Psychodynamic therapy

Figures checked September 2026

Psychodynamic therapy is the oldest of the talking therapies, and the one most people picture when they picture therapy. It looks at the parts of your life you can’t quite see from the inside. Why the same argument keeps happening. Why you pick the people you pick. Why something that should be fine isn’t.

The Approach (modality) The kind of therapy someone uses, such as CBT or psychodynamic therapy. You'll also see it called a modality. More in the jargon decoder grew out of psychoanalysis, and it has changed a great deal since. Modern psychodynamic therapy is usually face to face, once a week, and your therapist talks. The couch, the five days a week and the long silences belong to psychoanalysis, which still exists and is a much bigger commitment.

The core idea is that a lot of what shapes how you feel and act sits outside your awareness, and was laid down early. That’s why thinking hard about it tends not to shift it: the patterns were built to keep certain things out of view.

How it works

Your therapist will be paying attention to three things in particular.

Patterns rather than episodes. Not just this week’s argument, but the shape it keeps taking, and where you first learnt it.
What you do to avoid pain. Changing the subject, joking, getting analytical, going flat, getting angry first. Every one of them solved something once. They get in the way now, but they started out as a way of coping.
What happens between you and the therapist. This is the part that does the most work. Say you go quiet when they get something wrong, or notice yourself wanting their approval. The pattern is now happening in the room, where the two of you can look at it together.

The aim is to understand how you came to be like this, and to have more say in what you do next. Getting rid of a symptom isn’t the main target. Symptoms usually ease along the way, and that easing is what the research measures.

Psychodynamic therapy comes in two lengths, and it’s a fair question to ask which one you’re being offered. Open-ended therapy runs weekly with no end date set at the start, often for a year or more. Short-term psychodynamic therapy runs about sixteen to thirty sessions and works on one agreed theme.

What a session is like

Sessions are about 50 minutes, usually weekly. You start with whatever’s there, and nobody hands you an agenda at the door.

Your therapist speaks sparingly. What they do say is more likely to be something they’ve noticed than something for you to do. That you skipped past a name. That this sounds like the thing with your brother. That you looked away just then. Nothing gets set for you to work on between sessions.

Silence gets used deliberately, and most people find it uncomfortable at first. If it stays uncomfortable, say so — that conversation is part of the therapy rather than a complaint about it.

The pace is slower than in a structured therapy. Progress usually shows up outside the sessions before it shows up in them, in how an argument goes, or what you decide to do about something.

Who it tends to suit

This suits you if what you’re dealing with runs through a lot of your life rather than sitting in one place. The same relationship ending the same way. A sense of being a fraud that never quite lifts. A low mood with no obvious cause that’s been there for years.

It’s also for you if you want to understand why. If keeping a problem under control without knowing where it came from feels like managing it rather than being done with it, that’s the instinct this therapy is built on.

Plenty of people arrive after structured therapy that helped without going deep. The skills worked while they were using them, and nothing underneath moved. Cognitive behavioural therapy (CBT) and psychodynamic therapy get set against each other a fair bit. In practice, doing one and then the other is common, and it often works.

This therapy may suit you less if you want relief from something specific and soon. Or if sessions without structure make you anxious enough that little gets done. Or if the cost of open-ended weekly therapy isn’t realistic. That last one is the most common reason people rule it out, and it’s a fair one.

What the evidence says

For the shorter version, the evidence is solid. One review pulled together 54 studies, including 33 randomised trials and close to 4,000 people. It found short-term psychodynamic therapy clearly better than no treatment for depression. Against the other established therapies it was compared with, Cognitive behavioural therapy (CBT) A structured, practical form of talking therapy. It's built on a simple idea: what you think affects how you feel, and both affect what you do. More in the jargon decoder among them, it came out about the same (Driessen and colleagues, 2015). At follow-up it did a little better than those therapies on anxiety symptoms.

There’s a catch, and it applies to most of what you’d actually be offered here. Those trials test the short-term version: a set focus, a set number of sessions, run to a manual. Most psychodynamic therapy in Australia is the open-ended kind, which is much harder to study, and the evidence for it is thinner. That isn’t a finding that the longer version fails people. It means the confident numbers describe something narrower than what’s likely to be in front of you.

