Psychodynamic Therapy

Overview, assumptions, forms, research, treatments, goals, therapeutic relationship, sessions, relevance for social work.

Three sections follow:

1. Background Material that provides the context for the topic

2. Suggestions for Practice

3. References

Feedback welcome!

Background Material

Overview

Psychodynamic therapy, a form of depth psychology, emphasises the influence of the unconscious mind on behaviour. Rooted in the theories of Sigmund Freud, this therapeutic approach has evolved over the past century to encompass a variety of techniques aimed at helping clients explore their emotions, thoughts, and early life experiences (MHA, 2024).  It investigates the “why” behind people’s thoughts and actions. It focuses on questions such as “Why am I doing what I’m doing?” and “Why am I feeling this way?” (Tartakovsky, 2021).  Psychodynamic theory suggests that forces outside of a person’s awareness explain why they behave in a certain way (Online MSW Programs, 2023).

Psychodynamic therapy differs from most other therapeutic modalities.  Many modern types of therapy emphasize mitigating or getting rid of the symptoms of a problem. For example, if a person struggles with anxiety, then cognitive behavioral therapy can help them address the symptoms of that anxiety. Psychodynamic theory, however, explores a person’s deeply rooted drives, needs, and desires. It’s considered a more global approach to therapy than modern, problem-based therapy. Psychodynamic therapy can also be considered as the difference between focusing on an individual’s emotions versus their behaviour (Online MSW Programs, 2023).

At the core of dynamic theory are ideas with universal appeal: that people have a persistent personality, that the past impacts the present, that childhood experience matters in later life, that psychological defenses are used to help people cope with the trials and tribulations of life, that people often feel conflicted and at odds within themselves, and that emotions have behavioral consequences. Psychodynamic therapy is inclusive of culture, but also of orientation in time: the threefold technique of exploring the past to understand current perceptions in hopes of bringing about new behavioral responses addresses all three realms of time—the past, the present, and the future. The psychological trifecta of emotions, cognitions, and behaviors are addressed with such a strategy (Fulmer, 2018).

Assumptions / Presuppositions of Modern Psychodynamic Thought

There are several key assumptions in psychodynamic theory, including:

• All behavior has an underlying cause.

• The causes of a person’s behavior originate in their unconscious.

• Different aspects of a person’s unconscious struggle against each other.

• An adult’s behavior and feelings, including mental health issues, are rooted in childhood experiences.

• Both innate, internal processes and the external environment contribute to adult personality (Online MSW Programs, 2023).

Fulmer (2018) presents these as four presuppositions of psychodynamic thought:

1. Forces behind the scenes are influential.                  Examples of unseen forces include biological impulses, psychological motives, and cultural pressures—the unconscious—that often produce mental conflict.

2. Personality shapes experience. Experiences from one’s early environment either lead to the use of primitive defenses (e.g., denial) or facilitate the later use of mature defensive processes (e.g., sublimation). Functional early environments lead to healthy personality structures, while dysfunctional environments are associated with neurotic, borderline, or psychotic personality structures.

3. The theory is essentially concerned with helping clients to live fully in the present, unrestrained by what can be powerful, past hindrances.  Past relationships manifest therapeutically through transference, and possibly countertransference (described in detail below).

4. The heavy weight of the past, the inclination of temperament to act in ways unbeknown to the conscious mind, and a host of other hidden forces exert a tremendous impact on the lives of each client. A central aim of dynamic therapy is both cognitive and emotional awareness (Fulmer, 2018).

Forms of Psychodynamic therapy

Psychodynamic theory is not a unified theory. Instead, there are many related theories regarding human development and personality (Online MSW Programs, 2023).  Examples include:

• Brief psychodynamic therapy      Clients see a therapist one to two times a week for a limited number of sessions. For example, people with social anxiety might have 25 to 30 sessions over 6 to 8 months (Tartakovsky, 2021).

• Long-term psychodynamic therapy           This type of therapy typically lasts at least 2 years. Research suggests that long-term psychodynamic therapy (and medium-term, too) can help people with various mental health conditions, including depression, anxiety and obsessive compulsive disorder (OCD) (Tartakovsky, 2021).

• Ego-psychology                   Clients build their ego strengths, where the ego’s role is to negotiate between internal needs and pressure from the outside world (Harms, 2007).

• Drive theory        Freud believed a person’s behavior was the result of several drives including the sex (eros), self-preservation, and destruction/aggression (death) drives. When a person’s drive-based desires become conscious, it triggers a conflict between the drives and the superego or the ego. When a person fails to repress their desires, it creates anxiety and activates defense mechanisms (Online MSW Programs, 2023).

• Object relations therapy                 Clients work on repairing or recalibrating ways of relating with others that have been built on earlier experiences that no longer work (Harms, 2007; Online MSW Programs, 2023).

