What Is Psychodynamic Therapy?

By Clay Klaus-Wade ·

The short answer

Most of us come to therapy because something keeps happening that we can't quite explain: the same argument with a partner, the same pull toward people who aren't available, the same quiet sense that we're performing a version of ourselves rather than living as one. By the time we reach out, we've usually already tried to think our way out of it, and we're tired.

Psychodynamic therapy is a form of talk therapy built for exactly that kind of problem. It rests on the idea that a lot of what drives us happens outside of our awareness, shaped by our earliest relationships and by the ways we learned to protect ourselves, and that bringing those patterns into view gives us more room to choose how we live and love.

You'll often hear the terms psychodynamic and psychoanalytic used interchangeably. They draw on the same theories and the same way of listening; psychoanalysis proper usually refers to a more intensive, more frequent, and longer version of the work (Sharma & Spiro, StatPearls).

How psychodynamic therapy works

Rather than following a fixed protocol, psychodynamic therapy follows you. In a 2010 review published in American Psychologist, the American Psychological Association's flagship journal, psychologist Jonathan Shedler named seven features that set psychodynamic work apart from other approaches (Shedler, 2010). In plainer terms, a psychodynamic therapist will:

  • Pay close attention to feelings, including the ones that are hard to name or that seem to contradict each other
  • Notice the ways we steer around painful thoughts and feelings, often without realizing we're doing it
  • Look for patterns and themes that show up again and again, across relationships, jobs, and years
  • Explore how the past, especially our early relationships, is still alive in the present
  • Focus on relationships, since so much of what hurts us, and so much of what heals us, happens between people
  • Treat the relationship with the therapist as a place where those patterns can surface and be understood in real time
  • Make room for fantasies, dreams, wishes, and daydreams, which tend to say more about us than we expect

That sixth point is the one people find most surprising. If you tend to apologize for taking up space, or you brace for disappointment before anyone's actually let you down, there's a good chance that will show up with your therapist, too. In psychodynamic work, that isn't an obstacle to get around; it's the material. Clinicians call this transference, and it gives us a chance to understand, and slowly change, the relational patterns we've carried with us for years (Sharma & Spiro, StatPearls).

Modern psychodynamic therapy draws on a long and varied lineage, including object relations theory (Melanie Klein, Donald Winnicott, Ronald Fairbairn) and attachment theory (John Bowlby and Mary Ainsworth), which share a simple and, I think, profound premise: we become who we are in relationship with the people closest to us.

How is psychodynamic therapy different from CBT?

Cognitive behavioral therapy, or CBT, is the approach most people have heard of, and it's a good one. CBT tends to be structured and present-focused: you and your therapist identify unhelpful thoughts and behaviors and practice changing them, often with exercises or homework between sessions. Psychodynamic therapy is less structured and more exploratory. Instead of asking only what you're thinking and how to change it, it asks where a pattern came from, what it's been protecting you from, and what it might cost you to set it down.

It isn't a competition. Researchers have compared the two head to head, and both tend to help; one randomized trial of outpatient treatment for major depression found no significant difference in outcomes between them (Driessen et al., 2013), and later meta-analyses have generally landed in the same place, with some authors suggesting that the gains from psychodynamic therapy may last longer, and even grow, after treatment ends (Sharma & Spiro, StatPearls).

I happen to think the best therapy is the one that fits the person in the chair. If you want a clear set of skills for a specific problem, CBT may be exactly right. If you understand your patterns perfectly well on paper and still can't seem to change them, psychodynamic therapy is often where people find the missing piece.

Is psychodynamic therapy evidence-based?

For a long time, psychodynamic therapy had a reputation problem. The cartoon version (a silent analyst, a velvet couch, years of talk with little to show for it) stuck around long after the field had moved on, and the research has been telling a different story for well over a decade.

