What Is Psychodynamic Psychotherapy?

Today, over 400 modalities and approaches to talk therapy exist. Deciding on a type of mental health counseling can be challenging with so many options available, and some people may feel unsure about how to start their search for a psychotherapist. Here, we’ll explore one type in particular: psychodynamic psychotherapy, a talk therapy modality inspired by certain well-known psychologists throughout history. Learning more about the potential benefits of psychodynamic psychotherapy can help you make an informed decision about your care, whether you choose this approach or another.

What is psychodynamic psychotherapy?

Psychodynamic theory is similar to psychoanalytic therapy, a type of counseling popularized by psychologists like Sigmund Freud. Psychoanalysis is an in-depth method that encourages participants to freely verbally express their thoughts, dreams, urges, and ideas. This type of psychotherapy often focuses on how clients react to and interact with the world around them and the influence of their subconscious minds.

Unlike other forms of psychotherapy, like cognitive behavioral therapy, psychodynamic therapy is usually a long-term type of treatment and often dives deeply into various areas of psychology—unless it’s specifically being practiced as brief psychodynamic psychotherapy or short-term psychodynamic psychotherapy. It focuses on self-expression, self-examination, and cognitive function, and the goal of sessions is often to help the client lead a more fulfilling life or meet their personal goals. 

Typically, individuals who engage in psychodynamic psychotherapies will participate in ongoing discussions with their psychotherapist about their thoughts, ideas, emotions, and beliefs. This form of talk therapy can be used to treat mental illness or address daily stressors related to school, work, or relationships. During long-term or brief psychodynamic sessions, clients will use self-reflection to answer their questions with the help of the counselor's guidance and the counselor’s insights into current psychological research. 

Is free association used in psychodynamic psychotherapy?

Free association is a psychodynamic psychotherapy technique where a psychotherapist states a word or concept and the client responds with a word, thought, or image that pops into their mind after being prompted. Afterward, they may use self-reflection or consult with their psychotherapist to further understand the meaning of their association. Dream interpretation might also be utilized in this type of treatment, which is when the psychotherapist asks about the client's dreams and helps them draw conclusions about their meanings.

How can psychodynamic therapy benefit me?

A primary concept in psychodynamic psychotherapy sessions is self-esteem, and psychodynamic therapy aims to build self-esteem in many cases. Through exploring the inner workings of the mind and how specific memories might impact an individual, that individual may start to recognize their ability to make inferences and solve problems, and they may build self-esteem as a result. Improved self-esteem may help reduce symptoms of common mental health conditions like major depression and depressive symptoms. Psychodynamic therapeutic approaches may also be helpful in treating certain personality disorders and social anxiety disorder, according to randomized clinical trials analyzed in a systematic review.

Through this type of psychotherapy, you might also identify thoughts, emotions, memories, or relationship patterns you didn't previously consider working through in other forms of psychotherapy. Findings from randomized trials suggest that suppressing emotions may negatively affect physical and emotional health, so being able to identify and label your emotions and how they affect present behavior may be beneficial.

In addition, psychodynamic psychotherapy focuses on the present and releasing a client from past experiences that may be holding them back. They can learn how their past impacts their present reality and work with the psychotherapist to develop a healthy treatment plan for their future, often involving psychological medicine and therapeutic techniques. The psychotherapist can also offer coping mechanisms for the patient’s life that they can practice in sessions and at home. 

When would psychodynamic therapy not be beneficial?

This type of treatment is not necessarily beneficial for every client. As it is a historical treatment, it forms the basis of modern talk therapy. However, many of its concepts are controversial in modern psychology due to limited and inconsistent evidence for its effectiveness.

You might not benefit from the psychodynamic perspective if you are experiencing symptoms of psychological disorders like psychosis, schizophrenia, mania, delusions, or post-traumatic stress disorder (PTSD). In addition, free association’s aim of trying to bring to light repressed emotions may be associated with false memories, which are memories imposed by a mental health professional and "discovered" in psychotherapy that clients may not have actually experienced. False memories can cause individuals to feel that someone in their life has harmed them in a way that they have not and may also harm the patient-therapist relationship.