For post-traumatic stress disorder, Australia’s national guidelines put trauma-focused approaches ahead of it. For depression and long-standing relationship patterns, it stands up well against the alternatives.

Getting it in Australia

Who provides it. Psychologist Someone trained to assess mental health problems and treat them with therapy. It takes at least six years of study and supervised practice, and they're registered with Ahpra, the national regulator. Psychologists can't prescribe medication. More in the jargon decoder , Psychiatrist A medical doctor who has specialised in mental health. Psychiatrists can diagnose, prescribe and do therapy, though many spend most of their time on medication and diagnosis rather than weekly sessions. More in the jargon decoder , Psychotherapist Someone trained in therapy, often for longer-standing patterns. Like counsellor, the title isn't protected in Australia, and Medicare doesn't give a rebate for psychotherapists. More in the jargon decoder , Counsellor Someone trained to help people talk through and work on difficulties. The title isn't protected in Australia, so it's worth checking a counsellor's training and registration. Medicare doesn't give a rebate for counsellors. More in the jargon decoder and psychoanalysts. Training in this area often runs for years on top of the main qualification, through institutes rather than universities. Asking a therapist what they trained in is a normal question in this field.

What Medicare Australia's public health insurance scheme. For mental health, it gives rebates on sessions with psychologists and some other professionals, usually through a Mental Health Treatment Plan. More in the jargon decoder Rebate The amount Medicare pays back towards a session. It comes back to you after you've paid, so what you pay yourself is the fee minus the rebate. More in the jargon decoder . A Mental Health Treatment Plan gives you a Medicare rebate on up to ten sessions a calendar year with a psychologist, Mental health social worker A social worker with an extra mental health accreditation. They're trained in therapy, and in the practical things around it, such as housing, money, family services and the systems people get stuck in. More in the jargon decoder or mental health occupational therapist. Psychodynamic therapy isn’t named on Medicare’s list of approaches for Registered For psychologists, psychiatrists and occupational therapists, registration with Ahpra is required, and using the title without it is an offence. Counsellors and psychotherapists can register with their national associations, which is voluntary. More in the jargon decoder psychologists, though interpersonal therapy, which has roots in the same tradition, is. A psychologist using it will usually be working under a broader heading. Ask the practice whether the rebate applies. Ten sessions doesn’t go far in an open-ended therapy either, so ask early what happens afterwards.

Seeing a psychiatrist works differently. Psychiatrists are doctors, and their Medicare rebates don’t come from the plan or stop after ten sessions. A longer appointment in a psychiatrist’s rooms comes with a rebate of $189.70, and the yearly limits run to dozens of sessions. The catch is what you pay on top. Gaps are usually large, few psychiatrists offer weekly therapy, and the wait for a first appointment is long. Where it does fit, it’s the one route to rebated long-term therapy in this country, and it’s worth asking your GP (general practitioner) For most people, where getting help starts. A GP can write a Mental Health Treatment Plan, prescribe medication and refer you on, and some are trained to deliver a small number of structured therapy sessions themselves. More in the jargon decoder about.

Lower-fee options. Psychotherapy training institutes and some university clinics run low-fee services. You see a trainee, often weekly, and often for as long as you need. The therapist is less experienced and much more closely supervised, and the fee can be a fraction of the usual one. What therapy costs covers this and the other ways people manage the expense.

Schema therapy works on the same long-standing patterns with much more structure, and with a named model of what those patterns are. For some of them it also has better evidence. It’s often the better first suggestion if you want to work at that level without committing to open-ended therapy.

Internal family systems shares the interest in what sits outside your awareness, and gives it a more concrete shape: parts of you that you can name and talk to.

Because so much of this therapy runs through the relationship itself, fit matters here more than almost anywhere. Why who you see matters more than what they do explains why, and it’s worth reading before you commit to long-term work with anyone. If you’re still working out whether you want therapy at all, what therapy actually is covers the basics, and would I benefit from therapy? helps you work out whether it’s worth a try.