Psychodynamic Therapy (PDT): Application, How It Works, Limitations, and Efficacy

Psychodynamic Therapy (PDT) helps you uncover unconscious thoughts and past conflicts that shape current behavior. PDT is used for anxiety, depression, and personality disorders, aiming to reveal unresolved issues that surface in daily life.

PDT explores past experiences and emotional conflicts to reveal unresolved issues shaping current behavior. In New Jersey, 59% of 2022 substance-use admissions involved co-occurring mental illness, highlighting the link between mental health and addiction treatment.

The limitations of psychodynamic therapy are it is time-intensive and its associated costs. Psychodynamic therapy is emotionally challenging for some individuals, and the narrative fallacy of conceptualizing clinical issues for hard-to-treat conditions.

Psychodynamic therapy (PDT) shows about 40% long-term efficacy and isn’t suitable for all disorders. Leichsenring et al. (2014) found CBT and PDT had similar long-term outcomes for social anxiety disorder (≈70% response, 40% remission); CBT had a slight short-term edge, but no differences emerged at 24 months.

What Is Psychodynamic Therapy (PDT)?

Psychodynamic Therapy (PDT) is a form of talk therapy within the broader category of psychotherapies that emphasizes the exploration of unconscious processes, feelings, and childhood experiences to understand their impact on current behavior and mental health.

Psychodynamic therapy originates from psychoanalysis, developed by Sigmund Freud, and aims to explore unconscious thoughts to understand behavior, which is the essence of psychoanalysis. PDT requires a substantial time commitment to dig deeper to derive desired outcomes. The main goal of PDT is to aid individuals uncover underlying emotional conflicts that lead to psychological distress. This therapeutic approach is built on self-reflection, insight into past experiences, and the therapist-client relationship.

Psychodynamic therapy (PDT) has shown effectiveness comparable to other established therapies, without massive differences in efficacy. Meta-analyses support this but highlight the need for more randomized controlled trials (RCTs) focused on disorders like obsessive-compulsive disorder and post-traumatic stress disorder, along with well-powered equivalence trials. For example, a systematic review of 64 RCTs “Psychodynamic Therapy Meets Evidence-Based Medicine: A Systematic Review Using Updated Criteria,” by Leichsenring et al. 2015  assessed PDT for common mental health disorders and confirmed these findings. 

What Is the Difference Between Psychodynamic Therapy and Psychoanalysis?

The main difference between psychodynamic therapy and psychoanalysis lies in their center of attention and duration. Both psychodynamic therapy and psychoanalysis aim to address unconscious thoughts. Psychoanalysis encompasses more frequent sessions, lasting several years, and places a stronger emphasis on interpreting dreams and the unconscious mind. In contrast, psychodynamic therapy is a more structured and shorter-term approach, focusing on the patient’s current emotional state and relationships. 

As noted by the American Psychological Association (2017) in the study “Psychoanalysis vs. Psychodynamic Therapy,” psychodynamic therapy (PDT) is brief, with around 15 sessions being common—similar in duration to cognitive behavioral therapy (CBT). It is usually conducted once per week in a face-to-face setting. While the therapist does not have to be a certified psychoanalyst, they are trained in psychoanalysis or psychodynamic therapy and adopt this orientation in their therapeutic approach.

What Is Psychodynamic Therapy Used for?

Psychodynamic therapy is used to treat anxiety, depression, eating disorders, personality disorders, and substance use disorders. PDT explores the unconscious drivers of behavior, fostering emotional insight, and helping individuals break repetitive, unhealthy patterns formed in early relationships. The common mental health disorders treated by PDT are given below:

• Anxiety: PDT helps individuals explore hidden fears and unconscious thoughts that contribute to anxiety, promoting better emotional regulation. 

