Psychodynamic and Psychoanalysis Therapies


Psychodynamic and Psychoanalysis Therapies

What are psychodynamic and psychoanalysis therapies?

Both therapies are used to treat people who are experiencing psychological problems. Some people behave in ways or respond to others for reasons they don’t understand. These therapies help patients acknowledge the importance of unconscious psychological processes and the ability of childhood experiences to affect thoughts and behaviors in adulthood. The therapies give the individual a deeper understanding of their emotions, past conflicts and thoughts that are contributing to current negative feelings and behaviors. 

What is psychodynamic therapy?

Psychodynamic therapy, like psychoanalytic therapy, is an in-depth form of talk therapy based on the theories and principles of psychoanalysis. Psychodynamic therapy is used to treat many serious psychological disorders, especially in patients who have lost meaning in their lives and have difficulty maintaining personal relationships. Through self-reflection and self-examination, the patient gains a deeper understanding of early childhood experiences that can influence current struggles. As the patient learns why they think and behave as they do, they learn to make healthier choices about their lives and relationships. 

What is psychoanalytic therapy?

Psychoanalytic therapy is the oldest type of talk therapy, and is based on Sigmund Freud's theories. Freud described the unconscious mind as the root of desires, thoughts, and memories of which we are not consciously aware. Psychoanalytic therapists believe the origins of psychological problems are in the unconscious mind, and can be caused by unresolved issues during early development, or from repressed trauma. By bringing the unconscious to the surface, the patient gains an understanding of their current psychological disturbances. 

Freud makes several key assumptions in his theory, including:  

  • Psychological problems are rooted in the unconscious
  • Dreams are the key to the unconscious
  • Treatment focuses on bringing the repressed conflict to consciousness
  • Personality is largely influenced by childhood experiences
  • Individuals employ defense mechanisms against threatening information from the unconscious mind
  • The mind is composed of the id, ego, and superego
  • All tension is caused by the increase of libido; all pleasure is derived from its discharge

How do psychodynamic and psychoanalysis therapies differ?

Psychoanalysis focuses on the unconscious mind, the influence of the libido, and the patient-therapist relationship. It is provided by a trained psychoanalytic therapist, often a medical doctor.

Psychodynamic therapy, which is based on the theories of both Freud and his followers (neo-Freudians), places more emphasis on the patient’s relationships with other people and the external world. It places less emphasis on sex, giving more importance to the influence of social environment. Psychodynamic therapy is often less emotionally intensive. While traditional psychoanalysis can take years of therapy, psychodynamic therapy is shorter, more focused, and is delivered face-to-face. The therapist may not be a certified psychoanalyst but is trained in the psychodynamic method. 

Some of the neo-Freudians broke with some of Freud’s theories. Instead of being motivated by sexuality and aggression as Freud theorized, Alfred Adler believed humans are driven by feelings of inferiority in childhood and that people should be studied as a whole. Carl Jung held that Freud’s beliefs about the unconscious mind were too negative and incomplete. He said that humans had a deeper unconscious that was collective and universal.

How do psychodynamic and psychoanalysis therapies work?

Psychodynamic therapy helps the patient examine repressed emotions that may be affecting current feelings, behaviors, decision-making, and relationships. Patients learn how to:

  • Identify patterns in behavior and relationships
  • Develop new ways to cope with problems and healthier ways to express their emotions
  • Analyze and change their behavior based on the analysis of early experiences and emotions
  • Understand the emotional patterns that contribute to dysfunction

With psychoanalytic therapy, the patient is encouraged to speak freely about whatever comes to mind – fears, dreams, fantasies, or current problems. This open-ended talk can unlock unconscious, repressed memories that have affected the client’s thinking, behavior, and relationships in adulthood. The therapist can help the patient examine emotional blind spots, understand relationship patterns, and see the defenses they’re putting up to avoid past traumas. 

Psychoanalysts use a variety of techniques to gain insight into a patient’s behavior, including: 

  • Dream interpretation provides insight into repressed feelings that are hidden in symbols appearing in the dream.
  • Free association uses spontaneous word association. The patient says whatever comes to mind in response to words said by the therapist. The therapist looks for patterns in the patient’s responses to each word.  
  • Transference occurs when the patient projects his/her feelings about a person onto the psychoanalyst. The patient then interacts with the psychoanalyst as if he/she was the other person. This helps the therapist understand how the patient interacts with others. Or for example, the patient’s feelings toward a parent are transferred to an adult relationship later in life. 

