![Layers of earth and stone revealing hidden patterns](https://viacara.com/img/content/approaches-psychodynamic-feature-light.webp)

# Psychodynamic Therapy

Learn how psychodynamic therapy works, what to expect in sessions and how exploring your past can change your present.

## What is psychodynamic therapy?

Psychodynamic therapy explores how your past experiences, particularly early relationships, shape your present feelings and behaviours. It draws on the work of Freud but has evolved significantly since then. Modern psychodynamic therapy is warm, collaborative and grounded in evidence.

The core idea is that much of what drives us operates outside our conscious awareness. By bringing these patterns into the light, you can begin to make different choices.

## How it works

Psychodynamic therapy focuses on:

What *psychodynamic* work explores

- **Earlier experience** The therapist explores experiences that may shape present relationships.
- **Present patterns** They discuss recurring feelings and ways of relating.
- **Therapy relationship** What happens between client and therapist can also become part of the work.

Psychodynamic work explores meanings and relationships. It shares psychoanalytic roots, without always using the same intensity of sessions.

- **Unconscious patterns**: thoughts, feelings and behaviours you are not fully aware of
- **Early relationships**: how your formative experiences shaped the way you relate to others
- **Transference**: how you might replay old relationship dynamics with your therapist, and what that reveals
- **Defence mechanisms**: the ways you protect yourself from difficult feelings, and whether those defences still serve you

Your therapist will help you make connections between past and present. This is not about blame or dwelling in the past. It is about understanding why you react the way you do so you can respond differently.

Sources: [UKCP: approaches](https://viacara.com/approaches/psychodynamic/#ref-5), [BACP: types of therapy](https://viacara.com/approaches/psychodynamic/#ref-9)

![Exploring beneath the surface to understand present patterns](https://viacara.com/img/content/approaches-psychodynamic-mid-light.webp)

Psychodynamic therapy looks beneath the surface to understand what drives present feelings

## What sessions look like

Sessions typically last 50 minutes, often once or twice a week. Psychodynamic therapy tends to be longer-term than [CBT](https://viacara.com/approaches/cbt/), often running for months or years. Brief forms also exist, such as [dynamic interpersonal therapy](https://viacara.com/approaches/psychodynamic/#dynamic-interpersonal-therapy).

There is no set agenda. You are encouraged to talk freely about whatever comes to mind. Your therapist will listen for patterns, recurring themes and emotional responses. They may point out connections you had not noticed or gently explore moments when your feelings seem disproportionate to the situation.

Silences are welcome. Dreams and fantasies may be explored. The therapeutic relationship itself becomes material for understanding your patterns.

## Who is it best suited to?

Psychodynamic therapy may suit you if you:

- Notice repeating patterns in your relationships
- React to situations in ways that feel out of proportion
- Struggle with issues that have not responded to more structured approaches
- Want to understand yourself more deeply rather than just manage symptoms
- Experience chronic low mood, anxiety or dissatisfaction without a clear cause

It is used for depression, anxiety, personality difficulties and relationship problems, and often for complex or long-standing difficulties.

## How it differs from other approaches

Psychodynamic therapy goes deeper into the roots of your difficulties rather than focusing on present symptoms. Where [CBT](https://viacara.com/approaches/cbt/) teaches you to change your thoughts, psychodynamic therapy helps you understand why you have those thoughts in the first place. It shares some ground with [humanistic therapy](https://viacara.com/approaches/humanistic/), but places more emphasis on early experiences.

It requires a willingness to sit with uncertainty and explore difficult feelings. The pace is slower than in more structured therapies.

## *Attachment-based* therapy

Attachment-based therapy applies John Bowlby's work on early bonds to adult therapy. It looks at how the way you handle closeness now grew from your first relationships.

Attachment across *relationships*

- **Earlier bonds** The therapist and client explore experiences of closeness, separation and loss.
- **Relationships now** They consider how the client experiences closeness in present relationships.
- **Working together** The therapy relationship provides another place to explore trust and distance.

Attachment-based therapy centres on bonds and security within psychodynamic work. These areas overlap rather than follow a fixed order.

Your relationship with your therapist is the main material. How you test them, lean on them or pull away becomes something you look at together. The Bowlby Centre calls the therapy a joint venture that builds a secure base for exploring loss and trauma.

In the UK, the approach sits within the UKCP as a branch of psychoanalytic practice. The John Bowlby Centre runs the four-year training that leads to UKCP registration.

No trial has tested attachment-based psychoanalytic psychotherapy by name. Research has looked at attachment as a predictor instead. Levy and colleagues pooled 36 studies and found that people who start therapy securely attached tend to do better.

The same review saw a sign that less secure people may do better in therapy centred on close relationships. The authors call that finding preliminary.

