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What Is Psychodynamic Therapy and How Does It Work?

Rooted in the idea that much of our behavior is shaped by unconscious thoughts, past experiences, and unresolved conflicts, this therapeutic approach invites us to slow down and look beneath the surface.

By Taylor Pagniello, RP, M.A.

Oct 26, 2025

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Sometimes we find ourselves repeating the same patterns — choosing similar partners, reacting to stress in familiar ways, or feeling emotions that don’t quite make sense in the present. We know something isn’t working, but we can’t quite put our finger on why.

That’s where Psychodynamic Therapy comes in. Rooted in the idea that much of our behaviour is shaped by unconscious thoughts, past experiences, and unresolved conflicts, this therapeutic approach invites us to slow down and look beneath the surface. Rather than focusing only on symptoms or behavior change, psychodynamic work explores the meaning behind those patterns — helping clients develop deeper insight, self-awareness, and emotional freedom.

Originally influenced by the theories of Sigmund Freud, modern psychodynamic therapy has evolved far beyond its early origins. Today’s practitioners use a more relational, compassionate, and collaborative approach — one that honours both your history and your present-day needs.

Why Psychodynamic Therapy Is Used

Psychodynamic therapy is often chosen when a person wants to understand why they feel or act the way they do — especially when those reactions feel automatic, confusing, or deeply ingrained. It’s not just about managing symptoms, but understanding their roots.

This approach is used for a wide range of concerns, including:

  • Relationship struggles or recurring attachment patterns
  • Low self-esteem or identity confusion
  • Anxiety and depression linked to early experiences
  • Emotional numbness or difficulty connecting with others
  • Grief, guilt, or unresolved childhood wounds
  • Repetitive life themes (e.g., always feeling rejected, unseen, or “not enough”)

Psychodynamic therapy can also be incredibly valuable for people who have done other forms of therapy — like CBT or solution-focused work — but still feel like something deeper hasn’t shifted. It’s about moving from understanding your behaviour to transforming your inner world.

How Does Psychodynamic Therapy Work?

At its core, psychodynamic therapy is about making the unconscious conscious. It helps you become aware of the feelings, beliefs, and experiences that operate beneath your awareness but still influence your choices and relationships.

Therapy unfolds through a reflective, open-ended dialogue between you and your therapist. You’re encouraged to explore your thoughts freely — without judgment or filtering. Over time, patterns begin to emerge, revealing how your past experiences have shaped your present emotions, defenses, and relationships.

A few core elements define psychodynamic work:

1. Exploring the Unconscious

The therapist helps you notice hidden emotions, motives, or beliefs that influence your thoughts and behaviour. These unconscious processes often reveal unmet needs or internal conflicts that developed early in life.

2. Defense Mechanisms

We all use defenses to protect ourselves from pain — things like denial, repression, or rationalization. Psychodynamic therapy helps bring awareness to these defenses so they can be understood rather than judged.

For instance, someone who always stays “busy” might discover that constant activity protects them from feeling lonely or unworthy. When that awareness surfaces, new choices become possible.

3. Transference and Countertransference

Transference occurs when you unconsciously project feelings or expectations from past relationships onto your therapist. Rather than a problem, this is seen as valuable information. It allows you to experience — and gently repair — old relational wounds in real time.

Similarly, therapists reflect on their own emotional responses (countertransference) to understand what’s happening in the room and deepen empathy.

4. The Therapeutic Relationship

In psychodynamic work, the relationship itself becomes a mirror. How you connect, withdraw, seek reassurance, or respond to conflict with your therapist often reflects how you navigate relationships outside therapy. Over time, this awareness helps you develop healthier patterns of connection and trust.

5. Insight and Integration

As insight grows, clients begin to integrate new understandings into daily life — replacing unconscious reactions with conscious choice. The goal isn’t perfection or endless analysis, but greater emotional flexibility and authenticity.

What Does a Psychodynamic Therapy Session Look Like?