While CBT showed slight short-term advantages, no long-term distinctness was noted, indicating both therapies are effective for social anxiety disorder. Cognitive-behavioral therapy (CBT) and psychodynamic therapy (PDT) achieved approximately 70% response rates and nearly 40% remission rates over 24 months  according to Leichsenring et al. 2014 in “Long-Term Outcome of Psychodynamic Therapy and Cognitive-Behavioral Therapy in Social Anxiety Disorder”. 

• Depression: PDT is effective in uncovering unresolved emotional conflicts that trigger depressive episodes, fostering a deeper understanding of self-worth.

Wienicke et al. 2023, in their systematic review and meta-analysis “Efficacy and Moderators of Short-term Psychodynamic Psychotherapy for Depression,” showed that short-term psychodynamic psychotherapy (STPP) considerably minimized depressive symptoms relative to control conditions, with an effect size of d=−0.62. This effect size illustrates a moderate to large decline in depressive symptoms following STPP. The analysis consisted of data from 771 participants across 11 studies, revealing that STPP was particularly effective for individuals with longer depressive episodes.

• Eating disorders: PDT assists patients in recognizing emotional patterns and relational issues that contribute to disordered eating.

Abbate-Daga et al. 2016 in their review “A Comprehensive Review of Psychodynamic Treatments for Eating Disorders” analyzed 47 studies on psychodynamic therapies for anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). The findings suggested that psychodynamic interventions are promising, especially for AN, though many studies had methodological flaws. The authors call for more rigorous research and clearly defined therapeutic approaches to establish the effectiveness of these treatments.

• Personality disorders: PDT supports individuals in identifying deeply ingrained thought patterns that affect their interpersonal relationships.

Leichsenring and Leibing (2003) conducted a meta-analysis titled “The Effectiveness of Psychodynamic Therapy and Cognitive Behavior Therapy in the Treatment of Personality Disorders,” assessing 14 studies on psychodynamic therapy (PT) and 11 on cognitive behavior therapy (CBT). They found PDT had a large overall effect size of 1.46, indicating massive long-term benefits, while CBT had an effect size of 1.00. Both therapies were deemed effective, but further research is needed to explore specific therapy types and longer follow-ups.

• Substance use disorders: PDT explores the emotional triggers that contribute to addiction, aiming for long-term recovery by addressing the root causes.

In the dissertation “The Effectiveness of Psychodynamic Psychotherapy for the Treatment of Substance Use Problems: A Systematic Review and Meta-Analysis,” Warshaw D. 2022 conducted a meta-analysis and found an effect size of 0.44, indicating that psychodynamic therapy (PDT) is an effective treatment for substance use problems. Moderator analyses, including age and adjunctive treatments, did not impact outcomes, and no evidence of publication bias was found.

Who Is a Good Candidate for Psychodynamic Therapy?

A good candidate for psychodynamic therapy is an individual who is open to exploring their emotions and unconscious thoughts during therapy sessions. As indicated by Psychology Today (2022) in “Psychodynamic Therapy,” this person must have a willingness for self-reflection and be comfortable discussing deep-rooted feelings and experiences with their therapist. People who benefit most are those struggling with emotional conflicts, unresolved past traumas, or recurring patterns in relationships and behaviors. Individuals who are committed to a longer-term therapeutic process and are motivated to uncover and address the underlying causes of their psychological distress are well-suited for psychodynamic therapy.

Who Is Not a Good Candidate for Psychodynamic Therapy?

An individual who is not a good candidate for psychodynamic therapy is someone unwilling or unable to discuss their thoughts and feelings openly with a therapist. People who prefer quick, solution-focused treatment rather than exploring deep-rooted emotions and unconscious conflicts struggle with the slower, introspective nature of psychodynamic therapy. 

Chamlou, N. 2024 in the Psychology.org article “What Is Psychodynamic Therapy?” writes that those who are uncomfortable with self-reflection or who are not ready to commit to a longer-term therapeutic process also find this approach ineffective. Additionally, individuals in crises or those requiring immediate symptom relief benefit more from therapies that focus on short-term results. 