Attachment-based family therapy, for teenagers and their families, is a different therapy. A 2024 review pooled four trials and found it not significantly more effective than its comparisons.

Sources: [UKCP: approaches](https://viacara.com/approaches/psychodynamic/#ref-5), [Bowlby Centre: training](https://viacara.com/approaches/psychodynamic/#ref-6), [Levy et al. 2018](https://viacara.com/approaches/psychodynamic/#ref-7), [Schulte-Frankenfeld et al. 2024](https://viacara.com/approaches/psychodynamic/#ref-8)

## *Adlerian* therapy

Adlerian therapy comes from Alfred Adler, who worked alongside Freud. It is also called individual psychology. Its idea is that conclusions you drew in childhood still steer you as an adult.

The meanings *Adlerian* therapy explores

- **Early experience** The counsellor explores family experiences and the meanings the client gives them.
- **Goals and beliefs** They examine the goals and assumptions behind present behaviour.
- **Ways of acting** They consider how the client might act differently.

Adlerian work connects early meanings with present goals. Its focus includes the purpose of behaviour, alongside its history.

Early sessions feel like an interview. Your therapist asks about your family, your place among any siblings and your earliest memories. In Adlerian terms, those memories reveal the mistaken beliefs that still guide you.

The work looks at the purpose of what you do rather than its cause. Adler's aim was social interest, a sense of belonging and of contributing to other people.

The BACP describes Adlerian counselling in its list of therapy types. The Adlerian Society UK and Institute for Individual Psychology accredits Adlerian training courses and counsellors.

The trial evidence is thin. A review from within the tradition notes its absence from the American Psychological Association's list of research-supported treatments. It does not appear in NICE guidance on depression.

Sources: [BACP: types of therapy](https://viacara.com/approaches/psychodynamic/#ref-9), [Cedeno & Torrico 2024](https://viacara.com/approaches/psychodynamic/#ref-10), [ASIIP: overview](https://viacara.com/approaches/psychodynamic/#ref-11), [Kaynak 2024](https://viacara.com/approaches/psychodynamic/#ref-12), [NICE NG222](https://viacara.com/approaches/psychodynamic/#ref-13)

## Dynamic *interpersonal* therapy

Dynamic interpersonal therapy (DIT) is a short psychodynamic therapy built for depression. It works on one recurring pattern in your close relationships, which you and your therapist name early on.

A shared *relationship focus*

- **Earlier relationships** The therapist asks how patterns of thinking formed in earlier life.
- **Current relationships** They explore how those patterns appear in relationships now.
- **Agreed focus** Client and therapist agree which areas to work on during the course.

DIT gives psychodynamic work a brief, agreed focus. It is a different approach from interpersonal therapy.

NHS Talking Therapies lists DIT among its high-intensity treatments for depression. NICE says short-term psychodynamic psychotherapy can be used as a first treatment for depression. The service delivers it as DIT.

Most people have up to 16 sessions. The course moves from finding the pattern, to working on it, to preparing for the ending. Your therapist may also comment on what happens between the two of you.

Access varies by area. NHS guidance gives DIT up to 6% of a service's high-intensity therapists, and a service may have none. The British Psychoanalytic Council accredits the training.

up to 6%

of a service's high-intensity therapists, for DIT

NHS guidance [NHS England: talking therapies manual](https://viacara.com/approaches/psychodynamic/#ref-14)

The direct evidence is early. A pilot trial randomised 147 people in NHS services. The trial found DIT did better than a low-intensity comparison.

Its small CBT group, of 20 people, did about as well as the DIT group on most measures. The authors conclude that DIT can now be compared with [CBT](https://viacara.com/approaches/cbt/) in future trials.

For short psychodynamic therapy as a family, a Cochrane review of 33 trials found modest to large gains. Its authors urged caution in reading them. The review was last updated in 2014.

Sources: [NHS England: talking therapies manual](https://viacara.com/approaches/psychodynamic/#ref-14), [Lemma et al. 2023](https://viacara.com/approaches/psychodynamic/#ref-15), [Berkshire Healthcare: DIT](https://viacara.com/approaches/psychodynamic/#ref-16), [NICE NG222](https://viacara.com/approaches/psychodynamic/#ref-13), [Fonagy et al. 2020](https://viacara.com/approaches/psychodynamic/#ref-17), [Abbass et al. 2014](https://viacara.com/approaches/psychodynamic/#ref-4)

## Accelerated experiential dynamic psychotherapy

Diana Fosha developed accelerated experiential dynamic psychotherapy (AEDP). The model calls its central idea undoing aloneness. You face overwhelming feelings with someone beside you, not on your own.

Exploring emotion *together*

- **Therapist support** The therapist works to build a relationship the client experiences as supportive.
- **Emotional experience** Together they explore difficult feelings and relational experiences as they arise.

