Psychodynamic Therapy

Psychodynamic therapy is used to treat depression, anxiety, trauma, and other mental health challenges. This approach to therapy is helpful for people who have lost meaning in their lives and have difficulty forming or maintaining healthy intimate relationships.

Treatment Goals

The goals of psychodynamic therapy extend beyond symptom remission. Successful treatment should relieve unwelcome symptoms - like anxiety and depression - and foster the positive presence of healthy psychological capacities and resources. Depending on the person and the circumstances, positive outcomes from psychodynamic therapy might include the capacity to have more fulfilling relationships, make more effective use of talents and abilities, have more satisfying sexual experiences, understand self and others in more nuanced and sophisticated ways, and face life’s challenges with greater freedom and flexibility. These treatment objectives are pursued through a process of self-reflection, self-exploration, and self-discovery that takes place in the context of a safe and authentic therapeutic relationship between therapist and client.

How is psychodynamic psychotherapy different from other treatment approaches?

Seven features distinguish psychodynamic psychotherapy from other therapies, as determined by empirical examination by researchers:

1. Focus on affect and expression of emotion: Psychodynamic therapy encourages exploration and discussion of the full range of a client’s emotions. The therapist helps the client describe and put words to feelings, including contradictory feelings, feelings that are troubling or threatening, and feelings that the client may not initially be able to recognize or acknowledge.

2. Exploration of attempts to avoid distressing thoughts and feelings: People do a great many things, knowingly and unknowingly, to avoid aspects of experience that are troubling. This avoidance (in theoretical terms, defense and resistance) can take many forms, including missing sessions, arriving late, or being evasive. Avoidance may take subtle forms that are difficult to recognize in ordinary social interaction, such as subtle shifts of topic when certain ideas arise, focusing on incidental aspects of an experience rather than on what is psychologically meaningful, attending to facts and events to the exclusion of affect, focusing on external circumstances rather than one’s own role in shaping events, and so on. Psychodynamic therapists actively focus on and explore avoidances.

3. Identification of recurring themes and patterns: Psychodynamic therapists work to identify and explore recurring themes and patterns in client’s thoughts, feelings, self-concept, relationships, and life experiences. In some cases, a client may be acutely aware of recurring patterns that are painful or self-defeating but feel unable to escape them (e.g., a person who repeatedly finds themself drawn to romantic partners who are emotionally unavailable; a person who regularly sabotages themself when success is at hand). In other cases, the client may be unaware of the patterns until the therapist helps him or her recognize and understand them.

4. Discussion of past experience: Related to the identification of recurring themes and patterns is the recognition that past experience, especially early experiences with attachment figures, impact our experience of the present. Psychodynamic therapists explore early experiences, the relation between past and present, and the ways in which the past tends to “live on” in the present. The focus is not on the past for its own sake, but rather on how the past sheds light on current mental health difficulties. The goal is to help clients free themselves from the bonds of past experience in order to live more fully in the present.

5. Focus on interpersonal relations: Psychodynamic therapy places heavy emphasis on clients’ relationships and interpersonal experience (in theoretical terms, object relations and attachment). Both adaptive and nonadaptive aspects of personality and self-concept are forged in the context of attachment relationships, and psychological difficulties often arise when problematic interpersonal patterns interfere with a person’s ability to meet their own emotional needs.

6. Focus on the therapy relationship: The relationship between therapist and client is itself an important interpersonal relationship, one that can become deeply meaningful and emotionally charged. To the extent that there are repetitive themes in a person’s relationships and manner of interacting, these themes tend to emerge in some form in the therapy relationship. For example, a person prone to distrust others may view the therapist with suspicion; a person who fears disapproval, rejection, or abandonment may fear rejection by the therapist, whether knowingly or unknowingly; a person who struggles with anger and hostility may struggle with anger toward the therapist; and so on (these are relatively crude examples; the repetition of interpersonal themes in the therapy relationship is often more complex and subtle than these examples suggest). The recurrence of interpersonal themes in the therapy relationship (in theoretical terms, transference and countertransference) provides a unique opportunity to explore and rework them during session. The goal is greater flexibility in interpersonal relationships and an enhanced capacity to meet interpersonal needs.

