Psychodynamic therapy is a type of talk therapy that focuses on understanding the deeper factors affecting a person’s emotions, thoughts, and behaviours. This therapy goes beyond simple symptom management, exploring the underlying patterns causing the symptoms in the first place.

In this article, we’ll explore how psychodynamic therapy works in practice, look at an illustrative case study example, and examine how uncovering unconscious patterns can lead to deeper self-understanding.

Illustrative Case Study Example

Psychodynamic therapy emphasizes self-understanding and long-term change.

It’s rooted in the idea that much of our inner lives operate outside of conscious awareness. A trained psychodynamic therapist can listen to someone’s experiences and help them connect the dots about how things outside of their consciousness may be showing up in their present.

Here’s an illustrative case study example to demonstrate how this looks in practice.

Ivan, 65, is struggling to feel comfortable eating in public. He can eat in the quiet of his home but as soon as he goes out to dinner with some friends, he becomes petrified and can’t eat anything.

A symptom- focused therapist might teach him grounding techniques to calm him down at the restaurant and may create exposures to help him gradually become desensitized to eating in public.

A psychodynamic therapist might do some of this, but will focus the bulk of the work on getting Ivan to talk about his past, his fears, his feelings – anything at all, because it may shed light on the root cause of the issue.

After months of talking, one day, Ivan tells the therapist a story of his childhood: “My parents were Holocaust survivors. They used to watch me eat all my meals with amazement that I had so much good food on my plate.”

Bingo! “I wonder how it felt to be watched like that every time you ate?” The therapist might say. And Ivan might reply: “Like I was in a zoo! I hated it!” The therapist would then point out that perhaps that experience is related to his fear of eating in public. This insight may eventually then lead Ivan to feeling more comfortable eating in public

Looking Beneath the Surface

People often find themselves in the same situations: relationships, work stressors, issues of self-doubt.

Psychodynamic therapy believes these patterns aren’t random: they have roots in earlier experiences.

In psychodynamic therapy, the therapist explores the individual’s early relationships to understand how these relationships shaped their expectations, fears and ways of relating. Therapy helps make these patterns visible so they can be understood, not just repeated.

The famous psychoanalyst Carl Rogers said: “The curious paradox is that when I accept myself just as I am, then I can change” – and this is a core tenet of psychodynamic work.

The focus in psychodynamic therapy is less on quick fixes and more on lasting change. It can take a while. Often people are in therapy for several years.

The Role of the Unconscious

Psychodynamic therapy believes that not everything we feel or do is fully conscious.

Imagine an iceberg: the part underneath the water is much larger than the part above the water. Well, in psychodynamic theory, the idea is that a person’s unconscious is like the submerged part of the iceberg: huge and greatly impacting our every action, even though we’re unaware of it.

The unconscious can show up in many ways, such as:

• Emotional reactions that feel stronger than expected
• Our dreams at night
• Slips of the tongue
• Repeated behaviours that don’t make sense

The goal isn’t to “dig things up” for the sake of it, but to better understand what’s already influencing you to act in ways that work against you. We can never fully uncover the unconscious, but little by little, we can bring some of the unconscious into conscious awareness, which will lead to lasting change.

What Happens in a Session?

In psychodynamic therapy, the individual is encouraged to speak freely. Whatever comes to mind should be said aloud. No topic is too small, irrelevant, or off-limits. This is often called “free association.”

Some topics include:

• Talking about current worries
• Reflecting on past experiences
• Sharing memories that bubble up in the course of the work
• Exploring dreams
• Feelings that come up about the therapist

The therapist listens closely and helps the individual notice patterns, themes, and connections in the material. The pace is collaborative. You and your therapist are a team.

The therapist trusts that the person, deep down in their unconscious, knows what they need to talk about.