AEDP places shared emotional experience at the centre of its attachment-based work. Its name does not promise faster results.

Your therapist aims to be a safe haven and a secure base for you. Together you work through painful feelings in depth, and positive feelings too. The studied course ran to 16 sessions.

No randomised trial of AEDP has been published. Two studies from its own research network followed the same group of about 60 adults through that course. Neither had a control group, and the model's developer co-wrote both.

A separate team in Israel studied 46 more people through the same course, also without a control group.

In Britain, AEDP sits outside the main professional bodies. AEDP UK describes itself as an informal group of therapists. Neither BACP nor UKCP lists it as an approach.

Sources: [AEDP Institute: overview](https://viacara.com/approaches/psychodynamic/#ref-18), [Gross et al. 2026](https://viacara.com/approaches/psychodynamic/#ref-21), [Iwakabe et al. 2020](https://viacara.com/approaches/psychodynamic/#ref-19), [Iwakabe et al. 2022](https://viacara.com/approaches/psychodynamic/#ref-20), [AEDP UK: overview](https://viacara.com/approaches/psychodynamic/#ref-22), [BACP: types of therapy](https://viacara.com/approaches/psychodynamic/#ref-9), [UKCP: approaches](https://viacara.com/approaches/psychodynamic/#ref-5)

## The evidence

Psychodynamic therapy has a growing evidence base. Shedler (2010) reviewed earlier meta-analyses and reported effect sizes as large as those for other therapies. He also reported that people keep their gains and appear to keep improving after therapy ends.

Leichsenring and Rabung (2008) pooled 23 studies of therapy lasting at least a year. They reported large and stable gains in complex conditions, such as personality disorders. They also called for more research on specific conditions.

On this page

[What is psychodynamic therapy?](https://viacara.com/approaches/psychodynamic/#what-is-psychodynamic-therapy) [How it works](https://viacara.com/approaches/psychodynamic/#how-it-works) [What sessions look like](https://viacara.com/approaches/psychodynamic/#what-sessions-look-like) [Who is it best suited to?](https://viacara.com/approaches/psychodynamic/#who-is-it-best-suited-to) [How it differs from other approaches](https://viacara.com/approaches/psychodynamic/#how-it-differs-from-other-approaches) [Attachment-based therapy](https://viacara.com/approaches/psychodynamic/#attachment-based-therapy) [Adlerian therapy](https://viacara.com/approaches/psychodynamic/#adlerian-therapy) [Dynamic interpersonal therapy](https://viacara.com/approaches/psychodynamic/#dynamic-interpersonal-therapy) [Accelerated experiential dynamic psychotherapy](https://viacara.com/approaches/psychodynamic/#aedp) [The evidence](https://viacara.com/approaches/psychodynamic/#the-evidence)

Related

[Person-Centred Therapy](https://viacara.com/approaches/person-centred/) [Integrative Therapy](https://viacara.com/approaches/integrative/) [Understanding Different Approaches](https://viacara.com/guides/understanding-approaches/)