Either therapy can be very intense and personal because it involves the examination of painful events, feelings, and relationships. This can trigger pain and avoidance. Having the courage to confront and deal with past experiences is critical to successfully resolving the underlying conflict. 

What conditions are psychodynamic and psychoanalysis therapies used to treat?

Both therapies can help people with wide ranging diagnoses and multiple mental health challenges. They’re especially helpful with people who’ve had traumatic experiences, especially in early childhood. 

Psychodynamic therapy is used to treat:

  • Depression
  • Anxiety
  • Schizophrenia
  • Somatic disorders (excessive thoughts and behaviors related to physical symptoms)
  • Personality disorders
  • Eating disorders
  • Interpersonal problems
  • Psychological distress
  • Post-traumatic stress disorder
  • Social anxiety disorder
  • Substance use disorders

Psychoanalytic therapy is used to treat:

  • Depression
  • Anxiety
  • Trauma and emotional struggles
  • Identity problems
  • Self-esteem issues
  • Self-assertion
  • Psychosomatic disorders
  • Neurotic behaviors
  • Relationship issues
  • Self-destructive behavior
  • Sexual problems

Are psychodynamic and psychoanalysis therapies directive or nondirective?

Psychodynamic and psychoanalysis therapies can be practiced as either directive or nondirective. 

With directive therapies, the therapist prescribes and determines the course of action for a patient. 

Non-directive therapies rely on the patient to decide what to do. The therapist never chooses the direction of therapy. The goal is the independence and integration of the patient rather than a solution of the problem. The therapist may offer guidance such as an interpretation or clarification. Non-directive therapy teaches the patient to rely less on the judgments of others, and to trust themselves as the best expert on their life.

What are the advantages of psychodynamic and psychoanalysis therapies?

Psychodynamic and psychoanalysis therapies are as effective, if not more effective, than other types of therapy and antidepressant medications. 

People who receive psychoanalytic treatment tend to retain the gains they’ve made in healthier behavior and relationships, continuing to improve after therapy ends. One small study found that 77% of patients who completed psychoanalytic therapy reported significant improvement in symptoms, interpersonal problems, quality of life, and well-being. At one-year follow-up, 80% reported improvements. The benefits of other evidence-based therapies tend to diminish over time. 

Undergoing either of these therapies can increase self-esteem, and improve the ability to develop and maintain more satisfying relationships. Behavior changes and healthier thought processes are possible through increased insight and self-awareness of their mental health challenges. 

What are the disadvantages of psychodynamic and psychoanalysis therapies?

Both types of therapies are unstructured and require more of a time commitment, compared to other types of therapy such as cognitive behavioral therapy and dialectical behavior therapy. 

Both require a large number of therapy sessions, and are more expensive for the consumer. Even if the patient has health insurance, most insurance plans don’t cover the full cost of long-term intensive psychotherapy. 

Both therapies can be emotionally intense and psychologically uncomfortable. 

Patients may encounter limited access to therapy due to a shortage of trained therapists for complex psychotherapies outside of urban areas. 

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American Psychological Association. (2010). Psychodynamic Psychotherapy Brings Lasting Benefits Through Self-Knowledge. Retrieved 2-17-22, {}
Cherry, K. (2021, Jan.) What is Psychodynamic Therapy? verywell mind. Retrieved 2-17-22, {}
Psychology Today (n.d.) Psychodynamic Therapy. Retrieved 22-17-22, {}
Cherry, K. (2021, July.) What is Psychoanalytic Therapy? verywell mind. Retrieved 2-17-22, {}
Psychology Today (n.d.) Psychoanalytic Therapy. Retrieved 2-17-22, {}
American Psychoanalytic Association. (n.d.) Psychoanalytic Psychotherapy.  About Psychoanalysis. Retrieved 2-18-22, {}
Novotney, A. (2017, Dec.)  Psychoanalysis vs. psychodynamic therapy. American Psychological Association. Retrieved 2-18-22, {}
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Stephen, J. (2014, Aug.) What is Non-Directive Therapy? Psychology Today. Retrieved 2-18-22, {


Medically reviewed by:

Dr Roy Kedem, MD

Dr Roy Kedem started his premedical studies at Harvard, and research in genetics and gene sequencing at Harvard, Beth Israel. He attended medical school in the UK at the Cambridge Overseas Medical Program in 1998. Dr Kedem then completed his residency in Internal Medicine at Columbia College of Physicians and Surgeons in Stamford, Connecticut and his fellowship in Hospital Medicine at the Cleveland Clinic in Cleveland, Ohio.

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