Psychodynamic Psychotherapy

Orthopaedic & Spine Center
Dr. Andrew Martin

Andrew L. Martin, PsyD

What is psychodynamic therapy? Psychodynamic therapy is an evidence-based psychotherapy treatment for depression, anxiety, trauma, and relationship problems.

Psychodynamic therapy focuses on unconscious conflict. Unconscious conflict occurs when the brain tries to think two opposite things at the same time. For instance, trying to see one’s life as safe and controllable, and at the same time knowing something very traumatic happened. Psychodynamic therapists help us see these conflicting thoughts and resolve them through acceptance. Afterward, depression and anxiety symptoms reduce, and we can manage relationships better.  

Psychodynamic therapists don’t say much during therapy. They use silence to help unconscious thoughts emerge into awareness. This silence can be uncomfortable, but it almost always leads to valuable insights, or “a-ha” moments. Patients describe these moments like this: “that suddenly makes sense…I think I’ve always know that but wasn’t really aware of it…that explains so much that I didn’t understand before…now I see why I’ve been having this problem all my life….”   

Psychodynamic therapists also rely heavily on the patient-therapist relationship in order to promote insight. The relationship is carefully controlled, sometimes manipulated, and frequently analyzed. Psychodynamic therapists don’t share much about themselves with patients. This is to remain neutral, or like a “blank slate” to the patient. This way, when the patient has thoughts and feelings about the therapist, those thoughts and feelings are actually unconscious thoughts about a past or present relationship. Becoming aware of those thoughts and feelings helps the insight process.

The most powerful psychodynamic technique is the interpretation, where the therapist points out similarities between a past relationship, a present relationship, and the relationship with the therapist. In my experiences as both a psychodynamic therapist and patient, these are the most powerful moments, leading to the “a-ha” feeling, and significant insight and change.  

You might think that the therapist-patient relationship needs to be very strong and trusting for all this to happen, and you would be right! Psychodynamic therapists pay careful attention to the therapeutic relationship, avoiding judgement and criticism, and supporting as much as possible the healthiest part of the ego, or the part of the personality that makes important decisions.

Psychodynamic patients usually meet with therapists 1-2 times per week, so that the brain stays in the “insight” mode, versus slipping back into unconscious denial. Therapy usually lasts between a few months and a couple of years, ending whenever the patient meets their goals.

Psychodynamic therapy is more difficult to research than other forms of therapy, so there is less research showing its effectiveness compared to cognitive-behavioral therapy, or cognitive processing therapy. But it is still considered an evidence-based therapy, with plenty of studies showing effectiveness in treating a range of problems. Several studies suggest psychodynamic therapy may have a longer-lasting effect than other therapies.