How Psychodynamic Therapy Is Used to Treat Depression

Psychodynamic therapy for depression refers to a type of therapy that involves examining a person's past in order to fix their present situation. This type of therapy has its origin in Freudian psychoanalysis.

During psychodynamic therapy, the client will become aware of emotions and feelings that may have been repressed. In addition, the client will make these subconscious elements part of their present awareness so that unresolved problems and feelings can be dealt with.

Psychodynamic Therapy vs. Other Therapies for Depression

Psychodynamic therapy for depression is one of a handful of other talk therapies used for depression. How does it differ from these other types of therapy?

Whereas psychodynamic therapy focuses on unearthing the past to change the present, other therapies tend to focus more on the present without consideration for the past.

For example, cognitive-behavioral therapy (CBT) for depression involves changing thinking patterns or behaviors in order to alleviate depression. In this way, these therapies are based on the idea that faulty thinking patterns underly depression or maintain depression.

As another example, interpersonal therapy (IPT) for depression involves focusing on current issues and problems in relationships in order to improve functioning.

These types of therapies are usually time-limited (e.g., four months long), followed a structured format, and don't involve digging into your past. On the other hand, psychodynamic therapy for depression may take place over a much longer time frame (e.g., up to a year), sessions tend to be more open-ended with room for exploration, and the past is heavily emphasized in terms of how it affects your current functioning.

As one final difference, psychodynamic therapy considers the relationship between the therapist and client to be one piece of the puzzle when dealing with patterns of thoughts and behaviors. This is unlike other therapies such as CBT and IPT, in which the relationship with the therapist is considered important (e.g., in terms of rapport), but is not part of the therapy process itself.

Process of Psychodynamic Therapy for Depression

What is the process of psychodynamic therapy for depression? Below is what you can expect if you will be meeting with a psychodynamic therapist for your depression.

Discussion

You will engage in open-ended discussion with your therapist rather than following a structured plan each week. This means you'll be able to talk freely about whatever is on your mind, with your therapist guiding you through this process.

Unlike with classical psychoanalysis, you likely won't be lying on a couch with your therapist behind you. Rather you'll sit seated in a chair as you would with other therapies.

Once Per Week

You'll meet at least once a week but possibly more often. Your appointments will likely last up to an hour long. You will stay in therapy for at least several months, but depending on your therapist and the issues you are facing, your therapy could last years.

Your therapist will help you to focus on patterns in your life and how your past experiences and subconscious mind affect your behavior in the present.

Speak Freely

However, while your therapist may interrupt you to ask questions or redirect the discussion, it is not their place to give opinions on what you say. Instead, the therapist remains a neutral sounding board, which helps to strengthen your relationship and encourage you to speak more freely.

Discover Feelings

You may discover feelings and emotions that you were unaware of before entering psychodynamic therapy. While this process tends to be less intense than during psychoanalysis, it will help you to identify patterns of feelings and behaviors and how your past affects your present.

Research on Psychodynamic Therapy for Depression

Psychodynamic therapy for depression has received less research attention than other types of therapy. However, in the past few decades, more studies have been completed. Despite some problems in measurement, it has been shown that psychodynamic therapy for depression is at least as effective as other evidence-based therapies. 

In a review of 54 studies with 3946 subjects examining the use of short-term psychodynamic therapy for depression, it was found that short-term psychodynamic therapy was more effective than a control condition, and no different from other forms of therapy.

In addition, it was shown that short-term psychodynamic therapy for depression showed better results in terms of the relief of symptoms of anxiety.

Main Features of Psychodynamic Therapy for Depression

Psychodynamic therapy for depression has features that make it unique. Below are the main features of this type of therapy.

Explore Range of Emotions

Psychodynamic therapy for depression investigates a range of emotions including sadness, anger, distress, loss of desire, etc.

During therapy, clients explore a range of feelings including those that they may not have been aware of in the past (e.g., feelings of being let down, feeling unsafe).

Build Your Resources

Psychodynamic therapy focuses on building the client's internal resources to be able to deal with problems going forward without the aid of the therapist. For example, a client with depression may learn how to explore how reactions to present-day circumstances may be influenced by past events.

One such example might be reacting to a stressful day by withdrawing from friends and family. The client, armed with an understanding of this reaction based on their unique history, would be in a better place to make use of tools to pull themselves out of this phase of withdrawal.

Identify Defense Mechanisms

During psychodynamic therapy, the therapist may work to identify defense mechanisms used by the client. These are behaviors and reactions observed in the client that serve to avoid dealing with difficult topics.

