What is Psychodynamic Therapy?
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There is no universally accepted definition of what psychodynamic therapy is. Each practitioner has their own style and understanding of the approach, and they will place more or less emphasis on specific aspects of it. I will not attempt to explain what psychodynamic therapy is in and of itself, and I am unsure whether such a question can be answered without some degree of bias. Rather, in what follows, I will describe seven psychodynamic therapy features that distinguish my approach, as well as how these features can help alleviate psychic or emotional suffering.
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1. Exploring Recurring Themes and Patterns
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Psychodynamic therapy can help you identify and address recurring emotional, cognitive, and relational themes and patterns. These often stem from formative experiences in one's family of origin. For example, a person may be drawn to romantic relationships with partners who struggle with addiction. In these relationships, they may notice that they are frequently preoccupied with assisting their partner through a crisis or are concerned that they will relapse. Exploring their past may reveal that they have a younger sibling with alcoholism, whom they frequently care for and were concerned about dying. What might be discussed in therapy is how, in this person's family of origin, they assumed or were assigned the role of caregiver.
On the one hand, this may have felt burdensome to them, and they may have felt resentful of their sibling for receiving more attention from their parents while their own emotional needs went unnoticed and unmet. On the other hand, the caregiver's role may have felt meaningful, and they may have developed a sense of responsibility for keeping their sibling alive. As a result, in their romantic relationships, even if they are resentful of their partners repeatedly putting out fires or being unresponsive to their needs, being relied on in this way gives them purpose, and their identity may have been built around it. They may even believe that the only thing they can offer another person is care. As a result, for them, caring and feeling needed are synonymous with feeling loveable.
In therapy, you are invited to examine patterns such as this. The aim is to understand their origins and how they are being repeated in your life now. As you gain insight into these patterns, you may see that they served a protective function at an earlier point but are now causing more harm than good. Insight into these patterns provides an opportunity to make new choices that feel more purposeful and autonomous.
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2. An Emphasis on Emotional Experience
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​Another feature of psychodynamic therapy is its emphasis on the exploration and identification of emotions. In therapy, I encourage you to express how your are feeling, or how you felt about something, with as little censorship as possible. This can take time, practice and a great deal of trust. You may have learned that certain feelings, and the expression of them, is unacceptable, or that you are not entitled to feel them. Verbalising these in therapy can thus feel like a risk. For example, expressing anger when you were younger to a parent may have resulted in being invalidated, shamed or abused.
Therapy can be a setting for these feelings to be fully and safely expressed. As you engage with them, you may realise that feelings once deemed overwhelming or intolerable are, in fact, survivable and acceptable, both to yourself and others.
Psychodynamic therapy also highlights a distinction between emotional and cognitive insight. Emotional insight isn’t easily put into words; it is felt deeply, in the body, as a kind of embodied knowing. This kind of insight prompts real change, shifting not just how you think, but how you experience the world.​
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3. Addressing the Avoidance of Difficult Emotions
An essential part of psychodynamic therapy is becoming aware of how you may avoid distressing emotions that are difficult to acknowledge or tolerate. Therapy allows for the careful exploration of these defences. These defences often develop in childhood to protect you from overwhelming emotions or experiences. In early life, avoiding or suppressing these emotions have been necessary to cope with feelings of rejection, abuse, or neglect.
As an adult, the avoidance of these difficult experiences may have become maladaptive. They can prevent you from connecting with others, leading to misunderstandings, miscommunications, or feelings of disconnection. In therapy, you are encouraged to recognise these defensive patterns when they arise. This requires practice. You can learn to notice when these defences are in play, and understand how they once protected you but now come at a cost.
Psychodynamic therapy is a setting in which this defensive avoidance or difficult feelings can be understood. You may begin to experience emotions that once seemed intolerable, and through this experience, develop closer contact to what you are truly feeling. This greater intimacy and knowledge of your emotional life can lay fertile ground for a richer emotional experience. In the earlier stages of therapy, it not uncommon for people to describe feeling numb to all feelings, both pleasant and unpleasant. Learning to identify and tolerate difficult feelings often enables other, more pleasant, feelings to be fully felt.
