Psychodynamic therapy · An educational guide
A guide to understanding ourselves and our relationships
You may understand what you want to do, yet return to the same response: staying silent when you want to speak, agreeing while feeling resentful, or seeking closeness and then fearing it. This guide begins with the gap between what we know about ourselves and what we actually experience.
An introduction to feelings, defences, relationships, the therapeutic process and the research evidence.
By Dr. Ali Al Farhan ↗ · Consultant Psychologist and Psychotherapist - Associate Professor of Psychology · Last updated: 24 September 2026
Psychodynamic psychotherapy is a family of approaches rooted in psychoanalysis. It explores how feelings, wishes, fears and relational experiences, including influences we do not clearly recognise, interact in present life. This work takes place through conversation and the relationship with the therapist. [9] ↗
You may know that declining a small request need not end a relationship, yet still say "yes" and feel angry afterwards. What does saying no mean to you? What do you expect will happen if you express your own wish?
We may want closeness while fearing dependence, or feel angry with someone we love and then feel guilty. Defences are ways, often outside awareness, of easing feelings that are difficult to bear. Their purpose, cost and flexibility deserve respectful attention. [2] ↗
In object relations theory, we carry emotionally charged images of ourselves and others: I may experience myself as a burden and expect criticism. These images colour experience; they are neither literal records of the past nor proof of another person's intentions. [5] ↗
Mentalizing means reflecting on our feelings and intentions and trying to understand another person's experience while remaining open to being mistaken. Feeling rejected does not establish that the other person is rejecting us. [7] ↗
This is a fictional illustration, not a case from clinical practice.
Your partner asks to change your weekend plans. You say, "Whatever you want," although you have looked forward to those plans for days. You grow quiet that evening. Asked what is wrong, you reply, "You should know without me telling you."
Perhaps objecting feels selfish, or you expect your wishes to be ignored. Agreeing protects the relationship in the moment, but resentment accumulates and distance becomes an indirect expression of hurt.
This is a hypothesis to examine. Your partner may actually disregard your requests, or that day may have been exceptional. We consider what happened, what it meant to you and how you responded, without turning every disagreement into a childhood story.
A request → agreement with resentment → silence → misunderstanding → greater distance.
One possible aim is to notice your objection earlier, understand the fear accompanying it, express your wish and assess the response. This is a possible treatment aim, not a guaranteed outcome.
You might begin with a troubling event, a feeling that is hard to name or an all-too-familiar pattern. The therapist helps explore emotions, what happens as you approach them, expectations within relationships, and connections between earlier experience and present difficulties. Symptom relief and everyday functioning remain part of the work. [1] ↗
You do not need a perfectly organised life story. A recent example can be useful: what happened, what did you feel and how did you respond? Assessment considers the history of the difficulty, current circumstances, previous treatments and hoped-for changes, followed by discussion of goals, the plan, confidentiality and its limits. [8] ↗
You may worry that the therapist is bored, or expect criticism if you disagree. Some expectations carried into other relationships can also emerge in therapy; this is one aspect of transference. Exploring them carefully offers a direct opportunity to understand them. [1] ↗
Your reaction may also relate to something the therapist actually did. Feeling misunderstood deserves attention. Transference should never be used to dismiss a concern or remove the therapist's responsibility.
You might explain why you withdraw and still withdraw at the next disagreement. The work involves noticing the pattern as it happens, tolerating the feelings involved, trying a wider range of responses and revisiting them over time.
In the example above, progress might include saying, "I was looking forward to this plan, and I want us to agree before changing it," then tolerating a different view without erasing your own wish or deciding the relationship is over.
Progress can be reviewed through symptoms, work, sleep, relationships, decision-making and agreed goals. If improvement stalls, the plan and possible need for another intervention should be reconsidered. [8] ↗
Psychoanalysis and psychodynamic psychotherapy share theoretical and historical roots but do not always describe the same treatment arrangement. Frequency, duration and scope vary with the model and individual needs. Psychodynamic therapy does not necessarily require a couch or discussion of dreams. [2] ↗
Brief approaches usually work within a defined focus and set of goals. Longer work may address broader difficulties or established patterns. The balance of support, exploration and interpretation depends on the person's needs and capacities; intensive work should not mean pushing beyond what they can tolerate. [4] ↗
A 2023 umbrella review in World Psychiatry reported empirical support for psychodynamic therapy in adult depressive, anxiety, personality and somatic symptom disorders. Evidence quality varied by condition and comparison, with limitations including risk of bias and imprecision. [4] ↗
This does not establish superiority for everyone, equivalence across every psychodynamic model, or proof of every psychoanalytic explanation. Evidence that a treatment helps, a theory of how it may work and an individual clinical formulation are different kinds of claims.
One person finds it hard to feel angry with someone they love. Another struggles to trust that a relationship can survive disagreement. A third is unsure what they want apart from other people's expectations. The approaches below offer different questions about these experiences, with differing accounts of development and therapeutic work.
We begin with conflict, defences and object relations, then explore attachment, Winnicott's contributions and mentalizing. These are selected perspectives, not an exhaustive account of psychodynamic schools.
All examples in this section are fictional illustrations, not patient accounts or diagnoses. The therapeutic implications are possible formulations to explore with the individual.
In the tradition originating with Sigmund Freud, a wish may conflict with a fear or an internal prohibition without the conflict being fully conscious. Anna Freud systematised defensive processes in The Ego and the Mechanisms of Defence (1936): ways of easing difficult feelings that may operate outside awareness. Anna Freud's contribution to defence theory ↗; McWilliams on psychoanalytic work ↗.