In that 2010 review, Shedler looked across eight meta-analyses covering 160 studies of psychodynamic therapy (Psychiatric Times) and found that its effect sizes were as large as those of therapies widely promoted as "evidence-based" (Shedler, 2010). The benefits held for a wide range of concerns, including depression, anxiety, panic, and stress-related physical symptoms. The finding I find most moving is that people tended to keep improving after therapy ended, which Shedler read as a sign that the work sets in motion psychological processes that continue on their own (APA via ScienceDaily).

The research since then has largely backed this up. A Cochrane review of short-term psychodynamic therapies found modest to large gains across several common mental health conditions (Abbass et al., 2014), and a 2017 meta-analysis in the American Journal of Psychiatry tested whether psychodynamic therapy holds up against other empirically supported treatments (Steinert et al., 2017). The American Psychoanalytic Association keeps a running list of this literature for anyone who wants to dig in.

Who is psychodynamic therapy for?

Psychodynamic therapy can help with a very wide range of emotional and psychological difficulties (American Psychoanalytic Association), but it tends to be an especially good fit if:

  • You keep ending up in the same place, in relationships, at work, or with yourself, and you want to understand why
  • You can explain your problem clearly and still feel stuck inside it
  • You're carrying shame, grief, or old hurts that don't fit neatly into a diagnosis
  • You're working through questions of identity, whether that's sexuality, gender, neurodivergence, or the many other layers that make up a self
  • You want therapy to be a relationship and a conversation, not a set of assignments

How long does psychodynamic therapy take?

It depends on what you're hoping for. Short-term psychodynamic therapy usually runs 12 to 15 sessions and stays focused on a specific concern, while longer-term work is open-ended and aims at deeper, more lasting change in how you relate to yourself and others (Sharma & Spiro, StatPearls). Most people meet with their therapist weekly.

The first few sessions are mostly about getting to know each other. We'll talk about what brought you in, what you've already tried, and a bit of your history, and together we'll start to get a feel for whether the work is a good fit. You don't need to arrive with the right words or a tidy story; part of the work is finding the words together.

Psychodynamic therapy at Layered Health

The name Layered Health comes from a belief at the heart of psychodynamic work: we're all complex, we all contain multitudes, and we grow and heal by identifying, exploring, and gleaning insight from the many layers that make us who we are. I think of that process in three movements, Explore, Discern, and Integrate, and you'll see them woven through everything we do.

Layered Health is a Philadelphia-based psychotherapy practice opening in Summer 2027. My work is psychodynamic and attachment-informed, and I bring in person-centered, compassion-focused, somatic, and narrative approaches when they serve the person in front of me. I'm committed to affirming care for LGBTQ+ people, people in consensually non-monogamous relationships, and neurodivergent people, not as a specialty bolted onto the side, but as a starting point. I'm also a member of the Philadelphia Society for Psychoanalytic Psychology.

If you've been looking for a psychodynamic therapist in Philadelphia, or a place where all of your layers are welcome, I'd love to hear from you.

Contact me

Frequently asked questions

What is psychodynamic therapy?

Psychodynamic therapy is a form of talk therapy that helps you understand the patterns, feelings, and early relationships that shape how you live and love today, often outside of your awareness, so you have more freedom to change them.

Is psychodynamic therapy evidence-based?

Yes. Reviews of the research have found that psychodynamic therapy works about as well as other evidence-based therapies for concerns like depression and anxiety, and that people often keep improving after therapy ends.

What's the difference between psychodynamic and psychoanalytic therapy?

The terms are often used interchangeably. Psychoanalysis usually refers to a more intensive version of the same approach, with more frequent sessions over a longer period.

How is psychodynamic therapy different from CBT?

CBT is structured and focuses on changing current thoughts and behaviors. Psychodynamic therapy is more exploratory and focuses on understanding where those patterns came from and what they've been protecting.

How long does psychodynamic therapy take?

Short-term psychodynamic therapy usually lasts 12 to 15 sessions. Longer-term work is open-ended and aims at deeper change.

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