If you’ve been reading about psychodynamic therapy, you might already have a rough sense of what it is. What’s often harder to picture is what actually happens in the room, and, understandably, how long the process is going to take.
Because psychodynamic therapy is less structured than something like CBT, it can be difficult to imagine what a session even looks like when there’s no worksheet or set agenda to anchor it.
These are two of the most common questions I’m asked, so this post is a practical look at both: what happens in psychodynamic therapy session to session, and how long therapy might take.
What Is Psychodynamic Therapy?
In brief, psychodynamic therapy explores how past experiences, relationships and feelings that may sit outside your immediate awareness continue to shape how you think, feel and relate in the present. Rather than concentrating only on symptoms, it’s interested in what your difficulties mean and how they have developed, with the aim of creating more lasting change.
You can read more about the approach on my psychodynamic therapy page.
What Is the Goal of Psychodynamic Therapy?
The goal of psychodynamic therapy is not simply to reduce symptoms or give you strategies for managing them. It’s about developing a deeper understanding of yourself and the patterns that shape your life, so that you have greater freedom in how you respond to them.
You may already understand some of your difficulties intellectually, yet still find yourself caught in the same patterns. Or you may simply know that something isn’t right without being able to understand what it is or why you feel this way. Psychodynamic therapy explores both, helping you make sense of experiences that may be difficult to put into words or understand on your own.
This isn’t just intellectual understanding. Through the experience of therapy itself, you can begin to recognise feelings and patterns in a more immediate and personal way, including things you may not have been consciously aware of. The aim is not to tell you what to do, but to help you find your own way forward with greater freedom and choice.
What Is Psychodynamic Therapy Used to Treat?
Psychodynamic therapy can help with a wide range of concerns. In my practice, that includes:
- Anxiety
- Depression
- Trauma
- Relationship patterns
- Grief and loss
- Stress and burnout
- Sexual Concerns
- Difficulties with self-worth and identity
This approach can be particularly useful when difficulties feel longstanding, repetitive or hard to shift. Some people understand their patterns intellectually but find that understanding hasn’t translated into change. Others have tried different approaches and feel that something important is still missing.
You don’t need a formal diagnosis to benefit from psychodynamic therapy. Many people come simply wanting to understand themselves more fully or to make sense of patterns that they find difficult to change.
What Happens in a Psychodynamic Therapy Session?
Psychodynamic therapy is primarily a conversation, without a set agenda or series of exercises. We start with what’s on your mind and see where the conversation leads.
There’s no fixed agenda, no worksheets and no homework to report back on. You’re generally free to start wherever you like: what’s been on your mind, something that happened during the week, a feeling you can’t quite place, or a pattern you’ve noticed.
Sometimes people arrive knowing exactly what they want to talk about. Sometimes they don’t, and that’s also completely fine.
What emerges when you speak more freely, without having to organise everything into a neat explanation, is often where the useful material begins to appear.
My role isn’t to hand you a set of instructions or tell you what you should do. I work in a non-directive way, which means I’m interested in helping you make sense of your own experience and find your own way forward. I’ll listen closely, ask questions, reflect back what I’m hearing and draw attention to things that may be difficult to notice on your own.
As we talk, we might notice patterns in the way you think, feel and relate to other people, or begin to make connections between what is happening now and your earlier experiences.
Practically, sessions run for 50 minutes, and I recommend beginning with weekly or fortnightly sessions, as this continuity supports the work. The first two to six sessions are an assessment period where we discuss what’s brought you to therapy, I ask questions to get a sense of your history, and we both consider whether the fit between us feels right.
What Techniques Do Psychodynamic Therapists Use?
Psychodynamic therapy doesn’t follow a set sequence of techniques or exercises. Instead, the way I work develops from what you bring to each session and what emerges between us.
Some of the things I may encourage, pay attention to and think about while we work together include:
- Open conversation: Following where your thoughts and feelings take you, rather than working through a predetermined agenda.
- Free association: Allowing yourself to say what comes to mind, including thoughts that might initially seem irrelevant, uncomfortable or difficult to explain.
- Working with the therapeutic relationship: Noticing what happens between us in therapy and considering whether it connects with ways you relate to people elsewhere in your life. This is sometimes referred to as transference.
- Noticing defences: Becoming curious about the ways you protect yourself from difficult feelings and what those ways of coping might be doing for you.
- Exploring what’s beneath the surface: Paying attention to recurring concerns, strong reactions, dreams or other experiences that may have meanings that aren’t immediately obvious.
- Developing insight: Moving beyond simply knowing something intellectually towards a deeper, more personal understanding of how your patterns work and how they affect your life.
How Long Does Psychodynamic Therapy Take?
This is the question I can never answer with a single number, because it genuinely depends on you — what’s brought you to therapy, what you’re hoping to explore, and how things unfold.
