03) 7042 3300