Psychodynamic and Psychoanalytic Psychotherapy

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Why this is uncommon

Psychoanalytic training takes years, sits outside residency, and pays nothing extra. Very few psychiatrists still do it, and vanishingly few combine it with CBT, DBT skills, EMDR, ERP, and prescribing.

I trained at the Emory University Psychoanalytic Institute and the Columbia University Center for Psychoanalytic Training and Research. Columbia's is among the oldest and most rigorous institutes in the country.

I'm describing this as psychoanalytic psychotherapy training rather than claiming certification as a psychoanalyst — those are different credentials and the distinction matters.

What it's actually for

Most of this site is about conditions with protocols. ADHD has a medication algorithm. OCD has ERP. Panic has interoceptive exposure. Those are the right tools for those problems and I use them.

Psychodynamic work is for a different class of problem:

• The same relationship, repeatedly, with different people. Recognizing the pattern and being unable to stop enacting it.
• Symptoms that resolved and something that didn't. The panic stopped and you're still not living the life you wanted.
• Character-level difficulty. Not an episode with an onset — a way of being that has always been costly.
• Persistent self-states. A conviction of being fraudulent, unlovable, or fundamentally at fault that survives every piece of contrary evidence.
• Difficulty knowing what you feel. Where the presenting problem is not a symptom but an absence.

CBT would address the thought. Psychodynamic work asks where the pattern came from, what it protects against, and what it costs to keep.

The evidence

Worth stating plainly, because psychodynamic therapy is sometimes described as unevidenced. It isn't.

Meta-analytic work — Shedler's 2010 American Psychologist review and Leichsenring's studies among the most cited — supports efficacy for depression, anxiety, and personality pathology at effect sizes comparable to other established treatments.

The more distinctive finding is that gains from psychodynamic therapy tend to increase after treatment ends rather than fade. The interpretation is that what changes is capacity rather than symptom count. That pattern is not consistently found with shorter protocols.

It is not, however, first-line for everything. For OCD it is the wrong treatment. For acute panic disorder, CBT is faster and better supported. For bipolar disorder, medication is foundational. I'll say which I think you need.

What it looks like

Weekly or twice weekly, open-ended. No agenda, no homework, no session count agreed in advance — those are features of CBT and they're deliberately absent here.

The therapeutic relationship is itself material. What happens between us — irritation, idealization, the impulse to withhold something — tends to reproduce what happens elsewhere, and examining it as it occurs is where much of the work happens.

Duration is genuinely open. Some people work for a year, some considerably longer. I'll tell you honestly if I think you've gotten what you came for.

Combined with medication

Split care puts your therapist and your prescriber in separate rooms that rarely communicate — a particular problem in psychodynamic work, where medication changes and therapeutic material are frequently entangled. A dose change that arrives during a difficult period is not a neutral event, and it should be understood by the person making it.

Here it's one clinician. See medication management.

Choosing between approaches

These aren't exclusive. It's common to do focused CBT for an acute problem and open-ended work afterward.

Related

Psychotherapist NYC · CBT · DBT · EMDR · Depression · Medication vs. therapy vs. both

Frequently Asked Questions

What is psychodynamic psychotherapy?

An open-ended therapy addressing recurring patterns in relationships, self-concept, and emotional life, including material outside immediate awareness and what emerges in the therapeutic relationship itself. It targets patterns rather than discrete symptoms.

Is psychodynamic therapy evidence-based?

Yes. Meta-analytic reviews support efficacy for depression, anxiety, and personality pathology at effect sizes comparable to other established therapies, with evidence that gains continue increasing after treatment ends.

How is it different from CBT?

CBT is structured, time-limited, and symptom-focused, with agendas and between-session work. Psychodynamic therapy is open-ended and pattern-focused, without a fixed session count. They suit different problems and are often used sequentially.

How long does psychodynamic therapy take?

Genuinely open-ended — typically weekly or twice weekly, over a year or considerably longer. If you want a defined course with a symptom target, CBT is the better fit and I'll say so.

Is this psychoanalysis?

No. Psychoanalysis proper involves higher frequency, often use of the couch, and treatment by a certified analyst. This is psychoanalytically informed psychotherapy, drawing on the same theory at lower intensity.

Can I do psychodynamic therapy and take medication?

Yes, and they're frequently combined. Having one clinician manage both matters here more than in most modalities, since medication changes and therapeutic material tend to be entangled.