Someone may want to object while fearing that disagreement makes them cruel or unlovable. This invites questions about the wish, the fear and the response that reduces tension, including what that response protects and what it costs this particular person.
Nasser agrees to his brother’s requests despite exhaustion, then delays completing them and becomes angry with himself. He may need a boundary while fearing that setting one would be selfish. Keeping anger out of awareness might temporarily preserve his experience of the relationship while making direct expression harder.
Work could explore what Nasser expects would happen if he said "no", helping him notice, understand and express his anger appropriately. This is one possible reading: his brother may exert real pressure, or other reasons may explain his agreement and delay. The scene alone does not establish a particular defence.
Here, an "object" means another person towards whom feelings are directed, and their representation in the internal world. Klein explored internal relationships shaped by love, fear and anger. These are not literal copies of people: actual experiences, feelings and imagination interact. Melanie Klein Trust: internal objects ↗.
Kernberg and colleagues developed an account of representations of self and other linked by affect, including difficulties integrating valued and disappointing aspects. Transference-Focused Psychotherapy (TFP) is one application, exploring these experiences as they also emerge with the therapist. Kernberg and colleagues: the TFP model ↗.
Mazen feels completely understood by his friend. When the friend cannot help on one occasion, Mazen says, "He has never cared about me." We might ask whether disappointment makes earlier caring experiences difficult to hold in mind, and how Mazen’s sense of himself and his friend shifts with that pain.
Work might help make affection and disappointment thinkable together, exploring shifts between closeness and rejection. The friend’s actual behaviour still needs consideration. Changing feelings or an ordinary disagreement does not establish "splitting" or a personality disorder. Integration does not mean accepting harm.
Bowlby emphasised proximity and safety in relationships with caregivers. His "internal working models" describe expectations about another person's availability and the self in a relationship, shaped through repeated experiences and used to understand situations. The Open University's account of Bowlby and internal working models ↗.
During a difficult week, Reem rejects her friend’s offer of help before discussing it: "I’ll manage alone." She might expect that needing support makes her a burden or exposes her to a familiar disappointment. Her refusal could also concern this particular friend or reflect a legitimate preference for privacy.
Work could explore what Reem expects from asking for help and what she observes in current relationships, making room for a small request she chooses herself. Attachment language can help explore relational expectations; one incident cannot establish a fixed "attachment style" or diagnose a disorder.
Winnicott linked the developing sense of self to a caregiving environment that supports and responds to the infant. The idea of a holding environment draws attention to continuity and safety in development. British Psychoanalytical Society: Winnicott's contributions ↗.
His account of true and false self explores spontaneity, a sense of personal aliveness, and adaptations that offer protection from environmental demands. Social adaptation can be flexible and helpful; difficulty arises when compliance overwhelms personal experience and desire. Winnicott: true and false self ↗; Winnicott: the concept of the false self ↗.
Hind readily agrees with other people’s suggestions. Asked what she would prefer, she pauses: "I don’t know." We might wonder whether attending to everyone else’s wishes leaves little space to discover her own, while considering her circumstances, habits and what agreement means to her.
A reliable therapeutic setting may give Hind room to hesitate, disagree and discover preferences without being rushed. "False self" is a theoretical term, not an accusation of dishonesty or a stand-alone diagnosis. Difficulty expressing an opinion does not establish what happened in early caregiving.
Mentalizing means trying to understand our own and other people's actions in terms of feelings, wishes, beliefs and intentions. It involves curiosity and accepting that our understanding of another mind is limited and revisable. Fonagy, Bateman and colleagues developed Mentalization-Based Treatment (MBT) as a structured therapeutic application. Anna Freud: mentalizing and MBT ↗; The not-knowing stance ↗.
When her husband seems distracted as she speaks, Layla concludes, "He doesn’t respect me." One possible reading is that hurt has become certainty about his intention. Useful questions might include: "What did I notice? What did I feel? Which explanations need checking?"
Work might distinguish events, feelings and inferences, opening a conversation that can test understanding. Considering alternative explanations does not negate actual disregard. Mentalizing is a concept; MBT is a treatment model. Talking about feelings alone does not constitute delivery of that model.
Nancy McWilliams's work helps connect concepts with personality and the individual's meanings of symptoms and defences, informing a response to their needs. These approaches differ in explanation and method. They are attributed to their contributors here rather than presented as a single interchangeable theory. [3] ↗
See the research review of psychodynamic treatment outcomes ↗ for evidence of effectiveness, and the sources within each section for its theoretical foundations.
Assessment, the nature of the difficulty, your goals and preferences, and relevant evidence guide that decision. Recognising yourself in an example is not sufficient to select a treatment.
To explore what assessment involves, read psychodynamic diagnosis: assessment steps and examples ↗.
We start with present experience and explore the past when it helps understanding, while taking current circumstances, health and actual relationships seriously. There is no need to assume forgotten memories.
Duration and frequency are discussed after assessment and reviewed as work progresses. Psychotherapy and medication can be combined when appropriate, in coordination with the prescribing clinician. [8] ↗
Choice depends on the problem, evidence, preferences and therapist expertise. Depth and attention to emotion are not exclusive to one school, and no single approach suits everyone.
Consultant Psychologist and Psychotherapist and Associate Professor of Psychology. His interests bring together clinical practice, teaching and research, with a focus on short-term psychodynamic psychotherapy, relationships and personality disorders.
His published research includes:
The research link provides its scope, sample and findings; it does not guarantee any individual's treatment outcome.
These sources include theoretical and clinical texts, a research review of treatment efficacy, and patient information. They serve different purposes in this guide.
An assessment session can help clarify your concerns and whether this approach fits your needs. This educational guide does not replace an individual assessment.