How Do You Treat Depression Through Psychodynamic Psychotherapy?

Sorrowing Old Man ("At Eternity's Gate"), Painting by Vincent Van Gogh, 1890

Treating depression with psychodynamic psychotherapy, an approach that explores how past experiences and unconscious emotions influence present behaviours and mental health, has been proven to be very effective. Rooted in Freudian psychoanalysis, this therapy aims to uncover unconscious thoughts, feelings, and repressed memories that may influence current behaviours and mental health. Unlike other therapeutic methods that concentrate on resolving present-day issues, psychodynamic psychotherapy delves into early life experiences and internal conflicts to help clients gain insight into the deeper causes of their depression. By becoming aware of these hidden emotions, clients can work through unresolved issues and improve their current mental state.

One of the key differences between psychodynamic psychotherapy and other forms of psychotherapy, such as cognitive-behavioural therapy (CBT) and interpersonal therapy (IPT), is the focus on past experiences. While CBT targets maladaptive thinking patterns and IPT focuses on improving current relationships, psychodynamic psychotherapy emphasizes understanding how past events and repressed emotions shape present behaviours. Sessions are less structured than those in CBT or IPT, allowing clients to speak freely about their thoughts and feelings. This open-ended approach provides room for exploration and self-discovery, which can be crucial for addressing deeply ingrained emotional issues linked to depression.

In psychodynamic psychotherapy, the therapeutic relationship itself plays an essential role in the treatment process. Unlike in CBT or IPT, where the therapist-client relationship is primarily supportive, psychodynamic psychotherapy sees this relationship as a reflection of the client’s broader interpersonal patterns. The way clients interact with their therapist often mirrors how they engage with others in their life. The therapist observes these interactions to help the client understand how past relationships influence current relational dynamics. This focus on the therapist-client relationship helps the client become more aware of their behaviour and emotional responses, which can then be applied to improve their real-life relationships.

The process of psychodynamic psychotherapy involves weekly, or sometimes more frequent, sessions that can last for several months to even years, depending on the depth of the issues being addressed. During these sessions, clients are encouraged to speak freely without the constraints of a structured treatment plan. This approach allows clients to uncover hidden emotions, memories, and patterns that they may not have been consciously aware of. While the therapist may ask questions or guide the discussion, they generally maintain a neutral stance, allowing the client to lead the conversation and reflect on their inner experiences. This method fosters greater self-awareness and emotional insight, which is believed to be a key factor in reducing depressive symptoms.

The Seine at Saint-Cloud, Painting by Edvard Munch, 1890

One of the primary goals of psychodynamic psychotherapy is to help clients build internal psychological resources to manage their depression independently. This is achieved by helping clients understand how past experiences affect their current behaviours and feelings. By identifying patterns of behaviour, such as withdrawing from others in times of stress, clients can learn to respond to situations in healthier ways. The therapist also works with the client to recognize and address defense mechanisms—behaviours that protect the client from facing painful emotions, such as suppressing memories or avoiding difficult conversations. Over time, clients learn to break these patterns and develop healthier coping strategies.

While research on psychodynamic psychotherapy for depression is not as extensive as for other therapies, such as CBT, studies have shown that it can be just as effective. Additionally, psychodynamic psychotherapy has been shown to provide long-term benefits by helping clients understand and address the root causes of their depression, which may prevent relapse in the future. Moreover, it has been found to be particularly effective in reducing symptoms of anxiety alongside depression.

Psychodynamic psychotherapy offers unique benefits for individuals who struggle with depression, particularly those whose depression is linked to unresolved past experiences or unconscious conflicts. Clients may develop greater self-awareness and insight into their emotional lives, which can lead to lasting changes in how they manage their mental health. For example, clients may begin to recognize how past traumas or difficult relationships influence their present feelings of hopelessness or guilt. This increased understanding can empower clients to make more conscious decisions about how they respond to stress and emotional challenges, thereby improving their overall well-being.

However, psychodynamic psychotherapy may not be suitable for everyone. It requires a willingness to engage in long-term therapy and explore difficult emotional terrain, which can be challenging for some individuals. Those who prefer a more structured, short-term approach that focuses on immediate problem-solving may benefit more from therapies like CBT or IPT. Additionally, individuals who are not ready to delve into their past or who struggle with severe depression may find it difficult to engage in the open-ended nature of psychodynamic psychotherapy. Nonetheless, for those who are willing to invest the time and effort, psychodynamic psychotherapy offers a comprehensive approach to understanding and treating depression by addressing the root causes rather than just the symptoms.