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## References

1. Shedler, J. (2010). *The efficacy of psychodynamic psychotherapy*. American Psychologist. [doi:10.1037/a0018378](https://doi.org/10.1037/a0018378)
2. Leichsenring, F. & Rabung, S. (2008). *Effectiveness of long-term psychodynamic psychotherapy: A meta-analysis*. JAMA. [doi:10.1001/jama.300.13.1551](https://doi.org/10.1001/jama.300.13.1551)
3. Fonagy, P. (2015). *The effectiveness of psychodynamic psychotherapies: An update*. World Psychiatry. [doi:10.1002/wps.20235](https://doi.org/10.1002/wps.20235)
4. Abbass, A. A., Kisely, S. R., Town, J. M., Leichsenring, F., Driessen, E., De Maat, S., Gerber, A., Dekker, J., Rabung, S., Rusalovska, S. & Crowe, E. (2014). *Short-term psychodynamic psychotherapies for common mental disorders*. Cochrane Database of Systematic Reviews. [doi:10.1002/14651858.CD004687.pub4](https://doi.org/10.1002/14651858.CD004687.pub4)
5. UK Council for Psychotherapy (n.d.). *Psychotherapy approaches*. [psychotherapy.org.uk](https://www.psychotherapy.org.uk/psychotherapy-training/psychotherapy-approaches/)
6. The John Bowlby Centre (n.d.). *Four-year training in attachment-based psychoanalytic psychotherapy*. [thebowlbycentre.org.uk](https://thebowlbycentre.org.uk/training/4-year-attachment-based-psychoanalytic-psychotherapy-abpp/)
7. Levy, K. N., Kivity, Y., Johnson, B. N. & Gooch, C. V. (2018). *Adult attachment as a predictor and moderator of psychotherapy outcome: A meta-analysis*. Journal of Clinical Psychology. [doi:10.1002/jclp.22685](https://doi.org/10.1002/jclp.22685)
8. Schulte-Frankenfeld, P. M., Breedvelt, J. J. F., Brouwer, M. E., van der Spek, N., Bosmans, G. & Bockting, C. L. (2024). *Effectiveness of attachment-based family therapy for suicidal adolescents and young adults: A systematic review and meta-analysis*. Clinical Psychology in Europe. [doi:10.32872/cpe.13717](https://doi.org/10.32872/cpe.13717)
9. British Association for Counselling and Psychotherapy (n.d.). *Types of therapy: An A-Z of therapeutic approaches*. [bacp.co.uk](https://www.bacp.co.uk/about-therapy/types-of-therapy/)
10. Cedeno, R. & Torrico, T. J. (2024). *Adlerian therapy, StatPearls*. [ncbi.nlm.nih.gov](https://www.ncbi.nlm.nih.gov/books/NBK599518/)
11. Adlerian Society UK and Institute for Individual Psychology (n.d.). *Adlerian Society UK and Institute for Individual Psychology*. [asiip.org](https://asiip.org/resources/)
12. Kaynak, U. (2024). *Evidence-based individual psychology practice: Adlerian pattern focused therapy*. Current Approaches in Psychiatry. [doi:10.18863/pgy.1301197](https://doi.org/10.18863/pgy.1301197)
13. National Institute for Health and Care Excellence (2022). *Depression in adults: treatment and management (NG222)*. [nice.org.uk](https://www.nice.org.uk/guidance/ng222)
14. NHS England (2024). *NHS Talking Therapies for anxiety and depression manual, version 7*. [england.nhs.uk (PDF)](https://www.england.nhs.uk/wp-content/uploads/2018/06/nhs-talking-therapies-manual-v7.1-updated.pdf)
15. Lemma, A., Target, M., Fonagy, P., Abrahams, D. & Clarke, J. (2023). *Revised curriculum for dynamic interpersonal therapy for depression, version 1.1*. [hee.nhs.uk (PDF)](https://www.hee.nhs.uk/sites/default/files/documents/HIT%20Dynamic%20Interpersonal%20Therapy%20for%20Depression%20Revised%20Curriculum%20Dec%202023.pdf)
16. Berkshire Healthcare NHS Foundation Trust (n.d.). *Dynamic interpersonal therapy*. [berkshirehealthcare.nhs.uk](https://www.berkshirehealthcare.nhs.uk/services/talking-therapies/dynamic-interpersonal-therapy)
17. Fonagy, P., Lemma, A., Target, M., O'Keeffe, S., Constantinou, M. P., Ventura Wurman, T., Luyten, P., Allison, E., Roth, A., Cape, J. & Pilling, S. (2020). *Dynamic interpersonal therapy for moderate to severe depression: A pilot randomized controlled and feasibility trial*. Psychological Medicine. [doi:10.1017/S0033291719000928](https://doi.org/10.1017/S0033291719000928)
18. AEDP Institute (n.d.). *AEDP psychotherapy*. [aedpinstitute.org](https://aedpinstitute.org/about-aedp-psychotherapy/)
19. Iwakabe, S., Edlin, J., Fosha, D., Gretton, H., Joseph, A. J., Nunnink, S. E., Nakamura, K. & Thoma, N. C. (2020). *The effectiveness of accelerated experiential dynamic psychotherapy in private practice settings*. Psychotherapy. [doi:10.1037/pst0000344](https://doi.org/10.1037/pst0000344)
20. Iwakabe, S., Edlin, J., Fosha, D., Thoma, N. C., Gretton, H., Joseph, A. J. & Nakamura, K. (2022). *The long-term outcome of accelerated experiential dynamic psychotherapy: 6- and 12-month follow-up results*. Psychotherapy. [doi:10.1037/pst0000441](https://doi.org/10.1037/pst0000441)
21. Gross, N., Bar-Kalifa, E. & Shahar, B. (2026). *The role of positive emotions in accelerated experiential dynamic psychotherapy*. Psychotherapy Research. [doi:10.1080/10503307.2025.2534972](https://doi.org/10.1080/10503307.2025.2534972)
22. AEDP UK (n.d.). *AEDP UK*. [aedpuk.com](https://www.aedpuk.com/)

## Related

### [Person-Centred Therapy](https://viacara.com/approaches/person-centred/)

Learn how person-centred therapy works, what sessions look like and why the relationship with your therapist matters most.

### [Integrative Therapy](https://viacara.com/approaches/integrative/)

Learn how integrative therapy combines different approaches to create a flexible, personalised experience.

### [Understanding Different Approaches](https://viacara.com/guides/understanding-approaches/)

A plain-English guide to the main therapeutic approaches including CBT, person-centred therapy, psychodynamic and integrative methods.