How psychodynamic therapy can help you unpack past ordeals to treat anxiety, depression and more

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• Psychodynamic therapy evolved from psychoanalysis, Freud's well-known approach to psychotherapy.
• It requires in-depth unpacking of your childhood experiences, fears, desires, and other emotions.
• This exploration can help you pinpoint triggers of mental health symptoms and begin to resolve them.

If you feel perpetually hopeless, anxious, insecure, or angry but don't know why, psychodynamic therapy may prove helpful. 

This approach aims to help you identify the roots of your emotional distress so you can learn how to better cope with present challenges.

Psychodynamic therapy evolved out of Sigmund Freud's psychoanalysis as a way to help improve mental health, according to Dr. Steven Reidbord, a board-certified psychiatrist in private practice who specializes in psychodynamic therapy. 

Though less time-intensive than psychoanalysis, which can take years, psychodynamic therapy is based on some of the same principles:

• The fears, desires, and other content of your subconscious mind can have a major effect on your well-being.
• Events from your past may have a negative impact on your mental health in the present.
• You must resolve past issues in order to enjoy strong emotional health in the present.

Reidbord notes that originally, psychodynamic therapy aimed to treat what doctors once called "neuroses" — which today, mental health professionals would diagnose as depression or anxiety disorders.

Read on to find out more about the many potential benefits of psychodynamic therapy, and learn whether it might be a good fit for you.

Who it helps

Psychodynamic therapy can help treat a wide range of mental health conditions and symptoms, including:

Depression

Evidence suggests psychodynamic therapy can help reduce symptoms of depression — and these benefits not only last but can actually increase with time, even after the treatment ends. 

In fact, psychodynamic therapy may treat depression just as effectively as cognitive behavioral therapy (CBT), which many experts consider the "gold standard" approach to treating depression and other mental health concerns.

According to Mike Dow, a licensed psychotherapist at Field Trip Health, psychodynamic therapy works because it can help you recognize and understand deep-seated negative beliefs you developed over your past that may fuel or worsen your depression. 

For example, if you developed the belief that you're unlovable due to how a parent treated you during childhood, a psychodynamic therapist could help you explore the possible origins of that belief and challenge it to develop a more realistic mindset.

Anxiety

Psychodynamic therapy can help you identify past experiences that may drive or reinforce your anxiety — for example, instability or neglect from caregivers — so you can work on healing those old wounds, Dow says.

If you've already tried other approaches, like CBT, and found them unhelpful, psychodynamic therapy could offer another option to consider: Evidence suggests psychodynamic therapy is more effective for improving anxiety disorders than no treatment at all. 

This approach may also be worth considering if you live with social anxiety. A 2022 review found that psychodynamic therapy may prove particularly helpful for reducing intense fear in social settings and other symptoms of social anxiety.

Interpersonal difficulties

Research on psychodynamic therapy for relationship issues remains limited, but Reidbord says this approach may help you uncover any unhelpful unconscious beliefs negatively affecting your relationships. 

For example, he says a psychodynamic therapist may help you realize that your passive-aggressive tendencies serve as a defense mechanism that helps you avoid confrontation. From there, your therapist might help you untangle where your fear of confrontation comes from and build more productive coping mechanisms.

A small 2021 case study found that psychodynamic therapy helped treat couples' unresolved grief after losing a child. 

Before participating in therapy, the participants blamed themselves and their partners for their child's death. They also projected their own self-loathing onto their partners, which led to feelings of alienation and isolation. Through therapy, researchers reported these couples were able to let go of self-reproach and work on forgiving themselves and each other.

Eating disorders

Psychodynamic therapy considers disordered eating behaviors one method of expressing underlying distress. The goal of therapy involves identifying these concerns and guiding you toward more helpful ways of dealing with them.

One review found strong evidence that psychodynamic therapy can support recovery from anorexia nervosa. 

The review authors noted that available studies on psychodynamic therapy for bulimia nervosa are mostly small, with conflicting findings. However, one of the included studies did find evidence to suggest that 16 weeks of group psychodynamic psychotherapy helped:

• Reduce symptoms of binge eating disorder
• Improve symptoms of depression
• Boost self-esteem

Personality disorders

If you live with a personality disorder, you may find yourself using unhelpful defense mechanisms to handle unwanted or painful emotions. Examples include:

• Splitting: Also called all-or-nothing and black-and-white thinking, this defense mechanism involves perceiving other people, things, and situations as all good or all bad.
• Denial: This defense mechanism involves ignoring or refusing to acknowledge unpleasant thoughts, feelings, or events.

