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Understanding the Approach

What is psychodynamic therapy?

A form of depth therapy that goes beyond symptoms to understand why you're stuck

The short answer

Psychodynamic therapy is a form of depth therapy that explores how unconscious patterns from your past may shape your present relationships, emotions, and behaviour.

In brief

  • Psychodynamic therapy looks at why patterns keep repeating, not just how to manage symptoms.
  • Luke Row is a BACP registered psychodynamic therapist (#197852) in Croydon, South London.
  • Sessions are weekly and ongoing; individual therapy is £70 and couples therapy is £100.

Rather than teaching coping strategies or challenging negative thoughts, it seeks to understand why you're stuck. It examines the childhood experiences, family dynamics, and defensive strategies that may continue to influence your life without your awareness.

The premise is simple: most of what drives your behaviour happens outside conscious awareness. The patterns that keep you stuck aren't thinking errors to be corrected - they're survival strategies that made sense once but may not serve you now.

Understanding where they came from can be one way of getting more choice about whether to keep running them.

What it's not

It's not lying on a couch talking about your mother while someone silently takes notes. That's the cartoon version.

It's not blaming your parents for everything. Understanding where patterns came from isn't about finding someone to hold responsible - it's about making sense of how you became who you are.

It's not endlessly circling the past without change. The past matters because it's still operating in the present. We go there to understand what's happening now, not to wallow.

It's not vague, unstructured chat. There's rigour here - we're tracking patterns, noticing defences, paying attention to what's happening between us. The apparent freedom of the space is carefully held.

And it's not just for people with serious problems. Some of the most valuable work happens with people who function perfectly well but sense something's missing - who succeed at everything except feeling satisfied.

How it actually works

You talk. I listen - properly, not the polite nodding kind. I'll notice patterns in what you're saying, ask questions that might make you uncomfortable, point out what you seem to be avoiding.

We pay attention to what happens between us. If you find yourself always apologising to me, we might wonder where else that happens. If disagreement with me feels impossible, we can look at what disagreement has come to mean. The relationship becomes a laboratory for understanding how you relate.

Over time, connections can emerge. The anxiety that seems random may start to make sense when you understand what you learned about being seen. A pattern of choosing unavailable people may connect to how love was offered in your family. Compulsive achieving may link to what you had to do to feel acceptable.

Everything makes sense in context. Once you understand the context, you can choose differently.

This isn't insight for its own sake. Understanding can change things. Not immediately, not dramatically - but gradually, patterns may lose some of their grip. You may start catching yourself mid-reaction. Old triggers may feel less charged. You may respond more to what's actually happening instead of what happened twenty years ago.

Who it may suit

People who are tired of managing symptoms without understanding causes.

People who've tried other approaches - CBT, coaching, self-help - and found they helped for a while but the same patterns keep recurring.

People dealing with depression that hasn't lifted, anxiety that hasn't settled, relationships that keep going wrong in familiar ways.

People who function well on the outside but feel hollow, disconnected, or stuck. Who've achieved things but can't enjoy them. Who help everyone except themselves.

People who want to understand themselves, not just cope better.

It's not for everyone. If you want quick fixes or someone to tell you what to do, this isn't it. If you need practical strategies for a specific crisis, CBT or coaching might serve you better.

But if you're ready to look honestly at yourself - at the parts you've been avoiding, the patterns you can't seem to break, the questions you've been scared to ask - this may be the kind of work that gets closer to the root.

Why the relationship matters

Psychodynamic therapy isn't just talking about relationships - it uses the therapeutic relationship itself.

How you relate to your therapist reveals how you relate to everyone. The defences you use, the roles you fall into, the expectations you bring - they all show up in the room. And here, unlike in your other relationships, they can be examined.

If you're always trying to please me, we can explore that. If you hold back important things, we can understand why. If you expect criticism or rejection, we can look at where that expectation comes from and whether it matches reality.

This is where the real work happens. Not in talking about your patterns but in experiencing them, in real time, with someone who can help you see what you're doing.