Individuals who are resistant to discussing their thoughts and feelings or prefer more structured, directive treatments are suited for psychodynamic therapy. Those seeking quick symptom relief or unwilling to engage in long-term exploration of past emotional trauma struggle with the time-intensive nature of PDT.

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How Does Psychodynamic Therapy Work?

Psychodynamic therapy works by helping individuals uncover the unconscious thoughts and feelings that influence their current behaviors. Through talk therapy sessions, the therapist encourages the patient to explore their past experiences, relationships, and emotional patterns. Monk, Sara in the British Association for Counselling and Psychotherapy article “What Is Psychodynamic Therapy?,” outlines that by identifying unresolved conflagrations of the Psyche or suppressed emotions, the therapy empowers individuals to gain insight into the underlying derivations of their present behaviors and emotional struggles. 

The therapist plays a supportive role, assisting the patient make connections between their thoughts, past experiences, and behaviors, encouraging accelerated self-reflection and emotional awareness. Over time, this process enables individuals to understand and change deep-seated patterns that precipitate their mental health issues.

What Are the Techniques Used in Psychodynamic Therapy?

The techniques used in psychodynamic theory are free association, dream analysis, transference, and projective tests. These techniques collectively dredge up the substance of emotional and psychological issues. The 5 common techniques used in psychodynamic therapy are discussed below:

Free Association

Free association involves sharing random thoughts openly, allowing hidden fears and unconscious conflicts to emerge. This technique shores up patients to unearth unresolved issues by bypassing conscious filters.

The study “What Is Free Association and What Does It Measure?” by Nelson D. & Dennis S. 2000, published in Memory & Cognition examined free association reliability across word types and set sizes using single- and dual-response norms. Single-response norms showed high reliability (r = .89), particularly for small-strong items (.99). Dual-response norms were also reliable (r = .83), though lower, as second responses introduced weaker words. This study expresses that the free association technique using single-response procedures is more effective for identifying dominant associations, while dual-responses create the chance for confounding patterns.

Dream Analysis

Dream analysis provides a framework for interpreting the meaning of dreams to lay bare unconscious issues and undetermined conflicts. It helps identify patterns that influence waking behavior and emotional responses.

Matt G. & Navarro A. 1997, in a review of 63 meta-analyses on the effect of psychotherapy, “What Meta-analyses Have and Have Not Taught us About Psychotherapy Effects: A Review and Future Directions,” found that, on average, 75% of clients receiving dream analysis showed improvements.

Transference

Transference happens when patients transfer emotions or feelings about an intimate relationship onto the therapist, granting insight into their relational dynamics. Recognizing transference pivots the therapeutic process in addressing dysfunctional relationship patterns.

According to a systematic review, “Transference Interpretation and Psychotherapy Outcome: A Systematic Review of a No-consensus Relationship,” by Yılmaz M. 2024, 62% of studies measuring the use of transference interpretation (TI) in psychodynamic psychotherapy affirmed notable improvement in at least one therapy outcome. The review also highlighted substantial heterogeneity across the studies, making it challenging to draw firm conclusions.

Projective Tests

Projective tests such as the Rorschach test (or inkblot test), reveal unconscious thoughts by extrapolating ambiguous stimuli. These tests aim to bring subconscious feelings and conflicts to the surface for examination.

The research article “The Scientific Status of Projective Techniques” by Lilienfeld et al. 2000 reviews the Rorschach Inkblot Test, Thematic Apperception Test (TAT), and human figure drawings. They find limited empirical support for these methods, with only a few valid indices from the Rorschach and TAT. A meta-analysis on child sexual abuse detection showed minimal consistent results and a file drawer effect. The authors recommend improving the validity of projective techniques and offer guidelines for their forensic and clinical use.

What Are the Types of Psychodynamic Therapy?

