Most people who have never been to therapy carry some version of the same image. You lie on a couch, or sit in a chair, and talk about your childhood while someone nods and occasionally asks how that made you feel. It is not an image that inspires confidence, and it is not an accurate one either. Understanding what actually happens in relational psychodynamic therapy, and why it is structured the way it is,
changes what people are able to expect from it and what they are able to bring. This blog is for anyone who is curious about therapy but uncertain what it actually involves. It is also for people who have tried therapy before, found it useful but not quite transformative, and wondered whether something was missing.
What Happens in the Room
A relational psychodynamic therapist does not work from a manual or follow a predetermined sequence of techniques. Sessions are not structured around worksheets, homework, or a fixed agenda in the same way something like CBT might work. Sessions are structured around is you: what you bring, what emerges, what patterns become visible over time in the way you think, feel, and relate. In practice, this means sessions can look quite different from week to week. Some sessions involve working through something specific that has happened. Others involve sitting with something that is harder to name, a feeling, a recurring dynamic, a pattern that keeps asserting itself in different areas of your life. The therapist’s role is not to direct the content but to stay closely attuned to what is present, to notice what is being said and what is not, and to help you develop a more honest and nuanced understanding of your own experience. One thing that distinguishes relational psychodynamic work from more structured approaches is its attention to what happens between therapist and client in the room
itself. The way you relate to your therapist, the things that feel easy or difficult to say, the moments where something shifts or something closes down, all of this is information. It often reflects the same patterns that show up in your relationships outside the room, and working with it directly, rather than only talking about it in the abstract, is one of the most powerful things therapy can offer.
Why It Takes Time
One of the most common questions people have about long-term therapy is why it takes as long as it does. The answer is not that therapists are being deliberately slow, or that the process requires indefinite open-ended work with no particular direction. It is that the kind of change relational psychodynamic therapy aims for is not the same as symptom reduction. Symptom reduction is valuable and sometimes it is exactly what someone needs. But for many people, particularly those whose difficulties are relational, long-standing, or rooted in early experience, symptoms act as clues, they are expressions of something deeper. Addressing the symptom without addressing what it is expressing tends to produce temporary relief. The same pattern resurfaces in a different form. What long-term open-ended psychotherapy is working toward is a change in the underlying patterns, in how you relate to yourself, how you experience others, how you regulate emotion, how you make meaning of your experience. That kind of change requires time, not because therapists are inefficient, but because those patterns were formed over years and are maintained by processes that are largely outside conscious awareness. Bringing them into awareness, understanding their origins, and gradually revising them through a different kind of relational experience is work that cannot be meaningfully compressed into six or twelve sessions. The research supports this. Meta-analyses of long-term psychodynamic therapy
consistently show that gains continue to accumulate after treatment ends, and that longer therapy produces more durable change than shorter alternatives for people with complex or chronic presentations. The investment of time tends to produce results that hold.
What You Can Expect
Relational psychodynamic therapy is not a passive process. It asks something of you: a willingness to stay with discomfort, to notice your own patterns with curiosity rather than judgment, to bring the parts of yourself you might prefer to keep private. The therapist brings skill, training, and sustained attention. The work happens between you. What most people find, over time, is that the relationship itself becomes one of the most useful things therapy offers. It doesn’t replace other relationships, but because it provides a context in which patterns that have always felt fixed, they can begin to feel more fluid. That shift, modest at first and then more substantial, is what open ended psychotherapy is designed to produce. If you are considering therapy and want to understand more about what relational psychodynamic work actually involves, you are welcome to get in touch with me
Author Bio: Samantha Merry is a BACP Senior Accredited Psychotherapist and Clinical Supervisor based in Bromley, Southeast London. She works from a relational psychodynamic framework with adults navigating complex emotional experience and unresolved personal patterns. Find out more at samanthamerry.co.uk.
Resources
Books Psychoanalytic Psychotherapy by Nancy McWilliams. The clearest account of what relational psychodynamic therapy involves and why it works, readable for practitioners and general readers alike.
Maybe You Should Talk to Someone by Lori Gottlieb. An honest and often funny account of therapy from both sides of the room, widely recommended by clients as the book that finally made them make an appointment.
To Call Myself Beloved by Eina McHugh. A memoir of a woman’s experience of long-term therapy, written with literary precision and emotional honesty. One of the most direct accounts of what the therapeutic relationship actually feels like from the inside.
Podcast Speaking of Psychology (APA). Episodes on the therapy process, therapeutic relationship and what change in therapy actually looks like.
YouTube Alina | Psychodynamic Psychology. A psychodynamic psychotherapist making clear, accessible content specifically about relational and psychodynamic concepts for a general audience.