Psychodynamic Therapy

Key takeaways

• Psychodynamic therapy is the oldest form of modern talking therapy, and is closely based on the work of Freud
• Psychodynamic therapy prioritizes understanding unconscious needs, processes, and emotions. It often explores early relationships that helped to create conflicts within those unconscious experiences
• Psychodynamic therapy is typically used to address longer-term, deeper issues, although it can be used for short-term, focused treatments

Understanding psychodynamic therapy

Psychodynamic therapy is based on the belief that current problems and difficulties are typically rooted in patterns, beliefs, or ways of responding that were learned during childhood. These create conflicts in the client, who is believed to be unaware of many of their needs, defense mechanisms, or patterns of responding. Psychodynamic therapy aims to bring these unconscious processes into conscious awareness, allowing clients to resolve those conflicts and find new, more helpful, ways of dealing with difficult situations.

Clients are encouraged to express themselves emotionally, talking about how they feel without censoring themselves. Emotions such as shame and anger, which clients may feel are unsafe or socially unacceptable, are welcomed as normal, healthy reactions to life events. Clients become increasingly comfortable with their own emotions, allowing them to engage with those feelings rather than pushing them away or suppressing them.

History and origins

Psychodynamic therapy is the oldest form of modern talking therapy. It is based on the work of Freud, who developed psychoanalysis as a method to treat emotional difficulties. Some core principles, such as the existence of unconscious needs and desires, remain untouched, while much of the detail of his interpretation has been removed or modified by later therapists.

How does it work?

Psychodynamic therapy works by addressing underlying emotional issues or conflict. This can have a direct effect on emotional problems, such as anxiety or depression, and can also help deal with problem behaviors, such as self-harm or addiction, by resolving the emotions that drive those behaviors.

Psychodynamic therapy helps clients to explore patterns and themes, which may reveal unconscious processes.^[1] By bringing these into conscious awareness, clients start to understand how these issues developed and begin to process their feelings. Increasing conscious awareness can also help clients challenge negative beliefs about themselves or the world, which may have come from childhood experiences or teachings.

Emotional expression is another priority, with clients encouraged to share their emotions without judgment or shame. This helps heal past wounds and allows clients to be seen as their authentic selves by someone who understands and accepts them. Clients may experience a psychologically or emotionally corrective experience, where they receive the validation, care, or treatment that they needed during their early life but did not receive.

Although psychodynamic therapy can place a lot of significance on early life experience, this approach isn’t about blaming parents or other caregivers for a client’s current difficulties. Unless warranted because of abuse or neglect, psychodynamic therapy doesn’t seek to assign blame. Instead, the priority is knowledge, understanding, and empathy.

Psychodynamic therapy and psychoanalysis

Modern psychodynamic therapy isn’t the same as stereotypes of psychoanalysis from the late nineteenth century. Clients typically don’t recline on a couch with their therapist sitting behind them, for example.

Here are some important differences between psychoanalysis and psychodynamic therapy

• The role of the therapist. A psychoanalyst operates as an expert, giving clients their interpretation (or analysis) of what is going on. A psychodynamic therapist works with a client to help them find their own interpretations
• The relationship between therapist and client. A psychoanalyst tries to remain a neutral blank slate, encouraging clients to project their thoughts and feelings onto them. A psychodynamic therapist works to build a close, trusting relationship
• The importance of sexual drives. Freudian psychoanalysis connected almost all issues to some form of sexual drive. Modern psychodynamic therapists do not follow this approach

Types of psychodynamic therapy

In addition to core psychodynamic therapy, you may find other, specialized types of therapy that are closely linked to psychodynamic therapy and use the same principles. These include

• Brief psychodynamic therapy
• Psychodynamic family therapy
• Transactional analysis
• Trauma-focused psychodynamic therapy
• Mentalization-based therapy

Techniques used in psychodynamic therapy

Just like other forms of therapy, psychodynamic therapists have a set of techniques they use to help clients overcome their struggles. Here are some of the techniques used in modern psychodynamic therapy.

Building the therapeutic alliance

The relationship between therapist and client is essential for effective therapy.^[2] In psychodynamic therapy, therapists will often discuss the relationship between therapist and client in the moment, exploring how they both experience particular moments or exchanges.

Transference

Clients in therapy sometimes project their feelings about other important relationships onto their therapist, which is known as transference. Transference highlights unresolved issues and can allow clients to work through difficult relationships. The therapist may be able to provide an emotionally corrective experience, where a client receives the support and understanding they needed in the past.

Challenging defense mechanisms

Psychodynamic therapists believe that many problems come from unconscious defense mechanisms that are no longer helpful. These defenses can include using humor to mask strong feelings or projecting feelings you are uncomfortable with onto others. The therapist may point out to clients when they are using some of these defenses, bringing them into conscious awareness. This allows the client to make an informed decision about how they want to manage their feelings.