• Self-psychology                   A person’s perception of themself is in relation to their boundaries or differences from others. A person with a lack of self-esteem or an undeveloped sense of self might experience mental health issues. A person with a healthy sense of self can self-regulate and soothe and is resilient. Some theorists believe a lack of a sense of self comes from a lack of parental empathy during childhood (Online MSW Programs, 2023).

• Dynamic interpersonal therapy (DIT)     In this 16-session therapy, clients learn how mood disorder symptoms relate to specific patterns in relationships, and over time work through them (Tartakovsky, 2021)

• Psychodynamic art and music therapies                  Art and music therapy techniques can help clients ease into exploring difficult thoughts and feelings in a safe, supportive, creative way (Tartakovsky, 2021).

Research

The evidence base for psychodynamic therapy has grown significantly in recent years. Numerous studies have demonstrated its effectiveness for a variety of psychological conditions. A meta-analysis by Shedler (2010) reviewed 23 studies and found that psychodynamic therapy was effective for a range of mental health issues, including depression, anxiety, and somatic disorders. The benefits of psychodynamic therapy were found to extend beyond symptom relief, with clients showing continued improvement after treatment ended.

Research by Leichsenring and Rabung (2011) highlighted the effectiveness of long-term psychodynamic therapy for individuals with complex mental disorders, such as personality disorders and chronic depression. This study found that long-term psychodynamic therapy was more effective than shorter forms of psychotherapy for clients with more severe and persistent issues.

Recent studies have also explored the neurobiological impact of psychodynamic therapy. Fonagy and colleagues (2017) showed that psychodynamic therapy can lead to changes in brain activity and connectivity, particularly in areas associated with emotional regulation and self-reflection. These findings provide a biological basis for the therapeutic changes observed in clients undergoing psychodynamic therapy (MHA, 2024).

Tartakovsky (2021) suggests multiple studies have found that psychodynamic therapy can treat a variety of mental health conditions such as depression, social anxiety, panic disorder, somatic disorders, some personality disorders and PTSD.  Links to these sources are provided in Tartakovsky’s paper and those from MHA are included in the references section below.

Psychodynamic Therapy and Mental Health

Multiple studies have found that psychodynamic therapy can treat a variety of mental health conditions, including (MHA, 2024):

• Depression: Research indicates that psychodynamic therapy can be as effective as cognitive-behavioural therapy for treating depression, particularly for clients with chronic or treatment-resistant depression who may benefit from exploring underlying emotional conflicts.

• Anxiety Disorders: By addressing unconscious conflicts and early life experiences that contribute to anxiety, psychodynamic therapy can help clients understand and alleviate their symptoms.

• Personality Disorders: Individuals with personality disorders often benefit from the insight-oriented approach of psychodynamic therapy, which can help them understand the origins of their maladaptive patterns and develop healthier ways of relating to others.

• Trauma and PTSD: Psychodynamic therapy can be useful for clients who have experienced trauma, as it provides a framework for exploring and processing painful memories and emotions that are often suppressed or repressed.

• Relationship Issues: Many clients seek psychodynamic therapy to understand and improve their relationships. The focus on transference and relational patterns helps clients gain insight into how their past experiences influence their current interactions.

Opland and Torrico (2026) concur with the above and suggest other psychological conditions that psychodynamic therapy can assist with:

• Eating disorders 

• Panic disorder 

• Chronic illness and psychosomatic disorders 

• Older adults 

• Children/adolescents 

• Attachment problems

Psychodynamic therapy can also help people who are:

• looking to better understand themselves

• repeating patterns that don’t serve them and finding it really difficult to change

• finding that developing healthy relationships are difficult or rare for them

• having trouble feeling all their emotions

• making decisions that don’t serve them

• looking for a more open-ended approach to therapy as opposed to a highly structured therapy (Tartakovsky, 2021).

Goals / Objectives

There are at least five major objectives of psychodynamic therapy.

1. The development of cognitive and affective insight around the pattens in a client’s emotions, behaviours and relationships, resulting in clients making deliberate choices rather than being governed by reflexive actions.    

2. The expansion of choice to remedy past issues and nurture current strengths.

3. Defenses that worked in the past may now be a hindrance, so counsellors work to liberate clients from their pasts to enhance and enrich their presents.

4. Improvement of interpersonal relationships, something clients usually seek.              

5. Cognitive awareness alone is recognized as insufficient for progress. Dynamic practitioners work to develop a corrective emotional experience by helping build ego strength, agency, and authenticity in their clients, (or, in other words, build resilience, control and proactivity and self-congruence) (Fulmer, 2018; Online MSW Programs, 2023; Tartakovsky, 2021).

