What Actually Happens in Psychodynamic Therapy?
If you have never been to therapy before, it can be surprisingly difficult to find out what actually happens once you are in the room. You can read about different approaches, qualifications and theories, but that does not necessarily tell you what it will feel like to sit opposite a therapist and talk to them for fifty minutes.
Psychodynamic therapy is sometimes described in ways that make it sound rather mysterious. There is talk of the unconscious, childhood experiences and patterns in relationships, all of which are important, but they do not tell you very much about what a Tuesday afternoon session might actually be like.
In many ways, it begins quite simply. You come in and we talk. There is no worksheet waiting for you and usually no set subject that you are expected to discuss. You might arrive knowing exactly what you want to talk about, or you might sit down and realise that you have no idea where to begin. Both are completely normal.
Some weeks you might talk about something significant that has happened. Other weeks it could be an argument with your partner, something somebody said at work, a dream you had, a family conversation, or a feeling that has been following you around without an obvious explanation. Occasionally you might spend ten minutes talking about something that initially seems completely unimportant and discover that it has taken you somewhere you were not expecting.
My role is not simply to sit quietly while you talk. I am listening to what you are telling me, but I am also thinking about the connections between things. I might notice that a feeling appearing in one part of your life seems familiar from somewhere else, or that you repeatedly find yourself in a particular position with other people. I may ask a question, offer an observation, remember something you told me several weeks ago, or wonder with you about why something has affected you quite as strongly as it has.
This does not mean that everything is traced back to childhood. Your past matters because it is where you first learnt about relationships, safety, closeness, anger, disappointment, love and what was expected of you. Those early experiences can influence how you understand yourself and other people now, often without you consciously thinking about them. Therapy gives us somewhere to become curious about those connections rather than assuming that the way things feel today exists in isolation.
The relationship with the therapist is part of this too. After a while, you may notice that some of the feelings and expectations you experience elsewhere begin to appear in therapy. You might worry that I am disappointed in you, find yourself wanting my approval, feel irritated with me, struggle to disagree with something I have said, or wonder what I think of you. These moments are not a sign that therapy has gone wrong. They can give us a very immediate way of understanding how relationships feel for you and what you have come to expect from them.
There are also silences. They are rarely as alarming in reality as people imagine beforehand. Sometimes you need a moment to think. Sometimes neither of us knows immediately where something is going. I am not sitting there waiting for you to produce something profound. A pause can simply be a pause, although occasionally what happens in that space becomes interesting too.
Psychodynamic therapy can feel relieving, particularly when you begin saying things that you have carried privately for a long time. It can also feel uncomfortable at times. You may leave a session thoughtful, irritated, sad, lighter, confused or with a connection suddenly making sense. There are sessions that feel important while they are happening and others that seem quite ordinary. The work tends to develop through all of them rather than through a series of dramatic breakthroughs.
One of the things people sometimes expect from therapy is advice. There may be occasions when we think together about practical choices, but psychodynamic therapy is not generally about me telling you what you should do. If I make the decisions for you, we lose the opportunity to understand why the decision is difficult in the first place. The aim is for you to know yourself well enough that your choices increasingly feel like your own.
This is also why the work can take time. We are not only trying to make an uncomfortable feeling disappear. We are interested in why it is there, what seems to bring it about, what you do when it appears and whether it connects with something that has happened before. As those things become more familiar, there is often more room to respond differently rather than finding yourself pulled automatically into the same reaction or situation.
Over time, people often begin to notice themselves differently outside the therapy room. You might recognise that you are about to agree to something you do not want to do. You may notice the familiar feeling that appears when somebody becomes distant, or realise that criticism has sent you into a much older sense of not being good enough. The difference is that there can gradually be a little more space between the feeling and what you do next.
That, for me, is an important part of how psychodynamic therapy works. It is not about becoming endlessly analytical or finding a hidden explanation for everything you do. It is about becoming more familiar with your own emotional world, including the parts that have previously been difficult to understand.
If you are thinking about starting therapy, you do not need to arrive knowing what the problem is, how to explain your history or what you want to talk about first. That is part of what the sessions are for. We begin with whatever you bring, and we work from there.
Hannah Downing
Psychodynamic Psychotherapist