Emotional mobilization

Clients and therapists work together to recognize unconscious or repressed emotions. The therapist encourages the client to experience and express those emotions in a safe, supportive environment. This can help clients become more comfortable with their emotions, allowing them to tolerate transient anxiety and discomfort.

Silence

Sitting silently with another person often feels uncomfortable, but psychodynamic therapists become skilled at using silences. Clients may become silent when they are reflecting on an insight or if they are experiencing strong emotions. When a therapist remains comfortable and attentive through these silences, clients can feel safe, respected, and seen.^[3]

What is it primarily used for?

Psychodynamic therapy prioritizes understanding and resolving underlying conflicts, often stemming from childhood. Bringing these conflicts into conscious awareness allows clients to work through them, giving them more choice and control over their lives.

As a result, it’s ideal for addressing deep-seated issues around the self and relationships with others. It’s generally not the first choice of approach for short-term problems or resolving behavioral issues that don’t need the same level of deep work, because the longer timeframe makes it more expensive.^[4] Brief psychodynamic therapy can address those problems, but other approaches would usually be tried first.

Psychodynamic therapy is commonly used to help people with anxiety disorders, depressive disorders, eating disorders, self-harm, trauma, PTSD, and personality disorders.^[1]

Effectiveness and limitations

Psychodynamic therapy hasn’t traditionally received as much research attention as some other types of talk therapy, especially cognitive behavioral therapy (CBT). Recent studies have found that psychodynamic therapies have similar effectiveness to other approaches.^[5] Some people may respond better to one approach than others, and more research is needed to understand who will benefit from different types of therapy.

Psychodynamic therapy can be difficult for people who struggle to manage powerful emotions, dislike self-reflection, or find it difficult to face their underlying anxiety.^[1] Psychodynamic family therapy, for example, may be less effective if one person is reluctant to engage.

Psychodynamic therapy prioritizes clients’ emotional expression, and this has traditionally required being in a shared physical space. Although the COVID-related move to telemedicine demonstrated that psychodynamic therapies can be delivered successfully online, it can be difficult to find a therapist who is willing to offer psychodynamic therapy remotely.^[6]

Traditional psychodynamic therapy is usually long-term, which can make it expensive. Short-term psychodynamic therapies are increasingly being developed to help clients with common problems. Short-term psychodynamic therapy is anything under 25 sessions, which is still significantly longer than the 6-10 sessions considered standard for short-term cognitive behavioral therapy (CBT).^[7][8]

How to find psychodynamic therapy

Psychodynamic therapy is less popular than some other approaches, but it’s still a common type of therapy to find across the US. Therapists will almost always state which approach they use in their online bios, but you can also check that a therapist works psychodynamically during your first conversation.

The relationship with your therapist is one of the most important factors that determines the effectiveness of therapy, so it’s worth taking time to find someone you can trust and feel safe with.^[2] Consider contacting several psychodynamic therapists and having a short conversation to see how you feel when talking to them.

What to look for in a therapist

When looking for a therapist, here are some things you should expect

• They make you feel safe. You need to feel safe enough to be open and honest with a therapist. If you don’t feel comfortable, you may need to try someone else
• They have the right licenses for your state. State licenses are there to protect therapy clients. An ethical and responsible therapist will have all the necessary documentation and permissions.
• They continue to train. A great therapist is constantly looking for new ways to help their clients. Psychodynamic training is usually carried out in postgraduate certificates or training courses, which a therapist should be willing to tell you about.
• They are comfortable with the problem you are working on. Most therapists can work on a wide range of issues, but your therapist needs to be trained and competent in the problems you’re facing. Check whether your issue is listed as one of their core competencies in their bio, or ask them about their experience dealing with this problem.

Final thought

Psychodynamic therapy can be a powerful way to overcome problems and resolve underlying issues that cause them. It is not a quick-fix solution, but instead provides insight and understanding that can lead to meaningful long-term change.

Psychodynamic therapy FAQs

Is psychodynamic therapy more effective than medication?

Psychodynamic therapy has been shown to be effective for a wide variety of mental health conditions, as has medication. For many disorders, using therapy and medication together offers the best results.

Is psychodynamic therapy covered by health insurance?

Psychodynamic therapy is often covered by health insurance, but not always. It is always important to check in advance, as some insurers may require pre-approval for any type of talk therapy. Longer-term psychodynamic therapy may not be covered for the full duration.

Author

Natalie Watkins

Natalie has worked closely with trauma victims and survivors of domestic violence to help rebuild a sense of safety and confidence.

Activity History - Last updated: March 19, 2026, Published date: March 19, 2026

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Reviewer

Kaye SmithPhD

Dr. Smith is a behavioral health coach, clinician, writer, and educator with over 15 years of experience in psychotherapy, coaching, teaching, and writing.

Activity History - Medically reviewed on April 15, 2026 and last checked on March 19, 2026