The Therapeutic Relationship (Harms 2007)

The focus of psychodynamic therapy is on relationship dynamics or the ‘working alliance’.  This relationship provides a corrective emotional experience from the relationship models the client has developed in the past.  A positive therapeutic relationship between client and therapist provides the vehicle for change to occur, so trust, insight and growth can be activated and achieved.

The process for relationship change:  The client’s issues repeat themselves in the client-worker relationship through the client projecting conscious and unconscious experiences and expectations onto the therapist (transference).  Over time the therapist leads the client in developing insight into these experiences and expectations, i.e. what it says about the client and their way of relating to others, themselves and the world around them.

In this process countertransference can occur for the therapist, who may have unconscious emotional responses to the client that result in a distorted perception of the client’s behaviour (i.e. the therapist’s own experience with the situation and the emotions it arouses can impact on how the therapist sees the situation, and where the therapist leads the client).  Therefore, the therapist has to constantly reflect on how he or she feels and is reacting to the client’s story.  Professional supervision is crucial to this reflective process.

With this positive therapeutic relationship in place the therapist can implement the skills and techniques that enable the therapy to be effective.

1. Offering containment:  The therapist shows empathy and thoughtfulness towards the client in a structured way, so the client feels absolutely understood.  This enables the therapist and client to respond to external threats, with the therapist providing advice and direction to support client decision making and action.  

2. Providing interpretations, particularly through exploring internalised relationships across the lifespan: This exploration relies on the usual counselling skills: interpretation, using summaries, making observations/invitations, and using ‘why’ questions.

3. Encouraging the management of anxiety through providing insight into defense mechanisms:  Major anxiety can lead to dissociation as a defence against stress.  It is important the therapist leads the client to confront the causes and deal with them rather than dissociate from the situation.

Opland and Torrico (2026) offer this description of defense mechanisms: These mechanisms are unconscious psychological strategies that individuals use to cope with anxiety and protect themselves from uncomfortable thoughts or feelings. Examples include repression, denial, projection, and sublimation. Defense mechanisms can be adaptive or maladaptive with the aim of therapy being to move clients to healthy, conscious or semi-conscious ways of behaving, such as sublimation (channelling unacceptable urges into productive work), humour, and altruism (prioritising other’s concerns or needs over one’s own).

Psychodynamic Therapy Sessions

Psychodynamic therapy helps clients gain insight, supporting them in developing a nuanced understanding of how their prior experiences have shaped their current behavior and relationships.  In psychodynamic therapy, clients also explore:

• What healthy relationships look like.

• The full range of emotions.

• Self-defeating patterns.

• How and why clients avoid distressing situations (defenses).

• Difficult feelings and experiences.

• Daydreams, random thoughts, and fantasies to provide clues into wants, desires, and fears.

Because the therapist-client relationship often mirrors how the client behaves in other relationships and can be the basis of improving certain relationship patterns, the relationship with the therapist is pivotal (Tartakovsky, 2021).

Psychodynamic Therapy and Social Work

Psychodynamic theory appears to have lost credibility in the face of manualised treatment models that focus on symptom reduction (Mishna et al., 2013; Thyer, 2015).  These treatment models include applied behaviour analysis, solution focused brief therapy, family therapy, Aboriginal theory, chaos theory, narrative therapy, strength perspective, and task-centered model (Thyer, 2015).  However, remaining mindful of its limitations, the therapeutic community has a great deal to gain by adopting psychodynamic principles. Whether CBT or client-centered, one approach rarely works for all clients all the time. The inclusion of psychodynamic principles into his or her therapeutic practice would expand any given social worker’s repertoire (Fulmer, 2018).

In other words, social workers can benefit from integrating psychodynamic approaches with other therapeutic approaches, such as cognitive-behavioral therapy or mindfulness-based therapies, to create a more comprehensive treatment plan that addresses surface-level symptoms and deeper psychological issues.  Key assumptions of psychodynamic theory that are relevant to social work clients include:

• Every client’s behavior has a reason. It isn’t random or happening in a vacuum. Their behavior can also be in response to unconscious processes. The client might not realize why they behave a certain way. 

• Psychodynamic theory is focused on relationships. This aligns with social work. Social workers often focus on a client’s interpersonal relationships, including the client-worker relationship, to learn about the client’s behavior and promote change.

• Social workers often work with clients with multiple difficulties. Psychodynamic theory provides a conceptual framework for understanding seemingly unrelated symptoms or patterns of behavior.

• Social workers hope to promote change and improvement in a client’s life. By using psychodynamic therapy, social workers can help clients get to the root of their thoughts, emotions, and behaviors. This provides a chance for self-discovery. A client has the opportunity to learn more about themselves, recognize harmful patterns of emotions in relationships, and alter their behaviour (Online MSW Programs, 2023; Opland & Torrico, 2016).