Sessions are 50 minutes, usually weekly or fortnightly to begin with. Psychodynamic therapy exists in both shorter-term and longer-term forms, and both have been studied — some people do focused work over a number of months, while others engage in longer-term therapy.
My own approach tends to be medium- to long-term, simply because developing a genuine understanding of longstanding patterns takes time, and lasting change tends to follow that understanding rather than arriving overnight.
What I’d want you to know is that it’s collaborative and reviewed as we go. Some people choose to continue with regular sessions for ongoing self-exploration; others reduce frequency, pause, or finish as their circumstances and goals change.
There’s no expectation that you commit to something open-ended, and pace and duration are always things we discuss together rather than something imposed on you.
Psychodynamic Therapy Is Best Understood Experientially
If you’re reading this because you want to understand what psychodynamic therapy will actually be like, that’s understandable. Starting therapy can involve some uncertainty, and reading about the approach can give you a sense of what to expect. But there’s also a limit to how much psychodynamic therapy can be explained from the outside.
It’s something you really need to experience to understand. Much of the work happens through the conversation itself: what you find yourself talking about, what you notice as you talk, and what develops between us over time.
There isn’t a particular experience you’re supposed to have or a set of exercises to work through. The work is shaped by you, by what you’re bringing to therapy, and by what emerges as we talk.
So while I can explain how I work, the best way to understand what psychodynamic therapy is like is ultimately to try it. You don’t need to have the whole approach figured out before you begin.
Is Psychodynamic Therapy Evidence-Based?
Yes. Psychodynamic therapy has a substantial and growing body of research supporting its use for a range of psychological difficulties.
A widely cited review in American Psychologist found that psychodynamic therapy produced effect sizes comparable to those reported for other therapies actively promoted as “evidence-based”. It also found that the benefits of psychodynamic therapy often continued after therapy had ended, and in some cases increased over time.
A later systematic review in The Lancet Psychiatry concluded that psychodynamic therapy meets the criteria of evidence-based medicine for several common mental health conditions. More recent research has continued to support psychodynamic therapy as an evidence-based treatment, including for depression, anxiety, personality and somatic symptom disorders.
CBT has a particularly large research literature, reflecting its prominence in contemporary psychological research and practice. Psychodynamic therapy has a smaller research literature, but there is a substantial body of evidence supporting its effectiveness in its own right.
Getting Started with Alicia
I’m a registered psychologist offering psychodynamic therapy to adults across Australia via telehealth, with sessions held over Zoom on weekday mornings (Australian Eastern Standard Time, or AEDT during Victorian daylight saving). Because of those times, this tends to suit people in Victoria, New South Wales, Queensland, South Australia, the ACT and the Northern Territory.
I offer a free 15-minute phone call to talk through what’s bringing you to therapy and whether my way of working feels like a good fit. There’s no obligation, and if a different kind of support would suit you better, I’ll say so and can help point you in the right direction.
Frequently Asked Questions
How Often Will I Have Sessions?
I recommend weekly or fortnightly sessions where possible, as regular attendance supports continuity and depth. As therapy progresses, frequency can be adjusted depending on your circumstances and needs.
Is Psychodynamic Therapy Better Than CBT?
It depends on what you’re looking for from therapy. CBT is more structured and focuses on changing thoughts and behaviours, while psychodynamic therapy focuses on understanding the deeper patterns, feelings and relationships underlying your difficulties. If you want to understand why difficulties persist rather than primarily learning strategies to manage them, psychodynamic therapy may be a better fit.
You can read more in my guide to psychodynamic therapy vs CBT.
What’s The Difference Between Psychodynamic Therapy And Psychoanalysis?
Psychodynamic therapy developed from the psychoanalytic tradition and shares its interest in unconscious processes, relationships and the ways earlier experiences can shape the present. There is considerable overlap between the two, although psychoanalysis generally involves a more intensive and sustained exploration of these processes. The terms are also used somewhat differently by different practitioners, so there isn’t always a clear dividing line between them.
Do I Have To Talk About My Childhood?
Yes, childhood and earlier experiences are part of the assessment process in psychodynamic therapy. I will ask about your history so that I can understand the context in which your current difficulties have developed. As therapy progresses, we may return to experiences from childhood or earlier relationships when they seem relevant to what you’re experiencing now. This doesn’t mean that every detail of your childhood needs to be explored, but understanding your earlier experiences can be an important part of understanding patterns in the present.
What If I Don’t Know What To Say?
That’s completely normal, and it isn’t a problem. You don’t need to arrive with an agenda or know exactly what you want to talk about. We can start with whatever is on your mind, even if you’re not sure why you’ve brought it up. In psychodynamic therapy, what happens when you don’t know what to say can sometimes be meaningful in itself. Rather than needing to fill every silence or produce something useful to talk about, we can become curious about what you’re experiencing in the moment.
If you’re curious whether this way of working might suit you, the best next step is simply to talk it through. I offer a free 15-minute phone call — no pressure, and no obligation to book.
