Psychodynamic therapy: what is it and how does it work?

Sigmund Freud, whose theories laid the groundwork for modern psychotherapy, described psychological health in terms of the capacity to love, to create and to work.

Yet there are times when difficulties in life can affect one's ability to find satisfaction in the things that once felt meaningful. An individual may no longer be able to engage with relationships, work, or life itself with the same sense of interest and vitality.

What one is struggling with can be related to external circumstances: a demanding job, a difficult relationship, a loss, a major change, or circumstances that simply feel too heavy to carry. External reality always matters, but so does the way it intersects with an individual's internal reality.

How does internal reality shape one's experience?

Psychoanalytic theory suggests that each person develops a unique inner world through the interaction of past experiences, temperament, relationships, and unconscious processes. This means that people do not experience external reality in a completely neutral way. What happens in the outside world is perceived through the lens of a person's own inner world.

A specific problem in life may be difficult but tolerable for one person, while for another it may feel unbearable and draining. The difference does not necessarily lie in the event itself. Sometimes the intensity of an individual's response suggests that the situation carries a particular personal meaning.

A difficulty that emerges at a certain point in life may therefore reveal something important about the person experiencing it: a need that has been overlooked, a feeling that has been difficult to realise, an old conflict, or something that has not yet been put into words. Becoming aware of these meanings on one's own is not always easy, particularly when everyday life already feels heavy.

How can psychodynamic therapy help?

When external reality, or the way it's experienced, feels overwhelming, a person may feel restricted and find it difficult to make room for their own feelings and needs. Making this room can begin with looking at one's own story. From childhood onwards, people have always needed stories and fairy tales to understand and think about their experiences. In much the same way, each person has a story of their own, one that begins at birth, or perhaps even before.

The past can sometimes shape the present. Yet the past is not limited to what can be consciously remembered. Feelings, needs, desires, and memories may remain outside conscious awareness while continuing to influence present experience. During therapy, dreams and daydreams can offer different ways of expressing what lies outside conscious awareness, and ways of understanding how the past continues to affect the present.

Taking the time to look at these experiences with a therapist can facilitate a deeper understanding of oneself, one's experiences, and one's needs.

Why does understanding matter in therapy?

Adulthood does not necessarily mean leaving one's childhood self entirely behind. During difficult periods, more childlike sides of a person may come to the surface. Just as a child may throw a toy when a feeling becomes too much to contain, adults can also find themselves wanting to get rid of emotions that feel unbearable. One may withdraw, become angry, or repeat familiar patterns even though they no longer help.

Children need stories and play to make sense of experiences they cannot yet explain. Adults, too, sometimes need to return to their own stories, not to remain in the past, but to understand more clearly what they are experiencing in the present. Throughout therapy, understanding and being understood can enrich the way a person sees themselves. This can help them make more room for themselves in their own life, with greater awareness of their emotional world and their needs.

The supportive, empathic and creative nature of the therapeutic relationship can help a person feel more connected to life, more alive, and more able to carry on with an underlying sense of security.

When the ground feels more solid, it becomes easier to settle into life or move forward.

Written by Ezgi Firat Buyukbas, Psychologist and Psychotherapist at IASO Wellbeing Centre.