What is Psychoanalytic Psychotherapy?

Psychoanalysis is widely regarded as the foundation of much of Western psychotherapy, originating in Sigmund Freud’s work in the late 19th century, where he defined a method for treating psychological distress by bringing unconscious thoughts, conflicts, and motivations into conscious awareness. Over time, Freud’s original model evolved, giving rise to what is now more broadly referred to as psychodynamic psychotherapy—a term that encompasses classical psychoanalysis while also integrating later theoretical developments and clinical refinements.

Psychodynamic psychotherapy includes a range of post-Freudian approaches that expanded and revised Freud’s original ideas. These include the Object Relations movement, which conceptualises psychological functioning in terms of internalised relationships (or “objects”) that shape adult emotional and relational patterns, as well as attachment-based theories, which emphasise the impact of early caregiver relationships on emotional regulation, identity, and interpersonal functioning. While many of these perspectives have since developed into distinct therapeutic modalities, their core assumptions remain embedded within contemporary psychodynamic practice.

At the heart of psychodynamic therapy is the principle that adult emotional difficulties and maladaptive behaviours are largely driven by unconscious processes, often rooted in early developmental experiences. The conscious mind, or ego, continually negotiates between instinctual drives, internalised relational patterns, and external reality, giving rise to defence mechanisms that protect the individual from psychological distress. Through careful, attuned exploration of life history, relational patterns, and emotional experience—both past and present—psychodynamic therapy aims to increase insight into these unconscious dynamics. This growing awareness allows individuals to loosen rigid patterns, integrate disowned aspects of self, and develop greater psychological freedom and emotional depth.

History of Psychoanalytic Psychotherapy

Psychoanalysis was formally introduced by Sigmund Freud in the mid-1890s, with the term itself first appearing in 1896. Freud developed psychoanalysis through his work with patients suffering from what were then termed “neuroses,” employing techniques such as free association, dream analysis, and close attention to slips of speech and symbolic expression. Through this work, Freud became convinced that psychological distress was rooted in unconscious conflicts, particularly those originating in early childhood experience.

Central to Freud’s early theory was the belief that human behaviour is driven by instinctual forces, especially sexual and aggressive impulses, which must be repressed in order for the child to adapt to social life. Freud proposed that unresolved childhood conflicts—most famously articulated through the Oedipus complex, involving unconscious desire toward the opposite-sex parent and rivalry with the same-sex parent—were foundational in shaping adult personality and neurosis. While aspects of this theory have since been revised or challenged, it established the enduring psychoanalytic principle that unconscious developmental conflicts exert a powerful influence on adult emotional life.

Freud later elaborated his structural model of the psyche, introducing the concepts of the id, ego, and superego. In this model, the ego functions as a mediating agency, negotiating between instinctual drives (id), internalised moral and social demands (superego), and external reality. Psychological distress was understood as arising when this balancing function became overwhelmed, leading to the development of defence mechanisms that shape personality and behaviour.

Although Freud’s ideas initially faced strong resistance within both medicine and wider society, they exerted enormous cultural influence. One notable contributor to the dissemination of psychoanalytic ideas beyond clinical settings was Edward Bernays, Freud’s nephew, who applied psychoanalytic principles to mass communication and persuasion following his work in World War I propaganda. Bernays’ application of unconscious motivation to advertising and public relations helped embed psychoanalytic concepts into modern culture, further solidifying their influence.

By the mid-20th century, Freud’s emphasis on instinctual drives—particularly sexuality—came under increasing critique. Theorists such as Melanie Klein expanded psychoanalysis by focusing on early infancy and the internal world of the child. Klein introduced key concepts such as splitting, projective identification, and internal objects, proposing that psychological life is structured around internalised relational experiences rather than solely instinctual conflict.

Building on and diverging from both Freud and Klein, W. R. D. Fairbairn proposed that the primary motivational force in human development is not pleasure but the need for relationship. His work laid the foundation for Object Relations theory, reframing psychopathology as arising from disturbed early relationships rather than repressed instinctual drives. These ideas profoundly reshaped psychoanalytic thinking and marked a transition toward what became known as psychodynamic psychotherapy.

Psychodynamic approaches retain Freud’s central insight—that unconscious processes and early experience shape adult functioning—while integrating relational, developmental, and attachment-based perspectives. In doing so, they broaden psychoanalysis into a more flexible and clinically accessible framework, capable of addressing a wider range of psychological presentations while remaining rooted in depth, meaning, and relational understanding.

