Psychodynamic therapy: could it work for you?

Depression and other mental disorders are often thought to have deep roots in past events and relationships. Psychodynamic therapy aims to reveal these roots of emotional suffering. This is done through relatively unstructured sessions of self-reflection and self-examination with the help of a trained therapist.  This form of psychotherapy can help people recognize unconscious thinking and behavioral patterns that negatively influence their life. It has been shown to lessen symptoms and improve quality of life for people experiencing depression and other mental disorders. That said, the evidence for its effectiveness on many conditions is not strong.

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Your life today is influenced, perhaps significantly, by your childhood experiences, relationships then and throughout your life, and any unresolved conflicts that might be simmering in your subconscious. That's the theory behind psychodynamic therapy, also called psychodynamic psychotherapy or psychoanalytic psychotherapy. Whatever the name, it amounts to the same thing: a therapist helping you to discover unconscious behavioral patterns that can negatively affect relationships and contribute to mental disorders. (UpToDate, 2021).

Psychodynamic therapy is really just a fancy term for talk therapy. Talk therapy encompasses many different techniques that can help people get in touch with and improve their thinking and behavioral patterns, whether conscious or otherwise (Mayo Clinic, 2016). 

Psychodynamic therapy is less intense than traditional psychoanalysis. Psychoanalysis is a word used broadly but is sometimes meant to describe intense therapy sessions that might go on for years. These sessions would delve deeply into your childhood experiences and often involve a lot of time on a couch. Psychodynamic therapy might involve just 15 weekly sessions. (American Psychological Association, 2017).

Psychodynamic therapy is notably different from cognitive-behavioral therapy or CBT. CBT is a more structured form of talk therapy that focuses on recognizing distorted thinking patterns, facing fears, understanding what motivates other peoples' actions, and developing specific problem-solving skills to deal with specific challenging situations. 

Psychodynamic therapy is used for the treatment of several psychiatric disorders and other mental conditions (Fonagy, 2015): 

• Depression

• Eating disorders (anorexia and bulimia nervosa)

• Personality disorders

• Sleeping disorders

It has also been used in treating substance abuse and other addictive disorders. Can it help? Perhaps. The research on its effectiveness is mixed (Verma, 2018).

The best evidence for psychodynamic psychotherapy's effectiveness is in treating depression. 

It can be used alone for people with mild or moderate depression. More severe cases suggest the addition of antidepressants or other medications to complement therapy. Whether the therapy works, in any case, depends in part on the patient's goals, motivation level, and personality (UpToDate, 2021).

A review of 23 randomized controlled trials compared psychodynamic therapy to other treatments—including cognitive behavioral therapy and medications—known to treat mental disorders effectively. 

Overall, it found psychodynamic therapy to be just as effective as CBT, though the study did not suss out which might be most effective for particular individuals or conditions. The analysis suggested psychodynamic therapy was as effective as pharmacological treatments. However, the researchers only reviewed two studies, so the results were not deemed conclusive (Steinert, 2017).

An earlier analysis reached a similar conclusion, adding that the gains from psychodynamic therapy "appear to continue and improve after treatment ends" (Shedler, 2010).

But it remains unclear how effective psychodynamic therapy is for any given person or many of the conditions other than depression that it's used for. 

Another review of the available evidence found the therapy "generally but by no means invariably" helps with depression, some anxiety disorders, as well as sleep and eating disorders. But it found "little evidence" for effectiveness in treating psychosis, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), bulimia nervosa, or dependence on cocaine (Fonagy, 2015).

Psychodynamic therapy sessions are typically one-on-one, though some therapists conduct group sessions. Sessions are typically 50 minutes, once per week for 12 to 24 weeks (UpToDate, 2021).

Psychodynamic therapists don't focus extensively on the past, but it comes up as they help people explore their emotions and put feelings into words. Sessions tend to be casual and open-ended, seeking to accomplish several goals (Shedler, 2010):

• Identify avoided behaviors and evasions, like skipping meetings.

• Spot recurring behavioral and thinking patterns and understand them better.

• Recognize past experiences that might affect present thinking and behavior.

• Explore difficulties in relationships.

• Speak freely about desires, fears, and even fantasies.

There are multiple approaches, and lines between one type and another are often not clear as with many psychotherapies.

Because psychodynamic therapy sessions may be somewhat informal and the overall duration of treatment measured in weeks, not years, the approach is sometimes referred to as short-term psychodynamic therapy (Gatta, 2019). 

However, any real distinction between the short-term approach and other styles is fuzzy in the scientific literature. One study used the short-term premise and found the therapy effective, stating that the U.S. military recommends it for treating veterans with mild to moderate major depressive disorder (Ho, 2017). But the U.S. military has deemed the therapy weak compared to other therapies for treating depression, calling it an alternative for those who don't want medication or other types of more intense therapy (Psychological Health Center of Excellence, 2017).

One thing is clear: There are alternative treatments to consider. That doesn't mean psychodynamic therapy is not useful, but figuring out the best course of treatment for whatever might ail you or a loved one should start with a visit to a healthcare professional, who can evaluate your symptoms and suggest the best course of treatment.

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Current version

June 04, 2021

Written by

Robert Roy Britt

Fact checked by

Felix Gussone, MD

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About the medical reviewer

Felix Gussone, MD, Ro

Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.