For example, a client may actively try to suppress bad memories, may change the topic when uncomfortable situations are discussed or may show up late for therapy sessions or miss them altogether to try to halt or stall progress.

A client may also try to point the blame on external circumstances rather than taking responsibility for their own role in a situation. In the case of depression, a client may try to avoid talking about distressing events from their past or may cancel appointments to avoid having to face their problems.

Finding Patterns

During psychodynamic therapy, the therapist works with the client to identify patterns that may be below the level of awareness of the client. These patterns can only be perceived with the help of the therapist.

The therapist then works to explain to the client why these patterns are important to their current functioning, and how they affect their behaviors and feelings in the present.

Talking about these patterns allows the client to examine their past and see how those experiences have shaped who they are in the present moment.

Examining Relationships

Psychodynamic therapy also focuses on the relationship between the therapist and the client. For example, the therapist views how the client reacts in therapy as a signal of the types of reactions that the client has to other people outside of therapy. In this way, the relationship with the therapist serves as a springboard to work on problems relating to others that interfere with the client getting their needs met.

In the case of a depressed client, this might mean identifying how lack of interest, low mood, and other depressive symptoms could be affecting relationships with other people. In addition, the therapist will look for signs of transference.

Transference happens when a client makes assumptions about what the therapist is thinking, based on their own past relationships. The therapist watches for instances of transference and then points them out to the client. The hope is that the client then gains insight to be aware of this behavior and avoid it in the future.

Fantasy Life

Psychodynamic therapy may explore aspects of the client's imaginary or fantasy life, including imagery or dreams. Since the client is allowed to speak freely during therapy, there is an opportunity to explore all of this fantasy content and the meaning behind it in terms of the present-day struggles. For example, in the case of depression, a client might talk about dreams or fantasies related to feeling a loss of interest in their life.

Benefits of Psychodynamic Therapy for Depression

What are the benefits of psychodynamic therapy for depression? Below are some of the benefits you might be able to expect from this type of therapy.

Clients may attain greater insight and self-awareness about their feelings and behaviors as well as the subconscious conflicts that may help to explain them. This insight may help to relieve you of the symptoms of depression that you are experiencing.

Psychodynamic therapy may also help you to develop internal psychological resources to manage depressive symptoms on your own. This can include recognizing patterns in your feelings and behaviors, identifying past experiences and subconscious factors that may influence your present behavior, and working to use tools from therapy in your life going forward.

In this way, psychodynamic therapy for depression may help you to develop a stronger capacity to manage the issues in your life that cause you to suffer. Through psychodynamic therapy for depression, you may learn healthier ways to cope with issues in your life that bring up repressed and subconscious emotions. This may lead to you being able to live a more fulfilling life.

Psychodynamic therapy for depression helps to promote self-examination and self-reflection. It will allow you to develop coping strategies to deal with new problems based on awareness and intentional action, rather than reactive feelings and behaviors.

Who Is Best Suited to Psychodynamic Therapy for Depression?

Psychodynamic therapy for depression might be suitable for you if you struggle to make sense of your depression and need help to dig into your feelings and discover underlying issues that may be influencing your thoughts and behaviors.

Treatment-Resistant Depression

This type of therapy may be helpful for you if your depression has been resistant to other forms of treatment, or if you have relapsed after a period of improvement. This is because psychodynamic therapy for depression is aimed at uncovering the root problem of your psychological issues, which many other therapies for depression fail to address.

Problematic Childhood

If you had a problematic childhood or upbringing, have experienced negative events in your life, or feel as though being able to express yourself in therapy or talk in an open-ended way might be more helpful than following a manualized treatment program, then psychodynamic therapy might work for you.

This type of therapy might also be suited to you if you are interested in understanding the meaning underlying your depressive symptoms, and how your past life events are impacting your current feelings, emotions, and behaviors.

Negative Core Beliefs

Psychodynamic therapy for depression may also be helpful for you if you have core beliefs that are negatively impacting your mood and behavior. Examples of these beliefs in depression might include the feeling that everything is hopeless, feelings of guilt or shame, or feeling as though life has no meaning.

Psychodynamic therapy may also be helpful for you if you have a history of problematic relationships with other people in your life that are contributing to your depression. The reason for this is that your therapist will be watching how you interact with them.

For example, if you avoid talking about difficult issues with your therapist, then they may point out that you might also avoid talking about hard topics with people in your personal life.

Making these types of connections in other types of therapy may be harder since the therapist isn't using the relationship inside therapy to inform what you do outside therapy. This type of therapy will also give you the chance to try out new ways of relating to people that might help to alleviate your depression.

