Knowledge base Updated 2 November 2026 1 views

Psychodynamic Therapy

A family of therapies working with unconscious process, early relationship patterns, defence, and what happens between client and therapist, typically less structured and longer than behavioural treatments.

Definition

Psychodynamic therapy descends from psychoanalysis but is not it. Sessions are usually weekly and face to face rather than several times a week on a couch, and the treatment is often time-limited.

Seven features distinguish it empirically, following Blagys and Hilsenroth: focus on affect and its expression; exploration of avoidance; identification of recurring themes; discussion of past experience; focus on interpersonal relations; focus on the therapy relationship itself; and exploration of fantasy life.

History

Freud's work from the 1890s onward is the origin, but the clinically relevant lineage runs through object relations (Klein, Winnicott, Fairbairn), ego psychology, self psychology (Kohut) and attachment-informed developments.

The field spent decades outside the evidence-based mainstream, partly through its own resistance to trial methodology. That has changed substantially since the 2000s.

Theory

Core propositions:

Much mental life is outside awareness, including the reasons for one's own behaviour.
Early relationships shape expectations that are carried into later ones.
Defences protect against unbearable affect and have costs.
Transference — the patterning of the therapy relationship on earlier ones — is data, not interference, and working with it directly is a treatment component.

The aim is broader than symptom reduction: increased self-understanding, and a wider range of available ways to relate.

Research

The evidence base is real and has grown considerably. Meta-analyses find effects for depression, anxiety and personality disorders broadly comparable to CBT at the end of treatment.

The more interesting and more contested finding is that gains may increase after treatment ends in some psychodynamic trials, which does not happen in most treatment literatures and would be theoretically significant if it holds.

Evidence for long-term psychoanalytic treatment specifically is much thinner, and the trials that exist are small.

Applications

Depression, anxiety, personality disorders, and presentations where the difficulty is relational and recurrent rather than a discrete symptom.

Mentalisation-based treatment and transference-focused psychotherapy are manualised psychodynamic treatments with their own trial evidence, particularly in borderline personality disorder.

Criticism

The classical theory is largely unfalsifiable, and the parts that were testable have often not survived testing.
Long-term treatment has weak evidence relative to its cost and its confident advocacy.
The post-treatment gains finding rests on a small number of trials and may not replicate.
Access is skewed. Longer, less structured therapy is disproportionately available to people who can pay for it.
Recovered memory practices associated with parts of this tradition caused documented harm in the 1990s, and that history is not fully reckoned with.

References

Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2), 98-109.
Blagys, M. D., & Hilsenroth, M. J. (2000). Distinctive features of short-term psychodynamic-interpersonal psychotherapy: A review of the comparative psychotherapy process literature. Clinical Psychology: Science and Practice, 7(2), 167-188.
Leichsenring, F., & Rabung, S. (2008). Effectiveness of long-term psychodynamic psychotherapy. JAMA, 300(13), 1551-1565.
Bateman, A., & Fonagy, P. (2008). 8-year follow-up of patients treated for borderline personality disorder. American Journal of Psychiatry, 165(5), 631-638.

Written for PsychologyOrbit and reviewed before publishing. It is a summary for professionals and students, not clinical guidance, and it is not a substitute for the primary sources listed above.