Psychodynamic Therapy: What It Is and What to Expect

Psychodynamic therapy is a talk-based approach built on the idea that behavior and mental well-being are rooted in childhood and past experiences. It aims to help a person see recurring patterns in relationships, feelings and reactions, and understand where those patterns came from. Sessions are usually open-ended, with the relationship between therapist and client treated as central to the work. It is one of several approaches a licensed mental health professional may offer, and it is often described as insight-oriented therapy because the focus is on understanding rather than on following a set of weekly skill exercises.

The idea behind psychodynamic therapy

Psychodynamic therapy starts from the premise that much of what a person does, feels and expects from others is shaped by earlier relationships and experiences, some of which may not be fully in awareness. The work is to notice patterns as they show up in the present and connect them to the past. A person might, for example, keep expecting criticism from a boss or a partner, and over time the therapy looks at where that expectation began and how it plays out now.

This is different from approaches that focus mainly on changing a specific behavior or thought in the here and now. Psychodynamic therapy is less structured and more exploratory. The therapist may listen for themes, ask about early relationships, and invite the person to say what comes to mind without editing it. The aim is understanding, not a fixed lesson plan.

What a session looks like

A psychodynamic session is usually a conversation, but it has a particular shape. The person is encouraged to talk freely about what is on their mind, including feelings about the therapist and about the therapy itself. The therapist may say less than in some other approaches, and may offer observations or ask questions that link present reactions to past experience.

The relationship with the therapist is treated as part of the work. How a person feels in the room, what they expect from the therapist, and what they find themselves avoiding can all become material for the therapy. Sessions are typically held once every 1-2 weeks for about 30 to 50 minutes, though frequency is discussed between the person and the therapist and can vary.

There is no formal approval process for psychotherapies like the FDA’s for medications, so the approach is not certified by a regulator. What matters is that the therapist is licensed and trained in the method, and that the person understands what the therapy involves.

Psychodynamic therapy compared with CBT

Cognitive behavioral therapy (CBT) and psychodynamic therapy are both widely practiced, but they differ in focus and structure. The table below compares them in general terms; individual therapists vary.

CBT helps people identify and change thinking and behavior patterns that are unhealthy or ineffective, and exposure therapy is a type of CBT used for anxiety disorders. Psychodynamic therapy is more likely to explore how those patterns began. Neither approach is a single fixed protocol, and many therapists draw on more than one. A fuller comparison of approaches is available in types of therapy explained, and CBT is described in more detail in what cognitive behavioral therapy is.

Psychoanalysis and insight-oriented therapy

Psychoanalysis is a more intensive form of psychodynamic work. It traditionally involves more frequent sessions over a longer period, and it may use techniques such as free association and analysis of dreams and of the relationship with the analyst. Not every therapist offers psychoanalysis; it usually requires specialized training after a clinical degree.

The term insight-oriented therapy is sometimes used to describe psychodynamic and psychoanalytic work because the goal is self-understanding. The words are not interchangeable in every setting, so it is reasonable to ask a therapist which term they use and what it means in their practice.

Who offers psychodynamic therapy

Many kinds of licensed professionals offer psychotherapy, including psychiatrists, psychologists, clinical social workers, counselors, marriage and family therapists and psychiatric nurses. Any of these may have training in psychodynamic therapy. A psychiatrist is a medical doctor who can provide psychotherapy and prescribe medication; psychologists typically hold a doctoral degree and are licensed in every state, though requirements vary by state. Clinical social workers, counselors and marriage and family therapists typically hold a master’s degree and complete supervised clinical experience and the exams their state requires.

Coaching is not a licensed mental health profession. A person can ask any provider which state license they hold and whether they have specific training in psychodynamic therapy. Licenses can be checked on the state licensing board’s website.

What to ask about length and goals

Goals of treatment, and how long and how often to meet, are discussed by the patient and therapist together. Because psychodynamic therapy is often open-ended, it is worth asking early how the therapist thinks about length, how progress will be assessed, and whether a time frame is recommended. NIMH suggests asking about the therapist’s credentials, experience and specialty; the approach and its rationale; the goals of therapy; and how progress will be assessed. It is also reasonable to ask whether the therapist can explain how psychodynamic therapy differs from other approaches they offer.

Rapport and trust are essential, and a person should feel comfortable with the therapist. If therapy has gone on for what feels like a reasonable time without improvement, talk to the therapist; it may make sense to explore other professionals or approaches. More on timing is in how long therapy takes and how often to go.

What goes wrong, and common misconceptions

One common misconception is that psychodynamic therapy is only about the past. In practice, it connects past experience to present patterns, and the therapy relationship is used to notice those patterns as they happen. Another is that it is always long-term; length is discussed with the therapist and can vary.

A second mistake is expecting the therapist to give advice or homework every week. Psychodynamic work is more exploratory, and some people find the quieter pace uncomfortable at first. It is fair to raise that with the therapist.

A third issue is confidentiality. Psychologists must inform clients as early as feasible about the nature and expected course of therapy, fees, involvement of third parties and the limits of confidentiality, and discuss confidentiality at the outset. Confidentiality has limits: a psychologist may disclose without consent only where the law requires it or permits it for a valid purpose, such as protecting the client or others from harm. Mental health professionals are mandated reporters of child abuse and neglect in many states, and rules vary by state. Asking about these limits is part of informed consent, not a sign of distrust.

Finally, cost and coverage. Psychotherapy can be used instead of or alongside medication and other treatment, and choosing a treatment plan should happen with a mental health professional. Insurance coverage for psychodynamic therapy depends on the plan and the provider’s network status; a person can ask the therapist about fees, whether insurance is accepted and whether there is a sliding scale. For tax purposes, amounts paid for psychiatric care, to a psychologist for medical care, for psychoanalysis (except as part of training to become a psychoanalyst) and for therapy received as medical treatment count as medical expenses; only the part of total medical expenses above 7.5% of adjusted gross income is deductible, and only for people who itemize.

If you are in crisis or having thoughts of suicide, in the US call or text 988 (the 988 Suicide & Crisis Lifeline), or call 911 in an emergency.