Psychodynamic therapy: how the past shapes the present

Have you ever found yourself reacting to something more strongly than you expected, and not quite known why? Or noticed that you keep ending up in the same kind of situation, with work, friends or partners, even though you try hard to do things differently? Psychodynamic therapy is one way of exploring questions like these.

It is based on the idea that our past, especially our early relationships, can shape how we feel and behave now, often in ways we are not fully aware of. This article explains what psychodynamic therapy is, what happens in sessions, and how to think about whether it might be right for you.

Where psychodynamic therapy comes from

Psychodynamic therapy grew out of psychoanalysis, the approach developed by Sigmund Freud over a century ago. Since then, many other thinkers have added to and changed these ideas, and modern psychodynamic therapy looks quite different from the image some people have of lying on a couch talking about dreams.

Today, most psychodynamic therapists sit with you, face to face or on a video call, and have a conversation. The core ideas have stayed the same, though:

• Not everything we feel is in plain view. Some feelings, memories and wishes sit outside our everyday awareness, but can still affect us.
• Early experiences matter. The way we were cared for, and the relationships we grew up around, can shape what we expect from other people and from ourselves.
• Patterns tend to repeat. We may find ourselves returning to familiar ways of relating, even when they no longer help us.
• Understanding can bring change. Making sense of these patterns can give you more choice about how you respond in future.

Key ideas, explained simply

Psychodynamic therapy has some terms of its own. You do not need to know them to benefit from it, but understanding a few can make the approach feel less mysterious.

The unconscious

This simply means the parts of our mind we are not aware of in the moment. For example, someone might feel a wave of irritation whenever a manager gives feedback, without realising it reminds them of being criticised as a child. The feeling is real, but its roots are hidden.

Defences

Defences are the ways our minds protect us from feelings that seem too painful or overwhelming. Everyone uses them. Examples include keeping very busy so there is no time to feel sad, making a joke when something hurts, or brushing off a difficult event as not a big deal. Defences often helped us cope at some point. Therapy can help you notice them gently, so you can decide whether they are still serving you.

Transference

This is when feelings from past relationships get carried into present ones, including the relationship with your therapist. You might find yourself worrying that your therapist is disappointed in you, or wanting their approval in a way that feels familiar. In psychodynamic therapy, these reactions are not seen as a problem. They are useful information, and talking about them openly can help you understand patterns in your wider life.

What happens in a session

Psychodynamic sessions are usually less structured than some other therapies. There is often no set agenda, worksheet or homework. Instead, you are encouraged to talk about whatever is on your mind, even if it seems small, random or embarrassing. This is sometimes called free association.

Your therapist will listen closely, not just to what you say, but to how you say it, what you return to, and what seems hard to talk about. They might gently point out a link, such as:

You mentioned feeling invisible at that family dinner, and you described something similar at work last week. I wonder if that feeling is a familiar one for you.

The aim is not for the therapist to tell you what your life means. It is for the two of you to explore together, so that insights feel like your own.

Sessions are usually around 50 minutes and often take place at the same time each week. This regular rhythm is seen as part of the work, because it creates a steady, reliable space. Some people attend more than once a week, although weekly is common.

Short-term and longer-term work

Psychodynamic therapy can be offered in different lengths. Some forms are short-term, lasting a set number of sessions and focusing on a particular theme or difficulty. Others are open-ended and may continue for many months or longer, allowing deeper exploration. Your therapist can talk through what they offer and what might suit your situation.

How it differs from other approaches

It can help to compare psychodynamic therapy with approaches you may have heard of. Cognitive behavioural therapy (CBT), for example, tends to focus on present thoughts and behaviours and often uses practical exercises between sessions. Psychodynamic therapy tends to spend more time on why patterns developed, and on feelings and relationships, including the one with your therapist.

Neither is better in general. They are different routes, and people respond to them in different ways. Some people find a structured, skills-based approach helpful. Others feel they need space to explore and understand themselves more deeply. Some therapists also combine elements from several approaches.

Who might find it helpful

Research suggests psychodynamic therapy can help some people with difficulties such as depression, anxiety and ongoing relationship problems. NICE guidance on depression includes short-term psychodynamic psychotherapy among the treatment options that may be offered to some adults. As with any therapy, it does not work for everyone, and results depend a great deal on the person, the problem and the relationship with the therapist.

You might be drawn to psychodynamic therapy if you:

• notice repeating patterns in relationships and want to understand them
• feel low, anxious or stuck without being sure why
• are curious about how your upbringing has shaped you
• have tried more structured approaches and want something more exploratory
• want space to talk freely rather than follow a set plan

It may feel less suited if you want quick, practical tools for a specific problem, or if you would prefer clear goals and exercises. If you are unsure, it is fine to ask a therapist how they work, or to talk things through with your GP.

What it can feel like

Exploring the past can bring up strong emotions. You might feel relief at finally putting something into words, but also sadness, anger or confusion. Sometimes people feel a little worse before they feel better, as long-held feelings come to the surface. This is a normal part of the process, and a good therapist will go at a pace that feels manageable and check in with you about how you are finding things.

It can also take time. Change in psychodynamic therapy often happens gradually, through many small moments of understanding rather than one big breakthrough. You might notice, for example, that you catch an old reaction before it takes over, or that you feel a little freer in a relationship that used to feel tense.

It is always okay to tell your therapist if something does not feel right, including if you feel uncomfortable with them. Talking about this openly is often a useful part of the work.

If revisiting difficult memories leaves you feeling unsafe or in crisis, please remember that therapy sessions are not an emergency service. In the UK you can call 999 in an emergency, call NHS 111, or contact Samaritans free on 116 123 at any time, day or night.

Psychodynamic therapy online

Many psychodynamic therapists now work by video as well as in person. The core of the approach, careful listening, a reliable weekly space and an honest relationship, can carry across well to a screen. Some people find it easier to open up from a familiar, private space at home.

When choosing a therapist, it helps to check they are registered with a recognised professional body and to ask about their training and how they work. If you would like to explore this approach, you can book a registered therapist for a private video session through WebcamTherapy and take things at your own pace.

Understanding how your past shapes your present is not about blaming yourself or others. It is about making sense of your story, so that you can feel more able to choose where it goes next.