Key Terms in Psychoanalytic Psychotherapy

The Ego, Id and Superego

In Freud’s structural model of the psyche, the id represents instinctual drives and unconscious impulses, operating according to the pleasure principle and seeking immediate gratification. The superego develops through internalisation of parental and societal rules, functioning as a moral authority that judges and restricts behaviour through ideals and prohibitions. The ego mediates between these two forces and external reality, employing defence mechanisms to manage conflict. Psychological distress is understood to arise when the ego is overwhelmed in its balancing role, resulting in maladaptive defences or symptoms.

The Oedipus Complex

The Oedipus complex refers to a developmental stage in early childhood in which the child experiences unconscious sexual desire toward the parent of the opposite sex and rivalry toward the parent of the same sex. Freud proposed that successful resolution of this conflict leads to identification with the same-sex parent and the formation of the superego. While later psychodynamic theories have revised its emphasis on sexuality, the concept remains influential in highlighting how early relational dynamics and unconscious conflict shape adult identity, attachment, and authority relationships.

Splitting

Splitting is a primitive defence mechanism in which experiences of self or others are divided into all-good or all-bad categories in order to manage anxiety and emotional complexity. Commonly observed in early infancy and certain psychological presentations, splitting prevents the integration of contradictory feelings such as love and hate toward the same object. While developmentally normal at early stages, persistent reliance on splitting in adulthood can result in unstable relationships, rapid shifts in perception, and difficulties tolerating ambivalence.

Projection

Projection is a defence mechanism whereby unwanted thoughts, feelings, or impulses are disowned and attributed to another person. By locating distressing internal experiences externally, the individual reduces anxiety and preserves a coherent sense of self. Projection plays a central role in interpersonal conflict and can significantly shape relational dynamics, particularly when individuals perceive others as embodying traits they cannot tolerate within themselves.

Transference

Transference refers to the unconscious redirection of feelings, expectations, and relational patterns from significant figures in early life onto the therapist. These responses are not based on the therapist’s actual behaviour but on internalised relational templates formed through past experiences. In psychodynamic therapy, transference is viewed as a vital tool, offering live insight into the client’s unconscious relational world and enabling exploration of long-standing patterns as they emerge in the therapeutic relationship.

Countertransference

Countertransference describes the therapist’s emotional responses to the client, which may be shaped by the therapist’s own unconscious processes as well as the client’s projections. Once considered an obstacle, countertransference is now understood as a valuable source of information about the client’s internal world, provided it is recognised and reflected upon. Effective use of countertransference requires ongoing self-awareness, supervision, and ethical boundaries.

The Paranoid-Schizoid Position

The paranoid-schizoid position, conceptualised by Melanie Klein, describes an early developmental state in which the infant experiences the world through splitting and projection. Objects are perceived as either wholly good or wholly bad, and anxiety is dominated by fears of persecution and annihilation. While this position is developmentally normal in infancy, regression to paranoid-schizoid functioning in adulthood may occur under stress, leading to heightened suspicion, rigidity, and emotional fragmentation.

The Depressive Position

The depressive position represents a more mature developmental state in which the individual begins to integrate good and bad aspects of self and others into a whole. This integration gives rise to feelings of guilt, concern, and a desire for repair, as the individual recognises that the loved and hated object are one and the same. Movement into the depressive position enables empathy, emotional depth, and stable relationships, though it also introduces the capacity for loss and mourning.

Good Object / Bad Object

In Object Relations theory, good objects and bad objects refer to internalised representations of others based on early relational experiences. A good object is associated with safety, care, and satisfaction, while a bad object is linked to frustration, fear, or absence. Psychological health depends on the capacity to integrate these representations, whereas dominance of bad objects may contribute to anxiety, distrust, and relational instability.

Cathexis

Cathexis refers to the investment of psychic energy in an object, idea, or person. Freud used the term to describe how emotional significance is attached to internal or external objects, shaping desire, attachment, and motivation. When cathexis becomes fixed or excessive—particularly around early objects—it may contribute to repetition of maladaptive relational patterns and difficulty disengaging from past emotional investments.

The Death Instinct

The death instinct, or Thanatos, was proposed by Freud to describe an unconscious drive toward destruction, repetition, and a return to an inanimate state. Often contrasted with the life instinct (Eros), which promotes survival and creativity, the death instinct is thought to manifest in self-destructive behaviours, aggression, and compulsive repetition of trauma. While controversial, the concept remains influential in understanding unconscious tendencies toward harm and psychological stagnation.

Repetition Compulsion

Repetition compulsion refers to the unconscious tendency to repeat past relational or traumatic experiences, even when they are painful or harmful. Freud observed that individuals often recreate familiar dynamics in an attempt to gain mastery over unresolved conflicts. In psychodynamic therapy, recognising and working through repetition compulsion allows unconscious patterns to become conscious, enabling choice, change, and psychological integration.