If you’re looking for another form of psychotherapy with more robust evidence for its effectiveness than psychodynamic approaches have, you might explore:

• Cognitive-behavioral therapy (CBT) 
• Dialectical behavior therapy (DBT) 
• Exposure and response prevention (ERP) 
• Person-centered therapy 
• Solution-focused therapy
• Rapid eye movement and desensitization reprocessing therapy (EMDR) 

If you are in crisis, do not use this site. You can reach out to crisis services through the following hotlines and websites: 

• National Domestic Violence Hotline: 1-800-799-SAFE (7233)
• National Suicide Prevention Lifeline: 1-800-273-TALK (8255)
• Crisis Text Line: Text HOME to 741741
• Veterans Crisis Line: Call 1-800-273-8255 (and press 1) or text 838255. For support for the deaf and hard of hearing community, please use your preferred relay service or dial 711 then 1-800-273-8255.
• Trevor Lifeline (LGBTQ Lifeline): (866)488-7386 
• SAMHSA National Helpline for substance use: (800)662-4357
• Child Help Hotline: Call 1-800-422-4453 or use the online chat feature
•  National Anti-Hazing Hotline: 1-888-NOT-HAZE (1-888-668-4293) 
• Physician Crisis Support Line: Call 1-888-409-0141 if you are a first responder or medical professional experiencing crises related to COVID-19
• Sexual Assault Hotline: Call RAINN at 1-800-656-4673

How to find a psychodynamic therapist

There are various methods of finding a psychodynamic therapist—especially since psychodynamic therapy online is now available. If you’re interested in in-person psychotherapy, you can ask your doctor for a referral, check with your insurance company, or look up providers in your area. If you’re interested in online psychotherapy, see the end of this article for advice on finding a provider virtually.

Note that although psychodynamic psychotherapy was once popular, many therapists now practice CBT in place of it. That means it may be hard to find a professional who still practices psychodynamic therapy.

If you do find a potential provider of any type, ensure the psychologist you're considering is licensed and experienced. You can verify a psychologist's licensing through your state licensing board or ask them about their credentials during your intake session. Licensing lets you know someone has received the education and clinical hours required to properly support clients.

How to approach your initial therapy session

When you attend the first of your psychotherapy sessions with your psychotherapist, it may be helpful to bring a list of questions, symptoms, or concerns to discuss. Or, if you're uncomfortable sharing vulnerable details during the first session, you can ask your psychotherapist to lead with guiding questions and advice. 

A few questions you might ask your new psychotherapist include: 

• How does your approach to psychodynamic therapy differ from other psychologists’? 
• Do you prefer to lead sessions or let the client lead? 
• How do you know when therapy has been a success? 
• Are there any specific techniques you believe in? 
• Have you treated the emotional or psychiatric symptoms I’m experiencing in other clients before? 
• How long have you been practicing? 
• Where are you licensed? 
• Can I expect a certain number of sessions for general treatment with you?

Deciding whether to pursue psychotherapy online or in-person

Starting the search for a therapist can be overwhelming. Although talk therapy was historically carried out in a clinical setting while a client lay on a couch and discussed their thoughts with a psychologist quietly taking notes, modern therapy is often less formal and may be more personalized to the client's needs. 

Many clients are uncomfortable with the barriers that in-person therapy can come with. Some simply might feel most comfortable at home, while others may not be able to afford traditional in-office sessions. In these cases, partaking in psychodynamic therapy or another type of therapy, such as cognitive behavioral therapy, online can be more comfortable and affordable. With online therapy, clients can interact with a licensed psychologist from anywhere with an internet connection via phone call, video call, and/or in-app messaging. Plus, research suggests that online therapy can often offer similar benefits to in-person care.