The types of psychodynamic therapy are brief psychodynamic therapy, dynamic interpersonal therapy (DIT), psychodynamic art and music therapies, and long-term psychodynamic therapy. These forms of PDT cater to different mental health needs, emphasizing short-term and long-term approaches to dig up buried emotional turbulence. The 4 common types of psychodynamic therapy are explained as follows:

• Brief psychodynamic therapy: This short-term approach focuses on addressing a specific problem, related to anxiety or depression, within a limited number of sessions. It aims to quickly identify underlying issues and help the individual develop coping mechanisms.  It is a short-term approach focusing on a specific matter, lasting 10-20 sessions.

The randomized trial “Effectiveness of Long- and Short-Term Psychodynamic Psychotherapy and Solution-Focused Therapy” by Knekt et al. 2007 compared treatments for mood and anxiety disorders over 3 years. Short-term therapies showed quicker results in the first year, but long-term psychodynamic psychotherapy (LPP) proved more effective after 3 years, cutting symptoms by 14-37%. No major differences were beheld between the short-term therapies. The study implies LPP’s long-term benefits and calls for more research to guide treatment selection.

• Dynamic interpersonal therapy (DIT): Primarily used to treat depression, DIT helps individuals explore their relationships and patterns of interaction to understand how these dynamics contribute to emotional difficulties.

As mentioned by Landström et al. 2019 in the research article “Dynamic Interpersonal Therapy as Experienced by Young Adults,” although the research base for DIT remains limited, a recent randomized controlled trial (RCT) on DIT for moderate to severe depression (n = 147) established that DIT was superior to low-intensity treatment and comparable to CBT in minimizing depressive symptoms. At the end of treatment, 51% of DIT patients demonstrated clinically pertinent advancement.

• Psychodynamic art and music therapies: These creative therapies utilize art or music to help individuals express unconscious thoughts and feelings. They are applied in treating trauma, PTSD, or personality disorders.

The pilot study “A Pilot RCT of Psychodynamic Group Art Therapy for Patients in Acute Psychotic Episodes” by Montag et al. 2014 evaluated the feasibility and efficacy of psychodynamic art therapy for schizophrenia patients. Fifty-eight inpatients were randomized to 12 art therapy sessions plus standard treatment or standard treatment alone. Art therapy showed greater reductions in positive symptoms and enhanced psychosocial functioning, with sustained benefits at follow-up. Emotional awareness also made a weighty upsurge. These results showcase that psychodynamic art therapy aids recovery during acute psychotic episodes, warranting further research.

• Long-term psychodynamic therapy: A more extensive form of therapy, this approach addresses deep-seated psychological issues and is used for individuals with personality disorders or chronic mental health conditions requiring intensive exploration of subconscious processes. It is an extended treatment over several years to address deep-rooted emotional challenges.

Leichsenring F. and Rabung S. 2008 conducted a meta-analysis on the “Effectiveness of Long-term Psychodynamic Psychotherapy (PDP),” reviewing 23 studies (n=1,310). Long-term PDP showed huge progression in overall effectiveness (d 0.96), target problems (d 1.16), and personality functioning (d 0.90) relative to other therapies. For complex mental disorders, the improvements were even more pronounced. Contrarily, upticks in social functioning and psychiatric symptoms, while notable, were not statistically relevant. The study supports the strong efficacy of long-term PDP for mental health treatment.

How Effective Is Psychodynamic Therapy?

The efficacy of Psychodynamic Therapy (PDT) for long-term emotional growth is around 40%, and it is not appropriate for all mental health disorders. In the study “Long-Term Outcome of Psychodynamic Therapy and Cognitive-Behavioral Therapy in Social Anxiety Disorder,” Leichsenring et al. 2014 found that both CBT and PDT had comparable long-term effectiveness for social anxiety disorder, with response rates of 70% and remission rates of 40%. Although CBT showed some short-term advantages, there were no meaningful dissimilarities between the therapies after 24 months.

As published by the American Psychological Association (2010), Jonathan Schedler cites a meta-analysis from the Archives of General Psychiatry that reviewed 17 randomized controlled trials of short-term psychodynamic therapy. The study by Leichsenring et al. 2004 reported an effect size of 1.17 in contrast to controls, increasing to 1.57 at long-term follow-up. The authors noted that patients treated with psychodynamic therapy were “better off with regard to their target problems than 92% of the patients before therapy.”