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4. Integrating Disavowed Aspects of the Self
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Another core focus of psychodynamic therapy is integrating parts of yourself that you may have denied or identified in others rather than oneself. These disavowed parts are often referred to as "blind spots". They are traits or tendencies you may avoid because they conflict with the ideal version of yourself you have in your mind. For example, you may be unaware of a part of yourself that feels that feels the need to be right and "win" arguments. These parts of the personality can also be repressed and come out in opposite ways. For example, excessive agreeableness and people-pleasing may be a way of avoiding a part of yourself that feels angry but is fearful of being more assertive, perhaps because of an underlying sense that this will make others uncomfortable or you will be rejected if you express your needs.
Confronting these parts of yourself can be difficult, often evoking feelings of shame or discomfort. Therapy provides a setting where you can acknowledge these disavowed parts with openness and curiosity. It also provides an opportunity to explore the context in which these parts of yourself developed. They can then begin to coexist with the aspects of yourself you are already aware of, creating a greater sense of wholeness or self-cohesion.
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​5. Understanding the Impact of Trauma on Self-Development
If you’ve experienced difficult or adverse formative experiences, particularly in early relationships, psychodynamic therapy can help you understand how these experiences have shaped your emotional responses and relational patterns. Trauma can lead to feelings of emotional numbing and profound disconnection, and behaviours that function to appease others to avoid the perceived threat of hostility or retaliation.
Though protective at the time, it can result in you feeling you are compromising on things you fundamentally value. In psychodynamic therapy, you are encouraged to reflect on how these coping mechanisms developed in response to early trauma, and to approach this exploration with clarity and self-compassion. You may realise that these defences, although protective, were the only means you had at the time to tolerate unbearable feelings.
In therapy, I may encourage you to articulate emotions that may have felt unacceptable or dangerous. Furthermore, expressing such feelings may have actually been dangerous or could have resulted in core developmental needs being unmet. If this were the case, they were quite literally survival mechanisms. However, such mechanisms may have outlived their purpose. It may create a sense of safety that ultimately comprises greater emotional intimacy with, and trust in, others.
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6. Building Ego Strength
Another central focus of psychodynamic therapy is the strengthening of the ego (Terry, 2023). The ego is the seat of one's sense of selfhood and is vital for maintaining a stable identity that can withstand challenges, criticism, and failure. Self-criticism often takes root in early life, arising from shaming or harsh responses from others that are taken into, and persist within oneself. This critical and sadistic internal saboteur can then self influence and distort how you feel about yourself, which can lead to feelings shame and inadequacy.
In therapy, you are encouraged to identify this sabotaging part of yourself. The habitual observation of this part, sometimes termed the “destructive superego” can make you more adept at recognising how it undermines your conscious efforts to change. By understanding the developmental context in which this part of yourself developed, this can enable you to feel emboldened to talk back to this destructive part of yourself and put it in its rightful place.
As you develop awareness of this dynamic, you can begin to realise that your value as a person is not contingent on external validation or approval. Over time, this can lead to a more robust and resilient sense of self, one that can withstand internal and external challenges and setbacks.
7. The Experience of a Reparative Relationship
Psychodynamic therapy offers the opportunity to experience a different kind of relationship, one that may be unlike any you’ve known before. In therapy, you can share your thoughts, memories, and emotions with an other who is interested and open-minded. This can lead to a profound experience of feeling understood and accepted. This experience can be transformative, showing you that the aspects of yourself you once thought must be hidden or suppressed can actually be expressed and lived with. These parts of you are not to be ashamed of; they are part of your humanity. Over time, therapy provides the setting where emotions and parts of yourself that once felt intolerable or unacceptable become survivable in the gaze of another person.​​​
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