If you’ve never seen a therapist but you have a mental image of the experience, you’ve probably pictured psychodynamic therapy.
While psychotherapy can take many forms, and no one type is inherently better than another, psychodynamic therapy is what is most commonly seen in TV shows and movies.
Typically, and under non-pandemic circumstances, you make an appointment, go into an office of some kind (which sometimes can be a cordoned off section of a therapist’s home), sit on a couch or in a chair, and talk about your problems, feelings, and relationships, generally either once or twice a week.
The caricature of a stern, emotionally withdrawn therapist who makes you lie down on a couch while they silently sit behind you taking notes isn’t what you’re going to experience.
And it’s the discussion of relationships—and building one with your therapist—that’s particularly important to the psychodynamic process.
“The essence of psychodynamic therapy,” writes noted psychologist Dr. Jonathan Shedler, “is exploring those aspects of self that are not fully known, especially as they are manifested and potentially influenced in the therapy relationship.”
This means that examining your relationships with other people—including the relationship you have with your therapist—is a big part of what will help you begin to feel better. And it’s in this way that psychodynamic therapy in real life is quite different from how it’s often portrayed in fictional media.
What can I expect from psychodynamic therapy?
Psychodynamic therapy was born from psychoanalysis, the form of therapy pioneered by Sigmund Freud in Vienna, Austria in the late 1800s. Psychoanalysis has a lot of old-fashioned (and generally unfair) stereotypes connected to it, and sometimes people apply those assumptions to psychodynamic therapy as well.
But, rest assured, this isn’t your great-great-grandparent’s therapy. The caricature of a stern, emotionally withdrawn therapist who makes you lie down on a couch while they silently sit behind you taking notes isn’t what you’re going to experience.
Because the therapeutic relationship is built on trust—and because therapy involves examining intense emotions and strongly held beliefs—you’ll find the patterns you have in other relationships will very likely come out with your therapist.
A psychodynamic therapist will be engaged. They’ll ask you questions about your life and experiences, and they’ll be actively interested in you as a person. And while there may be times they’ll sit quietly and give you space to talk and think, they won’t be absent, or judgmental. This is a person-centered, empathetic approach to therapy.
Psychodynamic therapy is about relationships
As noted, a psychodynamic therapist will be particularly interested in your relationships. While you’ll have a safe space to discuss whatever particular issues have led you to therapy, the relationships you have with other people are a big part of your life and history; talking about them is integral to this specific form of therapy.
And this means that not only will you talk about your relationships with people like friends, family, colleagues or coworkers, bosses or supervisors, and neighbors—it also means you’ll be talking with your therapist about the relationship you have with them.
Dr. Michael Miller, the editor-in-chief of the Harvard Mental Health Letter, writes that “the psychodynamic therapist tries to help patients understand how they contribute both to beneficial and painful relationship patterns, and how such reactions often originate within the self, yet foster the tendency to see the outside world (including relationships) as the exclusive source of disappointment or other painful emotion.”
The thing is, because the therapeutic relationship is built on trust—and because therapy involves examining intense emotions and strongly held beliefs—you’ll find the patterns you have in other relationships will very likely come out with your therapist. If you had a parent you felt was distant and disapproving, you may very well experience your therapist the same way.
It’s your therapist’s job to help you identify, understand, and work through those patterns in a way that’s safe and supportive.
Psychodynamic therapy works
A good psychodynamic therapist is someone who will help you to feel safe when you sit down to talk about your problems, and if therapy is successful you’ll find that over time your problems and emotions will become increasingly manageable. This isn’t a coincidence.
Psychodynamic therapy has been rigorously studied and is grounded in research and supervised practice. According to Abbass et al. there’s evidence that even short-term psychodynamic therapy (where a person is in therapy for a combined 40 hours or less) can be beneficial.
And while it’s true it hasn’t been as rigorously studied as therapies like CBT (cognitive-behavioral therapy), Dr. Jonathan Shedler further writes that “the evidence indicates that the benefits of psychodynamic treatment are lasting and not just transitory and appear to extend well beyond symptom remission. For many people, psychodynamic therapy may foster inner resources and capacities that allow richer, freer, and more fulfilling lives.”
Abbass AA, Kisely SR, Town JM, Leichsenring F, Driessen E, De Maat S, Gerber A, Dekker J, Rabung S, Rusalovska S, Crowe E. Short‐term psychodynamic psychotherapies for common mental disorders. Cochrane Database of Systematic Reviews 2014, Issue 7. Art. No.: CD004687. DOI: 10.1002/14651858.CD004687.pub4.
Miller, M. (2010). Merits of psychodynamic psychotherapy. Harvard Mental Health Letter.
Schwartz, J. (2018). Cassandra's daughter: A history of psychoanalysis. Routledge.
Shedler J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist. (Feb.– March 2010): Vol. 65, No. 2, pp. 98–109.