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Some difficulties can begin to feel familiar, even when the circumstances surrounding them change. You may notice similar tensions emerging across different relationships, find yourself responding strongly to particular situations without fully understanding why, or recognise that you keep returning to ways of thinking, feeling or relating that you have tried to change but have found difficult to shift.
Psychodynamic Therapy offers a way of understanding these recurring experiences by exploring how earlier relationships and experiences may continue to influence how we see ourselves, respond emotionally and relate to other people in the present. Rather than looking only at the difficulty as it appears today, the therapy creates space to understand how it may have developed, what might be maintaining it and why certain patterns continue to recur.
What is Psychodynamic Therapy, and how does it differ from psychoanalysis?
Psychodynamic Therapy is a form of talking therapy based on the understanding that we are not always fully aware of the experiences, feelings and expectations that influence our behaviour and relationships.
Experiences within earlier relationships can shape what we come to expect from ourselves and other people, as well as how we respond when we feel vulnerable, rejected, criticised or uncertain. Over time, these responses can become familiar ways of managing our emotions and relationships, sometimes continuing long after the circumstances in which they first developed have changed.
Psychodynamic Therapy provides an opportunity to become more aware of these patterns and to understand how they may be influencing current experiences, relationships and emotional difficulties.
Although Psychodynamic Therapy developed from psychoanalytic ideas, it is distinct from traditional psychoanalysis, which is generally a more intensive form of treatment and may involve several sessions each week over an extended period. Psychodynamic Therapy is typically more flexible in its frequency and duration, while retaining an interest in unconscious processes, earlier relationships and the ways in which past experiences can become present in our current lives.
The therapist also takes an active role in helping the client think about what emerges during sessions, which may involve asking questions, noticing recurring themes or gently drawing attention to connections that have not previously been apparent.
Other therapeutic approaches also consider the influence of earlier experiences, although they may conceptualise and work with them differently. Schema Therapy, for example, explores patterns that can develop when important emotional needs are not adequately met, while using a more structured framework for understanding how these patterns continue to influence someone’s emotional life and relationships.
What actually happens in a Psychodynamic Therapy session?
Psychodynamic Therapy tends to be less structured than approaches that organise each session around a predetermined agenda, which means that clients are generally encouraged to begin with whatever feels most important, immediate or emotionally present for them at the time.
This might involve something that has happened during the week, a relationship that has been occupying their thoughts, a memory, a feeling that is difficult to understand, or even something that has happened within the therapy itself. As the conversation develops, the therapist listens not only to the immediate difficulty being described but also to themes, emotional responses and ways of relating that may appear repeatedly over time.
For someone who is accustomed to approaching difficulties by analysing them, finding solutions or taking immediate action, this way of working can initially feel unfamiliar, because the purpose is not always to resolve the subject being discussed within that particular session. Instead, the work involves gradually developing a fuller understanding of the connections between experiences, emotions and relationships, including connections that may previously have been outside conscious awareness.
What happens in the first session?
The first session provides an opportunity to begin understanding what has brought someone to therapy at this particular point in their life, while also considering the wider context in which their current difficulties have developed.
The therapist may ask about what is happening now as well as relevant aspects of the person’s history, including significant relationships, family experiences and previous emotional difficulties, although this does not mean that every aspect of someone’s history needs to be covered immediately.
There is also no expectation that someone should arrive with a clear explanation of what is wrong or why it is happening, because developing a more nuanced understanding of the difficulty is often part of the therapeutic process itself. These initial conversations also allow the client and therapist to consider whether Psychodynamic Therapy feels like an appropriate way of working and what the focus of the therapy might be.
How does the therapeutic relationship become part of the work?
One of the distinctive aspects of Psychodynamic Therapy is the attention given to the relationship that develops between the client and therapist, because the ways in which we have learnt to relate to other people can sometimes become visible within therapy itself.
We all enter relationships with expectations that have been shaped by previous experiences, some of which we recognise readily and others of which may be much less apparent to us. Someone who has become accustomed to anticipating criticism, for example, may find themselves worrying that their therapist is disappointed in them, while someone who has learnt to prioritise the needs of others may notice themselves trying to say what they imagine the therapist wants to hear rather than expressing what they genuinely think or feel.