A psychodynamic session often feels less structured than CBT or trauma-focused therapies. You might begin by talking about whatever’s on your mind — a dream, a recent argument, or a recurring feeling. The therapist listens deeply, not just to what’s said but to how it’s said — the pauses, patterns, and emotional undertones that reveal hidden meaning.

You and your therapist might explore questions like:

  • “What does this remind you of?”
  • “When have you felt this way before?”
  • “What do you imagine might happen if you express that emotion?”

These reflections help uncover deeper emotional truths that may have been buried for years. It’s not about dissecting your past endlessly but about connecting the dots between past experiences and present struggles.

Over time, as you feel safer to be open and vulnerable, new emotional experiences unfold in the therapy space — moments of connection, frustration, sadness, or relief — that model healthier ways of relating to yourself and others.

Why Psychodynamic Therapy Works

Psychodynamic therapy works because it focuses on understanding rather than managing. When you become aware of the unconscious forces driving your behaviour, you gain the freedom to make different choices.

Research consistently shows that psychodynamic approaches are effective for long-term improvement in mood, relationship satisfaction, and overall psychological health. What’s unique about it is the depth of change it promotes — not just symptom reduction, but transformation at the level of self-understanding and emotional regulation.

People often report that after psychodynamic work, they feel more grounded, less reactive, and more connected to their authentic selves. They begin to recognize triggers faster, communicate needs more clearly, and approach relationships with greater empathy and confidence.

Psychodynamic Therapy and Attachment

A key theme in psychodynamic therapy is attachment — how early relationships shape the way we connect later in life. If you grew up in an environment where emotions were minimized, or affection was inconsistent, you might have developed certain strategies to protect yourself from rejection or vulnerability.

Psychodynamic therapy helps uncover these attachment patterns and offers a space to experience a new kind of relationship — one based on empathy, safety, and consistency. Over time, this relational experience can reshape how you relate to yourself and others outside the therapy room.

Who Can Benefit From Psychodynamic Therapy?

Psychodynamic therapy can benefit almost anyone looking for deeper emotional insight, but it’s especially helpful for those who:

  • Feel stuck in repetitive relationship cycles
  • Struggle to identify or express emotions
  • Have long-standing patterns of anxiety, shame, or self-criticism
  • Want to understand the “why” behind their struggles, not just manage symptoms
  • Are interested in personal growth, meaning, and self-reflection

It’s also a strong fit for clients who have completed short-term or skills-based therapies and want to deepen their understanding of themselves at a relational and emotional level.

Limitations of Psychodynamic Therapy

Psychodynamic therapy can be more time-intensive than brief, goal-oriented approaches. It requires curiosity, patience, and a willingness to explore discomfort and vulnerability. Some clients may initially find it challenging to engage with abstract concepts or tolerate slower progress.

However, for those ready to look inward and explore the layers beneath their patterns, the long-term benefits can be profound. It’s not just about feeling better — it’s about being freer.

Final Thoughts

Psychodynamic therapy is less about “fixing” and more about understanding. It invites you to slow down, listen to the parts of yourself that have gone unheard, and make sense of the patterns that quietly shape your life.

When we bring awareness to those hidden dynamics, we begin to heal not just the symptoms, but the roots — allowing space for growth, deeper connection, and emotional honesty.

If you’ve ever felt like you keep ending up in the same place, despite trying to change, psychodynamic therapy might be the missing piece. It’s a journey toward self-awareness, self-compassion, and the kind of transformation that comes from understanding your story — and finally living it differently.

References

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.

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Leichsenring, F., & Klein, S. (2014). Evidence for psychodynamic psychotherapy in specific mental disorders: A systematic review. Psychological Medicine, 44(8), 1515–1527.

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Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2), 98–109.Truijens, F., Vanheule, S., De Smet, M. M., & Desmet, M. (2019). The value of insight in psychotherapy: A qualitative exploration of clients’ experiences. Psychotherapy Research, 29(8), 1085–1098.

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Wachtel, P. L. (2011). Therapeutic communication: Knowing what to say when. Guilford Press.

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