The therapist listens, asking guiding questions, reflecting to help the person feel heard and make sense of their experience. Sometimes the therapist offers interpretations to help the individual understand what’s happening. However, the most helpful part of the work is often the quality of the relationship between the individual and the therapist, and the insights that they come to on their own with the therapist’s non-judgemental, guiding presence.

Over time, individuals begin to understand themselves more clearly, feel they have more choice in how they respond to things; develop more meaningful relationships; and feel curious and amazed by their own minds.

The Therapeutic Relationship

One of the most unique aspects of psychodynamic therapy is how the relationship between the person and the therapist is central to the work.

The idea is that this relationship can serve as a microcosm of the person's other relationships in life. Feelings and reactions that come up in therapy, toward the therapist, can reflect patterns that arise in the person’s other relationships.

The therapist will encourage the individual to share whatever feelings and thoughts arise about the therapist, as they can provide fertile ground for understanding what unfolds in the person's other relationships.

For example, someone may share a worry that their therapist is judging them; feeling misunderstood by the therapist; craving approval or fearing rejection from their therapist. Talking about these experiences in real time can lead to deeper understanding, which can help people build more authentic and flexible relationships outside of therapy.

Is Psychodynamic Therapy Right for You?

You may be an especially good fit for psychodynamic therapy if you:

• Are curious about your inner world
• Want to understand “why” things feel the way they do
• Are open to exploring both past and present experiences
• Don’t like more structured or skills-based therapies
• Have tried other therapies and found them ineffective, or like they didn’t go deep enough

It may be less appropriate when:

• There are severe conditions requiring stabilization first (e.g. active psychosis, high-risk crisis)
• The person prefers practical tools over exploration

In those cases, approaches like cognitive behavioural therapy (CBT) or dialectical behavioural therapy (DBT) are often more direct for specific symptoms.

Practical Ways to Start Reflecting More Deeply

If you’re interested in thinking more deeply about your inner world, there are many things you can do.

First of all, you can seek a psychodynamic therapist. You should check that psychodynamic therapy is their primary modality.

On your own time and/or if you’re not ready to take this leap, you can start noticing patterns in your life. Ask yourself: when do I tend to feel the same emotions again and again?

Pay attention to strong reactions you have. What situations feel bigger than they “should”?

Think about the relationships in your life. Do similar dynamics show up with different people?

Stream-of-consciousness journaling can be a helpful way to think through these things. Many therapists recommend journaling every day to gain insight into your thoughts, feelings and behaviours.

Insight meditation can also be helpful: sitting in silence, with your thoughts, for a set amount of time every day to begin to notice what’s happening in your mind.

Paying attention to dreams at night is also very helpful. Dreams are one of the best ways to get in touch with your unconscious. The more you pay attention to them, the more you’ll remember them. Start jotting them down in the morning and pay attention to recurring themes that come up over time.

One of the most wonderful things a psychodynamic therapist teaches people to do is practice curiosity instead of judgement. Ask yourself: Where might this be coming from? Instead of: “What’s wrong with me?”

Summary

Psychodynamic therapy is a form of talk therapy that focuses on uncovering the deeper, often unconscious roots of a person’s thoughts, emotions, and behaviours.

Rather than just treating symptoms, it aims to create lasting change by helping individuals understand patterns shaped by past experiences, especially early relationships.

The therapy is based on the idea that much of our mental life operates outside conscious awareness – like the hidden part of an iceberg – and these unconscious influences can show up in emotional reactions, behaviours, and relationships.

Through open-ended conversation (“free association”), individuals explore current concerns, past experiences, dreams, and even their feelings toward the therapist.

A core aspect of psychodynamic therapy is attention to the here-and-now relationship between the individual and the therapist. Feelings, reactions, and patterns that emerge in this relationship can offer valuable insight into how the person relates to others in their life, making the therapy itself a space where these dynamics can be understood and worked through in real time.

Psychodynamic therapists don’t pretend to know all the answers; instead, they help people arrive at the answers that reside within them already.

Helpful Tools

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