Psychodynamic therapists may explore these experiences because they can provide valuable information about patterns that occur in other areas of a person’s life. The term transference describes the ways in which feelings, expectations and patterns associated with other relationships can become present within the therapeutic relationship, allowing them to be noticed and understood in a setting where they can be explored with curiosity rather than simply repeated.
The therapy may also involve paying attention to subjects that feel particularly difficult to approach, changes in emotion during a conversation, or the ways in which someone protects themselves from feelings that feel uncomfortable or threatening. Rather than treating these responses as something that needs to be corrected, the therapist may explore what function they serve and what they can tell us about how the person has learnt to manage difficult experiences.
How long does Psychodynamic Therapy usually take?
There is no single duration of Psychodynamic Therapy that is appropriate for everyone, as the length of the work will depend on the nature of the difficulties being explored, what the client hopes to gain from therapy and the model of therapy that has been agreed.
Some forms of psychodynamic work are time limited, with an agreed number of sessions or a planned end point, while others are open ended and allow the work to continue for longer, with the duration reviewed as therapy progresses. Neither format is inherently preferable, and the most appropriate structure will depend on the individual, the difficulties they are bringing and the depth or scope of the work they would like to undertake.
Questions about frequency, duration and ending should form part of the conversation between client and therapist, both when therapy begins and as the work develops, so beginning Psychodynamic Therapy does not mean making an indefinite commitment without opportunities to review whether it continues to feel useful.
Who can find Psychodynamic Therapy helpful?
Psychodynamic Therapy can be helpful for people who would like to understand themselves and their experiences more deeply, particularly when emotional or relationship difficulties feel longstanding, repetitive or difficult to make sense of.
Someone may be drawn to this approach because they notice similar difficulties arising across different relationships, find that particular situations evoke emotions that feel unexpectedly strong, or understand a pattern intellectually but continue to find themselves caught within it. Others may not be able to identify a particular recurring pattern at the outset but have a broader sense that something in their emotional life or relationships does not feel as they would like it to.
Psychodynamic Therapy is used with a wide range of psychological and emotional difficulties, including depression, anxiety and relationship difficulties, while also being relevant for people who do not have a particular diagnosis but would like to develop a deeper understanding of their emotional experiences and relationships.
As with any therapeutic approach, it will not necessarily be the preferred way of working for everyone, and some people may be looking for a therapy with a more clearly defined structure, a narrower focus or practical exercises to use between sessions. The question is therefore less about whether one approach is better than another and more about whether the way of working fits the person, the difficulties they are experiencing and what they hope to gain from therapy.
How does Psychodynamic Therapy compare with Cognitive Behavioural Therapy (CBT)?
Psychodynamic Therapy and Cognitive Behavioural Therapy (CBT) differ in their emphasis and in the way therapy is typically structured, although the distinction between them is more nuanced than simply describing one as focused on the past and the other as focused on the present.
CBT generally involves developing a shared understanding of a particular difficulty by exploring the relationships between thoughts, feelings and behaviour, with sessions often organised around an agreed focus and practical exercises or experiments sometimes forming part of the work between sessions.
Psychodynamic Therapy tends to provide more space for exploration as the session develops, with particular attention given to emotional and relational patterns, the meanings attached to different experiences and the ways in which earlier relationships may continue to influence present experiences. Rather than necessarily working towards changing a particular thought or behaviour directly, the therapy may seek to develop a fuller understanding of the emotional processes that contribute to the pattern and the reasons it has been difficult to change.
This does not mean that CBT is concerned only with the present or that Psychodynamic Therapy is concerned only with the past, as both approaches can consider previous experiences and both are ultimately interested in meaningful psychological change. Their differences lie more in how difficulties are understood, where attention is directed during therapy and the process through which change is expected to occur.
How do I know if Psychodynamic Therapy is right for me?
Choosing a type of therapy can feel surprisingly difficult, particularly when descriptions of several different approaches seem relevant to what you are experiencing, and there is no expectation that you should be able to determine the most appropriate therapeutic model before you have spoken to someone.
The type of therapy that may be most helpful depends on several factors, including what has brought you to therapy, how long the difficulty has been present, what you would like to understand or change and the way of working that is likely to suit you. An initial conversation can therefore be useful not simply for deciding whether to begin therapy, but also for thinking together about which approach might make the most sense for you.
If you would like to find out more about Psychodynamic Therapy or discuss whether it might be relevant for you, get in touch to arrange an initial consultation.
