Most therapists believe they work with feelings and with patterns from the past. Researchers decided to check. They listened to recordings of real therapy sessions and compared what therapists actually did.

Psychodynamic therapists stood out. They did seven things more fully and more consistently than therapists trained in other approaches. Those seven things are what I do every day in my practice. They also give you the clearest picture of what it might feel like to sit in the room with me.

What is psychodynamic psychotherapy?

Psychodynamic psychotherapy is a talking therapy that helps you understand how your past and your relationships shape the way you feel and live now. It is open-ended and exploratory. You bring whatever is on your mind, and your therapist helps you find the patterns
underneath it.

Seven things that happen in psychodynamic therapy

1. Everything is welcome

You can say anything here. A row with your partner, a dream that unsettled you, a fantasy you’ve never admitted to anyone, a petty resentment you feel ashamed of. Your mind will wander from last week to childhood and back again. Follow it. Nothing that crosses your
mind is too small or too strange to bring.

2. Your feelings get words

Some feelings arrive clearly. Others show up as a tight chest or a sudden urge to cry in the car. I help you name what you feel, including the frightening parts and the ones that contradict each other. You can love your mother and feel furious with her in the same sentence. Both get room.

3. We notice what you avoid

Everyone has ways of steering around pain. You might change the subject, make a joke, stay busy or go blank just as something matters. I pay attention to what you avoid, and to how you do it. Those habits once protected you. Seeing them clearly gives you access to thoughts and feelings you learned to skip.

4. Patterns come into focus

Perhaps you always end up as the reliable one. Close friendships might cool at the same point each time. Patterns like these repeat across jobs and relationships, often long before you notice them. Many people can already describe their patterns. In our work together, we focus
on the gap between knowing and changing.

5. The past explains the present

Your difficulties have a history. A child who learned to keep the peace in a tense home often grows into an adult who can’t bear conflict at work. We look back to understand what keeps a pattern alive today. The aim is freedom from habits that have outlived their purpose.

6. Your relationships hold the clues

Your earliest relationships taught you what to expect from people. Those expectations travel with you. They shape who you trust and who you choose. We look at those templates together, as they show up in your week, so you can start building different ones.

7. The relationship with your therapist becomes part of the work

Old patterns follow you into the therapy room. If you tend to apologise for taking up space, you may do it with me. Someone who expects people to lose interest might watch my face for signs of boredom. When that happens, we can talk about it as it unfolds. This is often where
change happens fastest, because you experience something different in real time.

Isn’t this what every therapist does?

When therapists from other traditions (sometimes called modalities) hear this list, many say they do these things too. The recordings tell a different story. Researchers compared transcripts of psychodynamic and cognitive behavioural therapy (CBT) sessions and coded what therapists said and did. Psychodynamic therapists returned to these seven areas far more often.

CBT has its own strengths. It is structured and time-limited, with a focus on current thoughts and practical exercises between sessions. Psychodynamic therapy suits people who want to understand why they feel and act as they do. Many therapies grew out of psychoanalysis, so you will find echoes of these seven features elsewhere.

Is psychodynamic psychotherapy evidence-based?

Yes, and the findings are strong. A major review in American Psychologist found its benefits match other evidence-based therapies. People also tend to keep improving after therapy ends, which suggests the changes last. A meta-analysis in the British Journal of Psychiatry found
longer-term psychodynamic therapy helped people with complex, long-standing difficulties.

In a UK trial at the Tavistock Clinic, people with depression that hadn’t responded to other treatments made gains that grew in the years after therapy finished. NHS guidance for depression lists short-term psychodynamic therapy as one treatment option.

Who is psychodynamic therapy for?

Psychodynamic therapy suits you if you want to understand yourself more deeply as well as feel better. It can help with long-standing anxiety or low mood, relationship difficulties, the effects of childhood trauma, and the sense of functioning well while carrying something
unresolved.

It asks for time and commitment. Most people attend weekly, at the same time each week, often for a year or longer. That consistency is part of the therapy. It gives you a reliable space where difficult feelings can surface and be thought about safely.

If you feel unsure, a first consultation gives you room to ask questions and see how it feels to talk.

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About the author

Samantha Merry is a BACP Senior Accredited Psychotherapist and Clinical Supervisor based in Bromley, South East London. She works psychodynamically, informed by attachment theory, with adults affected by trauma and dissociation, complex family dynamics, burnout
and midlife transitions. She offers sessions in person and online. Samantha is completing a Professional Doctorate in Psychotherapy and Psychological Trauma at the University of Chester.

If you would like to explore psychodynamic therapy, please get in touch.

Resources

Books

• The Examined Life: How We Lose and Find Ourselves by Stephen Grosz (Chatto & Windus, 2013). Short, true stories from a psychoanalyst’s consulting room. A gentle way to see what the work looks like.
• In Therapy: How Conversations with Psychotherapists Really Work by Susie Orbach (Profile Books, 2016). Annotated sessions from her BBC Radio 4 series, showing what a therapist notices and why.
• Why Do I Do That? Psychological Defense Mechanisms and the Hidden Ways They Shape Our Lives by Joseph Burgo (New Rise Press, 2012). A clear guide to the ways people avoid painful feelings.

Podcast

• Between Us: A Psychotherapy Podcast, hosted by psychotherapists John Totten and Mason Neely. Conversations about what happens between therapist and patient, from both sides of the relationship.

YouTube

• Jonathan Shedler’s recorded talks on psychodynamic therapy. Search his name on YouTube for his lectures on how the approach works and what the research shows.

Useful links

• British Psychoanalytic Council: What is psychoanalytic therapy? (bpc.org.uk)
• Tavistock and Portman: What is psychodynamic psychotherapy? (tavistockandportman.ac.uk/articles/what-is-psychodynamic-psychotherapy)

References

Blagys, M. D., & Hilsenroth, M. J. (2000). Distinctive features of short-term psychodynamic-interpersonal psychotherapy: A review of the comparative psychotherapy process literature. Clinical Psychology: Science and Practice, 7(2), 167-188.

Fonagy, P., Rost, F., Carlyle, J., McPherson, S., Thomas, R., Pasco Fearon, R. M., Goldberg, D., & Taylor, D. (2015). Pragmatic randomized controlled trial of long-term psychoanalytic psychotherapy for treatment-resistant depression: The Tavistock Adult Depression Study (TADS). World Psychiatry, 14(3), 312-321.

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.

National Institute for Health and Care Excellence. (2022). Depression in adults: Treatment and management (NICE guideline NG222).

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