Some key benefits of psychodynamic therapy include:

• Improved self-awareness
• Enhanced emotional expression
• Better interpersonal relationships
• Greater emotional resilience

What Are the Limitations of Psychodynamic Therapy?

The limitations of psychodynamic therapy are its time-intensive nature, emotional intensity, and limited effectiveness for certain conditions. PDT is less effective for mental health conditions like post-traumatic stress disorder (PTSD), obsessive-compulsive disorder, and drug addiction. It is frequently criticized for requiring long-term commitment, sometimes spanning years, to achieve results. Additionally, patients experience emotional distress during sessions as they explore deep-seated emotions and unconscious conflicts. PDT offers long-term benefits, comparable effectiveness to other therapies, and is relatively cost-effective. 

Leichsenring et al. 2023, in the review “The Status of Psychodynamic Psychotherapy as an Empirically Supported Treatment for Common Mental Disorders – An Umbrella Review Based on Updated Criteria,” confirmed psychodynamic therapy (PDT) as an evidence-based treatment for common mental disorders. High-quality evidence supports PDT for depressive and somatic symptom disorders, with moderate evidence for anxiety and personality disorders. PDT showed a medium effect size (g = –0.58) for cutting back depressive symptoms, and a large effect size (g = –1.14) in comparison to waiting-list controls and other active therapies like cognitive behavioral therapy (CBT). Despite some research limitations, PDT is strongly recommended for treating these disorders.

How Long Does Psychodynamic Therapy Take?

Psychodynamic therapy lasts 45-50 minutes per session. According to the Substance Abuse and Mental Health Services Administration (2010) in the “Treatment Improvement Protocol (TIP) Series, No. 34,” short-term PDT takes no more than 25 sessions. The administration further outlines the existence of models that allow for 40 sessions under short-term PDT. In contrast, long-term psychodynamic therapy requires at least two years of sessions, as it aims to facilitate tremendous changes in identity or personality or to integrate crucial developmental lessons that the client missed while experiencing emotional stagnation.

Does Psychodynamic Therapy Help With OCD?

No, psychodynamic therapy is not recommended for treating obsessive-compulsive disorder (OCD). Cognitive-behavioral therapy (CBT) offers more effective results for individuals with OCD. In the research article “Psychodynamic Therapy of Obsessive-Compulsive Disorder: Principles of a Manual-Guided Approach,” Leichsenring F. & Steinert C. 2016 present a manual-guided psychodynamic therapy model for obsessive-compulsive disorder (OCD). They note that cognitive-behavioral therapy (CBT) and SSRIs yield 50-60% response rates and less than 25% remission. Their model adapts short-term psychodynamic therapy using Luborsky’s supportive-expressive therapy framework, accenting core conflictual relationship themes to help patients understand their OCD symptoms.

Is Psychodynamic Therapy Evidence-Based?

Yes, psychodynamic therapy is evidence-based, supported by decades of research showing its efficacy in ameliorating emotional well-being. As published by the American Psychological Association (2010), Jonathan Schedler references a meta-analysis from the Archives of General Psychiatry that examined 17 randomized controlled trials of short-term psychodynamic therapy. The research conducted by Leichsenring et al. 2004 recounted an effect size of 1.17 compared to control groups, which increased to 1.57 during long-term follow-up. The authors concluded that patients undergoing psychodynamic therapy were “better off with regard to their target problems than 92% of the patients before therapy.”

What Is the Difference Between Psychodynamic Therapy and CBT?

The main difference between psychodynamic therapy and cognitive behavioral therapy (CBT) is in the underlying principles and approaches to treatment. PDT accentuates the exploration of unconscious thoughts and past experiences, while CBT is more structured, and built on altering current thought patterns and behaviors.