Psychoanalytic and insight-oriented psychotherapy

Domain I · Psychodynamic & depth psychology

What it is

A talking treatment in which therapist and patient attend to whatever comes to mind: feelings, wishes, fears, fantasies, dreams, and reactions to the therapist. The aim is to find the unconscious conflicts, defences and relationship templates that produce symptoms and repeated life problems.

Format

• Psychodynamic therapy is not manualised into fixed stages. The phases below follow Gabbard's chapter sequence (assessment → getting started → middle work with resistance, transference and dreams → termination), with McWilliams on preparing the client. The session counts are typical ranges, not…
• Format. 45–50-minute sessions at a fixed time, 1–2×/week (more frequent sessions deepen the transference and the expressive work). Sitting face to face. Duration open-ended, usually 1 year to several years; Gabbard's working definition of "long-term" is longer than 24 sessions or 6 months.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• lecturing as a defence against affect, yours or the patient's.
• hearing it as criticism. Working = curiosity ("Huh, I hadn't noticed").
• over-questioning that becomes an interview. Working = richer detail and affect.
• you imposing your own frame. Working = the patient corrects or refines it, adding precision.
• shame (normalise it) and acting on fantasies. Working = the patient can own wishes they had disavowed.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.