7. Exploration of fantasy life: In contrast to other therapies in which the therapist may actively structure sessions or follow a predetermined agenda, psychodynamic therapy encourages clients to speak freely about whatever is on their minds. When clients do this (and most clients require considerable help from the therapist before they can truly speak freely), their thoughts naturally range over many areas of mental life, including desires, fears, fantasies, dreams, and daydreams (which in many cases the patient has not previously attempted to put into words). All of this material is a rich source of information about how the person views self and others, interprets and makes sense of experience, avoids aspects of experience, or interrupts a potential capacity to find greater enjoyment and meaning in life.

Further Reading

If you are interested in learning more about the underlying theories & principles guiding psychodynamic practice, I suggest the following reading:

General Theory

Center for Substance Abuse Treatment. (1999). Brief Interventions and Brief Therapies for Substance Abuse: Brief Psychodynamic Therapy. In Substance Abuse and Mental Health Services Administration Treatment Improvement Protocol (TIP) Series (No. 34, Chapter 7) .

Levenson, H. (2017). Brief dynamic therapy (2nd ed.). American Psychological Association.

Lemma, A, Target, M & Fonagy, P. Brief Dynamic Interpersonal Therapy: A Clinician’s Guide. (2011). Oxford Press.

McWilliams, N. (2004). What defines a psychoanalytic therapy? In Psychoanalytic Psychotherapy: A Practitioner’s Guide, (pp. 1-27) New York: The Guilford Press.

Ego Psychology

Berzoff, J., Flanagan, L., & Hertz, P. (2016). Drive and Beyond. in Inside out and outside in (4th edition, pp 18-49). London, UK: Rowan & Littlefield.

Object Relations Theory & Attachment Theory

Berzoff, J. & Flanagan, L. (2016). Object relations theory in inside out and outside in; Psychodynamic clinical theory and psychopathology in contemporary multicultural contexts. (Fourth edition, pp. 123-136). New York, NY: Rowman & Littlefield.

Knight, Z.G. (2005). The use of the ‘Corrective emotional experience’ and the search for the bad object in psychotherapy. American Journal of Psychotherapy, 51, 1, 30-41.

Wallin, D. (2007). The foundations of attachment theory. In Attachment in psychotherapy. New York: The Guilford Press.

Self-Psychology

Flanagan, L. M. (2016). The theory of self psychology In Berzoff, J., Flanagan, L. M., & Hertz, P. (Eds.), Inside out and outside in: Psychodynamic clinical theory and psychopathology in contemporary multicultural contexts (pp. 166-195). Rowman & Littlefield.

Kohut, H. (1984).Chapter 10: The selfobject transferences and interpretation. In How does analysis cure? (pp. 192-210). The University of Chicago Press.

Kottler, A. (2015). Feeling at home, belonging, and being human: Kohut, self psychology, twinship and alienation. International Journal of Psychoanalytic Self Psychology, 10, 378-389.

Humanistic Theory

Rogers, C. (1975). Empathic; an unappreciated way of being. The counseling psychologist, 5, 2- 10.

Rogers, C. (1965). The therapeutic relationship: Recent theory and research. Australian Journal of Psychology 17 (2), pp. 95-108.

Throne, B., & Sanders P. (2012). Carl Rogers (3rd ed). Sage Publication Ltd. Chapters 2 & 4.

This summary of psychodynamic psychotherapy includes content pulled from Psychology Today.

The treatment approach section is an edited excerpt of Jonathan Sedler’s, “The efficacy of psychodynamic therapy," University of Colorado Denver School of Medicine,

Most of the reading suggestions are drawn from psychodynamic coursework at the Smith College School for Social Work in Northampton, MA.