Psychodynamic Psychotherapy

Psychodynamic therapy has its roots in Sigmund Freud's psychoanalysis in the early twentieth century, but it has changed greatly since. Today it usually happens face to face or by video, not on a couch, and the therapist is more active and conversational than the old stereotype.

Its core assumption is that some of our feelings, wishes and fears operate outside everyday awareness. They often formed in early experiences and relationships with caregivers, and show up today as repeating patterns: choosing partners who hurt us, anxiety we cannot explain, or anger we cannot express.

"Psychodynamic" is an umbrella for several related approaches with shared roots but different methods.

Classic psychodynamic therapy: open conversation about feelings, memories, dreams and the therapy relationship, aiming at deeper self-understanding. Contemporary psychoanalysis: today's psychoanalysis, emphasising relationship and the two-way experience of therapist and client, usually long-term. ISTDP (Intensive Short-Term Dynamic Psychotherapy): developed by Davanloo in Canada, actively working on avoided feelings, anxiety and defences as they arise in session. MBT (Mentalization-Based Treatment): developed by Bateman and Fonagy for borderline personality disorder, strengthening the ability to understand one's own and others' mental states. TFP (Transference-Focused Psychotherapy): a structured approach by Kernberg and colleagues for personality disorders, examining relational patterns as they appear with the therapist.

In most psychodynamic forms you speak freely about what is on your mind, while the therapist notices patterns, contradictions and feelings you may not see yourself. The relationship with the therapist is part of the work: if you feel judged in session, that feeling can open a window onto your relationships outside.

Imagine Ali, living in Canada for years, who grows cold in relationships without knowing why and then regrets it. Gradually it may become clear that closeness activates an old fear of rejection rooted in childhood. In ISTDP the therapist is more active, asking for example: "As you talk about your father right now, what do you feel in your body?"

Contrary to a common belief, psychodynamic therapy is research-supported. Short-term forms can help with depression, some anxiety disorders and medically unexplained physical symptoms, with results in some comparisons close to CBT, and some studies suggest gains may continue after therapy ends.

MBT and TFP have good evidence for borderline personality disorder. Research volume differs across forms, though, and for specific problems such as OCD or simple phobias, behavioural approaches are usually the first choice.

Duration varies widely. Short-term psychodynamic therapy and ISTDP may take 12 to 30 sessions. MBT and TFP usually last about a year or more, and contemporary psychoanalysis can continue for several years. Discuss goals and timeframe in the first session.

Language matters especially here. Childhood memories, parents' words and old feelings are often stored in the mother tongue and come alive more fully in Farsi. A therapist familiar with Iranian culture understands concepts like "aberu" (honour), "taarof" or the role of extended family without long explanations.

For migrants, separation from home can reactivate old wounds of separation and attachment. Online sessions keep therapy continuous even when you move country. Practical tip: keep a fixed time and a private space.

If you want quick, specific tools for a narrow problem, or are in acute crisis, a psychodynamic approach may not be the first choice. Some forms such as ISTDP are emotionally intense and not right for everyone at every time. Understanding roots does not always change behaviour on its own.

If you want both childhood roots and structure, Schema Therapy, which blends psychodynamic and cognitive elements, is a close option.