But psychodynamic therapy can help you identify and shift those patterns.

A 2020 review found psychodynamic therapy can help treat symptoms of:

• Borderline personality disorder
• Avoidant personality disorder
• Dependent personality disorder
• Obsessive-compulsive personality disorder

Researchers noted that psychodynamic therapy appeared especially helpful for reducing suicide attempts and self-harm among people living with personality disorders.

Theory and techniques

Psychodynamic therapy has three goals, according to Dr. Steven M. Sultanoff, a former clinical psychologist and current psychology professor at Pepperdine University. These goals include:

• Recognizing repressed emotions and past experiences that shaped how you view and interact with the world.
• Resolving "transference," or the act of transferring or projecting your feelings and attitudes toward someone from your past onto your therapist.
• Developing coping techniques for responding to challenging situations in more useful ways.

Common techniques used in psychodynamic therapy include:

• Facilitation: According to Reidbord, this often involves encouraging you to elaborate on your experiences. For example, if your parent never made it to your soccer games, or often harshly reprimanded you for small mistakes, your therapist might ask, "What was that like for you?" or "How did that make you feel?"
• Clarification: To confirm their understanding of the thoughts and feelings you've just expressed, your therapist might reflect back and summarize what they heard from you.
• Free association: Your therapist encourages you to discuss whatever's on your mind — including current conflicts, nightmares, or other events of the week — without editing the thoughts and emotions that come up during the process. You'll generally need to feel safe and comfortable in therapy before you can try this exercise.
• Dream analysis: Your therapist will ask you to describe your dreams in as much detail as possible and then guide you in parsing out themes that may relate to subconscious fears and desires. Not all therapists use this technique.

"With psychodynamic therapy, the therapist maintains the position of being the 'curious observer' in guiding the discussion,'" Sultanoff says.

"For example, the therapist might say, 'You said you feel angry. What happens when you are angry?' and "As you feel angry here in the room with me, does that remind you of feeling angry at earlier times in your life?"

What to expect from treatment

The duration of psychodynamic therapy can vary widely, depending on the severity of your symptoms, Reidbord says.

Dow says short-term psychodynamic therapy usually lasts for 25-30 sessions, while long-term psychodynamic therapy can last for 50 sessions or more. 

Sessions usually last 45 minutes to an hour and happen once or twice a week.

While your sessions won't follow any specific arc or format, Reidbord says early sessions typically focus on gathering information about your personal history. After that, your therapist may work with you to identify the pressing issues or goals you'd like to focus on during sessions.

"Unlike CBT models of therapy that can be highly structured, psychodynamic therapy tends to be more fluid," Dow says.

According to Dow, the psychodynamic approach can also work well in a group therapy setting. 

Sultanoff says a skilled therapist can draw parallels between everyone's experiences and help them relate to and project onto other members of the group. 

Also, since the group serves as a miniature version of the outside world, members may become more aware of unhelpful habits and patterns. For example, through your interactions with other group members, you might realize you have a tendency to project your own insecurities onto other people and take everything very personally.

Can it work as online therapy?

While you can try psychodynamic therapy via teletherapy, evidence has yet to determine whether an online approach offers the same benefits as in-person therapy. 

A small 2022 study found when people with depression and anxiety conditions participated in online group psychodynamic therapy, their symptoms improved, and so did their self-esteem.

Sultanoff and Reidbord agree, however, that in-person therapy tends to be more effective in terms of developing transference and ensuring both you and your therapist remain present and engaged.

How to try it

To find a therapist who offers psychodynamic therapy, Reidbord recommends using online directories or asking your primary care doctor for referrals. 

You can try the following searchable databases and filter for therapists trained in this approach:

• Psychology Today
• GoodTherapy
• Zencare

According to Dow, insurance covers psychodynamic therapy as long as your therapist accepts your insurance.

Insider's takeaway

In psychodynamic therapy, your therapist will help you connect the dots between your past experiences and your current mental health symptoms and other difficulties.

"Instead of focusing on what you have — in other words, your symptoms — psychodynamic therapy focuses on why you're experiencing distress," Dow says.

In addition to exploring those past events and their impact on you, your therapist can also help you develop positive coping techniques for distressing situations.

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