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What is psychodynamic psychotherapy?

What is psychodynamic psychotherapy, and how does it differ from other talking therapies? Senior Lecturer Thomas Booker explores its origins, how it works, and associated training.

Explainer

Psychodynamic psychotherapy is a talking therapy that helps people understand their feelings, behaviours and relationship patterns. It is based on the idea that current difficulties may be influenced by past experiences and unconscious thoughts and feelings, and that exploring these influences can lead to greater self-understanding and emotional wellbeing. There is an important emphasis on the dynamics that play out between the therapist and the patient, as a way of understanding more about the patient’s experiences of the world and relationships.

Available through the NHS, voluntary organisations or in private practice, psychodynamic psychotherapy treatments can be conducted individually, in groups or in couples.

The origins of psychodynamic psychotherapy

Psychodynamic psychotherapy has its roots in psychoanalysis, which started with the work of Sigmund Freud in the late nineteenth and early twentieth centuries. Freud developed a theory of the mind based on the idea that unconscious thoughts, feelings, and conflicts shape human behaviour and emotional experience. He offered the view that troubling symptoms can come from unresolved internal conflicts and early relationships, and that bringing unconscious material into awareness can support change.

Many others have since developed the field further, including Anna Freud, Melanie Klein and Donald Winnicott, as well as others who worked at the Tavistock Clinic, including Wilfried Bion, John Bowlby, Martha Harris, Esther Bick, Ron Britton and John Steiner – to name but a few. These thinkers moved psychoanalysis beyond Freud’s original model, toward a broader, relational understanding of the mind, influencing contemporary psychodynamic psychotherapy today.

How does psychodynamic psychotherapy work?

Psychodynamic psychotherapy works through having conversations with a trained listener, at regular times, in a safe and confidential space, and generally over at least one year or longer.

Patients are encouraged to share whatever is going through their mind while the therapist tunes into different layers, maintaining a neutral and empathic stance. Therapists tend to keep their own personal feelings to themselves, focussing instead on the patient and what they are sharing. The work is about resurfacing thoughts, feelings or experiences which frequently remain hidden to us, often referred to as the unconscious. The patient’s past and childhood are explored, surfacing unwanted thoughts or difficult feelings.

The patient-therapist relationship can also be used as a focus of the conversations, helping the patient to better understand their role in relationships. This is done by looking at how the patient relates to the therapist, and what roles are assigned to the therapist by the patient at different times (transference), in different emotional ways – something which is made possible by the therapist being more neutral. The importance that is placed on this therapeutic relationship is something which distinguishes psychodynamic psychotherapy from other therapies.

Is psychodynamic psychotherapy effective?

Research strongly suggests that psychodynamic psychotherapy is an effective treatment for a wide range of mental health disorders.

For example, Taylor (2008) reviewed evidence on psychodynamic and psychoanalytic therapies for depression and concluded that short-term psychodynamic therapy is as effective as antidepressants and Cognitive Behavioral Therapy (CBT). This was supported by Shedler (2010), who found psychodynamic therapy equally effective as other widely used treatments, with the added benefit that patients often continued improving after therapy ended. Town, Abbass, and Hardy (2011) reviewed short-term psychodynamic therapy for personality disorders and found significant medium- and long-term improvements. Similarly, Leichsenring and Rabung (2008, 2011) showed that long-term psychodynamic psychotherapy was more effective than shorter therapies, especially for complex disorders involving depression, anxiety, and relational problems. A later review by Leichsenring et al. (2023), covering over 320 trials, confirmed strong evidence for psychodynamic therapy across multiple disorders.

Overall, research indicates that psychodynamic psychotherapy is effective, durable, and often cost-effective, especially for complex or long-term mental health conditions.

How do I train as a psychodynamic psychotherapist?

Training as a psychodynamic psychotherapist usually involves a combination of academic study, personal therapy, supervised clinical practice, and an accredited professional training.

At Tavistock Education and Training, we offer psychodynamic psychotherapy training, alongside related introductory courses, to ensure students are thoroughly prepared for the demands of clinical practice and supported across the full training pathway and beyond.

Depending on your previous experience and interest, there are various courses which can be taken at the beginning of your journey, in order to develop a strong foundational understanding of the profession, and to explore whether it is something you might be interested in pursuing in the long-term. For example, our Introduction to Counselling and Psychotherapy and Psychodynamic Reflective Practice in Mental Health courses can be helpful starting points for work with adult mental health. Then, when you are ready to undertake qualifying training, our Psychodynamic Psychotherapy MA course will prepare you to join the Tavistock Society of Psychotherapists and register with the British Psychoanalytic Council (BPC) as an accredited psychodynamic or forensic psychotherapist.

References

  1. Taylor, D. (2008). The evidence for the effectiveness of psychoanalytic psychotherapies. Psychoanalytic Psychotherapy, 22(3), 193–201.
  2. Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2), 98–109. https://doi.org/10.1037/a0018378
  3. Town, J. M., Abbass, A., & Hardy, G. (2011). Short-term psychodynamic psychotherapy for personality disorders: A critical review of randomized controlled trials. Journal of Personality Disorders, 25(6), 723–740.
  4. Leichsenring, F., & Rabung, S. (2008). Effectiveness of long-term psychodynamic psychotherapy: A meta-analysis. JAMA, 300(13), 1551–1565. https://doi.org/10.1001/jama.300.13.1551
  5. 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.
  6. Leichsenring, F., et al. (2023). Psychodynamic therapy: A comprehensive review of randomized clinical trials. American Psychologist.

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If you are considering training in psychodynamic psychotherapy, we have a pathway to support you from the very beginning through to qualification and beyond.

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