Longer-Term Therapy

Psychodynamic therapy may also be more cost-effective for you in the long-term, particularly if you are paying out of pocket for therapy. While it might be tempting to go with a shorter-term therapy, there is evidence that psychodynamic therapy for depression helps to prevent relapse.

This means that you may end up feeling better for a longer period of time, making it less likely that you will need to go back to your therapist, or a different therapist, for additional treatment.

This type of therapy may also be ideal for you if you are less interested in a "quick fix" and prefer to spend more time getting to the root of your problem. While it may take longer for you to see results, and it may feel as though you are moving too slowly, putting the work into examining your past and how it influences you today will ensure that you are addressing also potential obstacles to feeling better.

Comorbid Personality Disorder

Psychodynamic therapy for depression may also be a good option for you if you are also diagnosed with a comorbid personality disorder. Research has shown that this type of therapy may show better outcomes for depression than other types of therapy, for those with a diagnosed personality disorder.

This makes sense if you consider the fact that personality disorders may become part and parcel of depression, and many manualized treatment modalities may fail to consider the impact that personality has on depression.

In contrast, psychodynamic therapy would take into account all of the factors that have lead you to where you are today, including any personality disorders or personality conflicts. This may be especially true if you have been diagnosed with borderline personality disorder.

Medication

Finally, this type of therapy may be good for you if you are looking for an add-on therapy in addition to medication. Research has shown that psychodynamic therapy is more effective than medication alone, so it's reasonable to assume that combining this type of therapy with medication will have positive outcomes.

Who Might Not Be Suited to Psychodynamic Therapy for Depression?

How do you know if this type of therapy might be wrong for you? Below are some cases in which psychodynamic therapy may not be the best fit for you. Read through the list and see if any seem to describe your situation.

  • You prefer to work through problems with a focus on present-day issues rather than delving into your past experiences or subconscious conflicts.
  • You aren't interested in attending therapy over the long term or for more than one session per week.
  • You don't like the idea of your therapist examining the relationship you have with them in therapy and applying it to your real life.
  • You don't have good insight into your feelings or emotions or have trouble expressing them verbally. Or you don't enjoy speaking freely without specific guidance on what to say.
  • You want to examine your past and how it influences you today, but you don't feel ready for that type of emotional examination right now. At this time, you want a strictly present-focused approach that will help you get back on your feet and taking action in your life.
  • You are opposed to the idea that your past influences your present experience, or feel strongly that the psychodynamic tradition or form of therapy is flawed. This might be the case if you have poor perceptions of this type of therapy based on stories you have heard or your perception of psychoanalysis. While this could change over time, you might be better off starting with a more time-limited therapy that is focused on the present day.
  • Your depression is severe to the point that attending therapy would feel impossible. In this case, you may be struggling with a biological cause that could be better addressed with medication to get your depressive symptoms under control.

Short-Term Psychodynamic Therapy for Depression

Are you interested in psychodynamic therapy but concerned about the time commitment or the cost? If so, you might prefer short-term psychodynamic therapy.

While traditional psychodynamic therapy tends to be longer lasting over months or years, with clients sometimes meeting their therapist multiple times per week, short-term psychodynamic therapy takes place over a much shorter time frame. This type of psychodynamic therapy is actually becoming much more common for managing specific emotional problems and can take place over as little as a 12 to 20 week period.

A Word From Verywell

Are you wondering about psychodynamic therapy for depression? While in the past, evidence for the use of this type of therapy for depression was scarce, increasingly it is being recognized as a valuable contribution in the field of therapy. This type of therapy may promote long-term reversal of symptoms and is a viable alternative to other approaches such as cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT).

This type of therapy is ideal for the client with depression who wants to explore their past, make connections to their feelings and behaviors in the present, and improve their own coping skills going forward. It's also best for those who prefer to speak freely during therapy compared to those who like to follow a manualized treatment program.

Finally, psychodynamic therapy for depression may be combined with other treatment options such as medication or other forms of therapy. In this way, it may augment the gains that you attain during therapy, and make it easier for you to deal with upsetting emotions that arise during therapy. If you feel as though going to therapy is too large of a step for you right now, starting out with medication until you are feeling better, and then moving on to see a psychodynamic therapist may be key.

Above all else, remember that any type of therapy will involve facing difficult emotions and exploring better ways to cope. While it might feel difficult at the time, you will be creating a better foundation for your future. Be sure to attend all therapy sessions and put in your best efforts. In the end, nobody can force you to do the work. However, you will make more progress in therapy if you can make it a priority in your life. While depression might make this feel impossible, try doing the bare minimum that your therapist asks of you and being consistent with it.

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