Applications of Psychoanalytic Psychotherapy

While the terminology and concepts of classical psychoanalysis can sometimes feel unfamiliar or intimidating to clients, Psychodynamic Psychotherapy offers profound benefits through the in-depth exploration of familial relationships, internalised object relationships, and unconscious relational patterns. By uncovering the ways early experiences and internalised dynamics shape adult behaviour and emotional responses, clients gain greater self-understanding, perspective, and insight into how and why they relate to others as they do. This understanding creates a foundation for adaptive change, enabling the development of new ways of thinking, feeling, and interacting. Because family systems and early relational experiences are highly individual and complex, psychodynamic work allows clients to see patterns they may have previously been unable to perceive, recognise areas where developmental needs were unmet, and integrate these insights into healthier relational and emotional functioning.

Presentations and issues where Psychoanalytic Therapy is particularly useful:

  • Difficulty understanding recurring relational patterns or conflicts

  • Chronic interpersonal problems in family, work, or romantic relationships

  • Unexplained emotional distress linked to early life experiences

  • Persistent anxiety, depression, or low self-esteem with relational roots

  • Attachment difficulties or insecure relational styles

  • Personality structure challenges (e.g., borderline or narcissistic traits)

  • Repetition of maladaptive behaviours or destructive relational dynamics

  • Grief, loss, or unresolved developmental trauma

  • Challenges with self-identity, self-concept, or individuation

Limitations ofPsychoanalytic Psychotherapy

A common limitation of Psychodynamic / Psychoanalytic Psychotherapy is the tendency to focus primarily on the influence of early development, familial relationships, and unconscious dynamics, sometimes at the expense of addressing current life pressures, practical challenges, or future-oriented goals. Therapy can become heavily oriented toward exploring the past, which may leave clients feeling stuck in repetitive analysis without experiencing tangible behavioural or emotional change in the present. While gaining insight into childhood influences is valuable, interpretation alone may not be sufficient to release blocked emotions, resolve trauma, or develop adaptive coping strategies. Furthermore, delving into familial patterns and early relational wounds requires careful handling; if mismanaged, it can provoke feelings of guilt, shame, or blame, potentially increasing distress rather than alleviating it.

Psychodynamic approaches can also demand a high level of capacity for reflection, emotional tolerance, and sustained engagement, which may not be feasible for all clients, particularly those experiencing acute distress or limited psychological resources. The non-directive, exploratory nature of this therapy may be insufficient when immediate symptom management, structured coping strategies, or behavioural interventions are required.

Presentations and scenarios where Psychodynamic Psychotherapy may be less appropriate:

  • Acute or severe mental health crises (e.g., severe depression, psychosis, or suicidal ideation requiring immediate intervention)

  • Individuals requiring short-term symptom relief or rapid behavioural change

  • Clients with limited capacity for reflection or insight due to developmental stage, cognitive constraints, or acute distress

  • Presentations that require structured skills-based intervention (e.g., cognitive-behavioural techniques for phobias, anxiety, or OCD)

  • Situations demanding immediate problem-solving or practical guidance in day-to-day life

  • Clients seeking brief, goal-directed therapy for work, social, or academic pressures

  • Individuals with low tolerance for extended emotional exploration or discussion of early relational trauma

  • Those who may become overwhelmed by intense focus on familial or parental dynamics without concurrent support or containment

Further resources

Professional Organisations & Associations

  • International Psychoanalytical Association (IPA) – Global association supporting psychoanalytic training, research, and practice: https://www.ipa.world/ (ipa.world)

  • British Psychoanalytic Council (BPC) – UK-based professional body providing accreditation and directories of psychodynamic and psychoanalytic therapists: https://www.bpc.org.uk/ (bpc.org.uk)

  • American Psychoanalytic Association (APsaA) – Promotes psychoanalysis in clinical, research, and educational contexts: https://apsa.org/ (apsa.org)

  • International Association for Relational Psychoanalysis and Psychotherapy (IARPP) – Focused on relational approaches within psychodynamic therapy: https://iarpp.net/ (iarpp.net)

Books & Reading Lists

  • “The Ego and the Id” – Sigmund Freud – Core text on Freud’s structural model of the psyche

  • “Object Relations in Psychoanalytic Theory” – Melanie Klein, W.R.D. Fairbairn, Donald Winnicott – Key readings on relational and developmental contributions

  • “Psychodynamic Psychotherapy: A Clinical Manual” – Deborah L. Cabaniss et al. – Modern guide to psychodynamic techniques and theory

  • Open Library: Psychoanalysis and Psychodynamic Therapy – Searchable collection of relevant texts: https://openlibrary.org/subjects/psychoanalysis (openlibrary.org)

Journals & Scholarly Resources

Other Useful Resources