It requires a therapist you can trust - not because they're perfect, but because they won't flinch when you bring the difficult stuff. Someone who can tolerate your anger, your despair, your need, without needing to fix it immediately or make you feel better.

Common questions

How psychodynamic therapy compares to other approaches, and what to expect.

More questions

How is psychodynamic therapy different from CBT?

CBT focuses on changing current thought patterns and behaviours through structured techniques and homework. Psychodynamic therapy goes deeper - it's interested in why those patterns exist in the first place. CBT treats your mind like software that needs debugging. Identify the faulty code, replace it with better code, problem solved. Psychodynamic therapy treats it like a history that needs understanding. Not simply what's wrong with your thinking, but what may have happened to make you think this way. CBT asks "how can you think differently about this?" Psychodynamic therapy asks "why do you think this way at all?" Both approaches have value. CBT can be useful for specific problems with clear triggers - a phobia, panic attacks, certain forms of OCD. But if you've done CBT and the same patterns keep recurring, if you understand your cognitive distortions perfectly and they still run your life, you might want work that goes deeper.

How is psychodynamic therapy different from counselling?

Counselling typically focuses on specific current problems and offers support through difficult periods. It's often shorter-term and solution-focused. A good counsellor creates a safe space to process what's happening and may help you find practical ways forward. Psychodynamic therapy goes further. It examines the underlying patterns that create recurring problems, the unconscious dynamics that shape your choices, the historical roots of your current difficulties. A counsellor might help you through a difficult breakup. A psychodynamic therapist might explore why you keep choosing partners who can't meet your needs, what you're unconsciously seeking, what familiar dynamics you're recreating. Both are valid approaches. They serve different purposes. If you're dealing with a specific crisis and need support, counselling may be a good fit. If you're tired of the same patterns recurring regardless of circumstances, psychodynamic work may be worth considering.

How is psychodynamic therapy different from psychiatry?

Psychiatrists are medical doctors who specialise in mental health. They can prescribe medication and often focus on diagnosis and pharmaceutical treatment. Some psychiatrists also offer talking therapy, but many primarily work with medication. Psychodynamic therapy is a form of talking therapy. No medication, no diagnosis required. The focus isn't on categorising what's wrong with you but on understanding the specific patterns and history that brought you here. Sometimes people need both. Medication can create enough stability to do the deeper work. A psychiatrist might help stabilise severe depression while psychodynamic therapy explores what may sit underneath it. They're not competing approaches - they address different aspects of human suffering.

How long does psychodynamic therapy take?

Longer than you want, shorter than you've been struggling. Most people work for months to years, not weeks. This isn't inefficiency - it's recognition that patterns laid down over decades don't shift in six sessions. You can't rush the nervous system. You can't shortcut genuine understanding. The goal isn't simply to get you functional as quickly as possible. It's to help you understand yourself well enough that the same problems may have less need to recur. That takes time. Real time, not managed expectations. You may notice it working when you start catching yourself mid-pattern. When old triggers feel less charged. When relationships begin to go differently without you having to force it. It's gradual - more like ice melting than glass breaking.

Is psychodynamic therapy evidence-based?

There is a research base for psychodynamic therapy, including studies involving depression, anxiety, personality difficulties, and relationship problems.

Some studies suggest gains can be maintained, and in some cases continue, after therapy ends. A 2010 meta-analysis by Jonathan Shedler summarised evidence that patients in psychodynamic therapy maintained gains and continued improving after treatment concluded.

The Tavistock Adult Depression Study reported better two-year follow-up outcomes for long-term psychoanalytic psychotherapy than for CBT in a treatment-resistant depression group. Other studies suggest psychodynamic work may be relevant for complex, recurring problems rather than only single-episode difficulties.

The evidence is there, but it should not be turned into a promise. What's harder to measure is exactly what this work does, because understanding yourself can't be captured only in questionnaire scores.

Working with me

I'm a psychodynamic therapist practising in Croydon, South London. I work with individuals and couples in person.

If you're curious whether this approach might help, you can read more about how I work with individuals or who I am. The FAQ covers practical questions about sessions, fees, and what to expect.

Or you can just get in touch.

Get in touch