Suggestions for Practice

If contemplating using psychodynamic therapy as part of practice it is important to note that effective psychodynamic therapy requires extensive training and expertise that may not be available in all regions or institutions. Learning psychodynamic psychotherapy is a complex and lengthy process. Trainees must progress through multiple stages of skill acquisition, from novice to expert levels. Training effectiveness can vary significantly (Opland & Torrico, 2026). Therefore, it will be more appropriate for social workers to be aware of the assumptions of psychodynamic therapy (see dot points immediately above) and, where relevant, incorporate them into practice.  Fulmer (2018) points out that a single social work approach (e.g. solution-focused therapy, CBT, task-centered approach) is unlikely to work all the time for all clients.  Having knowledge of other approaches and therapies, including psychodynamic therapy, will be not only useful, but essential.

What aspects of psychodynamic therapy can be easily incorporated into a social work session with a client?

Psychodynamic therapy aims to build resilience, control, proactivity and self-congruence (the state where true feelings, thoughts, and actions are perfectly aligned) in clients.  Keeping this in mind as an aim of any support offered to clients would seem to provide a platform for assessing the potential strategies to be implemented by the client.

Psychodynamic therapy reminds social workers of the importance of the therapeutic relationship.  A positive therapeutic relationship between client and therapist enables trust, insight and, ultimately, growth to be activated and achieved by the client. This therapeutic alliance is built on empathy, compassion, genuineness, and accepting the client exactly as he or she is without criticism.  It arises when the social workers communicates appropriately with the client—active listening, paraphrasing, reflecting and working collaboratively when goal setting.

Psychodynamic therapy seeks to identify the cause of a client’s behaviour.  Social workers will also be supporting the client to identify the cause and put strategies in place to deal with or change this behaviour. Psychodynamic therapy suggests social workers also keep in mind that the causes of a person’s behaviour can originate in their unconscious.  If the adopted strategies are not working, social workers may wish to consider whether the behaviour is unconscious and possibly refer the client to someone with the skills to explore this.

A client may present seeking support with multiple difficulties and social workers may choose to explore a grounded, step-by-step approach with the client: divide and conquer, avoid multitasking, and/or break issues into separate pieces.  Psychodynamic therapy suggests that social workers consider that the problems may not be superficial, i.e. different aspects of a person’s unconscious may be struggling against each other.  Looking at the presenting issues in this way may provide an alternative strategy if the step-by-step approach is not working.  It may ultimately result in referring the client elsewhere.

Being open to the influence of childhood experiences is a central theme of psychodynamic therapy and one that may be relevant when social workers are engaging clients.  The behaviour a client exhibits—psychodynamic therapy refers to these as defenses—may lie in past learning and experiences.  Realising current behaviour may be linked to their childhood could be liberating for clients.  Solutions may present that are divorced from approaches used in and built on the past.  The social worker can help by normalising these new approaches, showing the client these approaches are used by people they are engaging with daily.     

References

Harms, L. (2007).  Working with people:  Communication skills for reflective practice.  Oxford University Press.

Fonagy, P., Luyten, P., Allison, E., & Campbell, C. (2017). What we have changed our minds about: Part 1. Borderline personality disorder, epistemic trust, and the developmental significance of social communication. Borderline Personality Disorder and Emotion Dysregulation, 4(9).

Fulmer, R.  (2018).  The evolution of psychodynamic approach and system.  International Journal of Psychological Studies, 10(3).  https://doi.org/10.5539/ijps.v10n3p1  

Leichsenring, F., & Rabung, S. (2011). Long-term psychodynamic psychotherapy in complex mental disorders: Update of a meta-analysis. British Journal of Psychiatry, 199(1), 15-22.

MHA: Mental Health Academy.  (2024, September 11).  What is psychodynamic therapy? https://www.mentalhealthacademy.com.au/blog/what-is-psychodynamic-therapy

Mishna, F., van Wert, M., & Asakura, K. (2013). The best kept secret in social work: Empirical support for contemporary psychodynamic social work practice.  Journal of Social Work Practice, 27(3), 289 – 303. http://dx.doi.org/10.1080/02650533.2013.818944  

Novotney, A. (2017, December). Psychoanalysis vs. psychodynamic therapy.  Monitor on Psychology, 48(11), 45. https://www.apa.org/monitor/2017/12/psychoanalysis-psychodynamic     

Opland, C, & Torrico, T. J. (2026). Psychodynamic Therapy.  StatsPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK606117/ 

Online MSW Programs. (2023).  Introduction to psychodynamic theory in social work. https://www.onlinemswprograms.com/social-work/theories/psychodynamic-theory/

Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2), 98-109.

Tartakovsky, M. (2021). Is Psychodynamic Therapy Right for Me?  https://psychcentral.com/lib/psychodynamic-therapy

Thyer, B.  (2015). It is time to delink psychodynamic theory from the definition of clinical social work.  Clinical Social Work Journal.  Doi: 10.1007/s10615-015-0530-9