Relational Psychodynamic Therapy: What It Is, How It Works, and Who Benefits Most
The word "psychodynamic" carries a lot of cultural baggage. Say it in conversation and you are likely to conjure — in many people's minds — a bearded man behind a couch, a patient free-associating, a conversation about the mother. Freud. Cigars. Dreams.
The stereotype is understandable. Psychoanalysis is the ancestral tradition from which contemporary psychodynamic and relational therapy descend. But the distance between that founding tradition and what actually happens in a modern relational psychodynamic session is considerable — and worth describing clearly, because the approach is one of the most richly supported and clinically powerful available, and it tends to be underexplored by people who might benefit most from it.
This post is a genuine attempt to describe what relational psychodynamic therapy is, what it looks like in practice, and who it tends to serve best.
Where it comes from: a very short history
Freud's original contribution — contentious, overstated in some respects, profoundly generative in others — was the idea that a significant portion of what drives human behaviour, feeling, and experience operates outside conscious awareness, and that making that unconscious material available to reflection is central to psychological healing.
What happened to that insight over the following century is a story of progressive enrichment and correction. Object relations theorists — Winnicott, Klein, Fairbairn, Bowlby — shifted the fundamental unit of analysis from the individual drive to the relational world: the way the mind is shaped by its early relationships, and the way those early relational templates become internalised patterns that organise how we experience ourselves and others throughout life.
The relational turn in psychoanalysis — particularly prominent from the 1980s onward in the work of figures like Stephen Mitchell, Jessica Benjamin, and Lewis Aron — went further still. It brought into question the classical ideal of the neutral, blank-screen analyst and replaced it with a recognition that therapy is, always and inescapably, a two-person enterprise. The therapist is not a mirror or a technician. They bring their own subjectivity, their own relational patterns, their own history, into the encounter with the client — and acknowledging and working with that mutuality, rather than pretending to its absence, is now understood as central to the work.
Alongside this, attachment theory — Bowlby's original formulation, extended and deepened by decades of infant and adult attachment research — provided an empirical foundation for what clinicians had long observed: that the patterns of relating we develop in our earliest relationships become, in a profound sense, the template for all subsequent connection. Not mechanically, not deterministically — but powerfully, and largely outside conscious awareness.
Contemporary relational psychodynamic therapy holds all of these contributions together. It is not primarily Freudian. It is not focused on recovering repressed memories, or on lengthy five-times-weekly sessions, or on the classical transference interpretation as the primary therapeutic tool.
It is a collaborative, two-person practice in which the therapeutic relationship itself is the medium through which change happens.
What actually happens: the mechanisms
Understanding a few key concepts helps illuminate what is distinctive about this approach.
The unconscious — not as a sealed vault of forbidden drives, but as the vast dimension of human experience that operates beneath reflective awareness. Our automatic emotional responses. The lightning-fast relational assessments we make when we walk into a room. The particular way the quality of a colleague's voice can produce an unaccountable discomfort. The pattern of choosing unavailable partners despite wanting something different. Much of what shapes our experience and behaviour is not available to conscious inspection — and making it so, gradually and collaboratively, is a central aim of the work.
Transference and countertransference — transference refers to the way clients bring their relational history into the therapeutic relationship: the expectations, the patterns, the particular emotional colourings that are activated in relation to the therapist and that often mirror significant earlier relational experiences. Countertransference refers to the therapist's emotional and somatic responses to the client — which, when attended to with care, often carry important information about what is alive in the relational field between them.
In relational psychodynamic practice, both are attended to. The therapist does not pretend to be without responses. They use their own experience — carefully, ethically, in the service of the client — as a source of therapeutic information. This is the core of what makes relational practice relational.
Enactments — moments in the therapy when an old relational pattern plays itself out in the therapeutic relationship itself, often without either party initially recognising it as such. The client who repeatedly arrives slightly late, and the particular texture of the therapist's response. The moment when something shifts in the quality of contact between them. The session that feels inexplicably flat. These moments, when recognised and worked with honestly, are often among the most generative in the entire therapy.
The depth dimension — relational psychodynamic therapy takes time. It does not follow a predetermined protocol or a fixed number of sessions. It goes at the pace of what is actually emerging — which means some sessions are quiet and exploratory, while others arrive suddenly at something much older and deeper. It is not unusual for people to discover, several months into the work, that what they came with was a surface expression of something with much longer roots.
What this looks like in a session
A relational psychodynamic session tends to begin with what is present — what the person has brought with them into the room that day. Something from the week. An image that has stayed. A dream. A conversation that is still sitting heavily.
From there, the work moves. Sometimes it follows the material associatively, allowing what is in the foreground to lead toward what is in the background. Sometimes it attends to what is happening in the room right now — between therapist and client, in the quality of the contact or its disruption. Sometimes it moves toward the past, toward the earlier experiences whose shape can be felt in the present pattern.
The therapist is not primarily a question-asker, though questions arise. They are not primarily a teacher, though psychoeducation has its place. They are, most essentially, a genuinely present, genuinely responsive relational partner — someone who can remain with what is difficult without either collapsing into it or retreating from it, and whose steady presence, over time, provides the relational conditions in which something genuinely new can begin to form.
The evidence base
There is a persistent and inaccurate cultural narrative that psychodynamic approaches are philosophically interesting but empirically unsupported — that the evidence belongs to CBT and its variants.
This is outdated. The research on psychodynamic therapy, including relational psychodynamic approaches, is substantial and growing. Shedler's 2010 meta-analysis in the American Psychologist — now one of the most cited papers in the field — found that the effect size for psychodynamic therapy is equivalent to those reported for other therapies, including CBT. More significantly, it found a "sleeper effect": that the benefits of psychodynamic therapy continue to increase after treatment ends, while the gains of other approaches tend to plateau or decline. This finding makes sense within the model — because the aim of the work is not skill acquisition or thought modification, but a reorganisation of the underlying relational and psychological structures from which experience and behaviour arise.
Additional research supports the particular importance of what are called "common factors" in therapy — factors shared across different modalities, including the therapeutic alliance, the experience of being understood, and the quality of the relationship between therapist and client. These factors, which are intrinsic to relational psychodynamic practice rather than incidental to it, consistently account for more of the variance in therapeutic outcomes than any specific technique.
Who benefits most
Relational psychodynamic therapy tends to be a particularly good fit for people who:
Have longstanding or recurring patterns — in relationships, in emotional life, in self-concept — that they haven't been able to shift through understanding alone, or through shorter-term approaches. The pattern that seems to follow them from one relationship to the next. The depression that lifts and returns. The particular way of being that they can observe in themselves but cannot seem to change.
Feel that their difficulties are relational in origin — that their current struggles have roots in earlier experiences of being in relationship, and that genuinely working with those roots requires a relational context.
Have tried cognitive and behavioural approaches and found them partially effective or insufficient — not because those approaches are without value, but because for some people and some presentations, the level of the work needs to go deeper than thought patterns and behavioural strategies.
Are interested in self-understanding as a value in itself — not merely in resolving a presenting problem, but in developing a richer, more grounded, more authorial relationship with their own inner life.
Are willing to commit to the work over time — relational psychodynamic therapy is not a brief intervention. Meaningful change in deeply established relational patterns tends to take time, and the people who benefit most are those who can make a genuine commitment to the process.
At Turning Ground
Our practitioners bring a depth-oriented, relational sensibility to their psychodynamic work. Sessions attend to what is present, to what is being enacted between therapist and client, and to the longer story from which the current difficulty emerges.
We work with individuals across a wide range of presentations — depression, anxiety, relational difficulties, identity questions, life transitions, grief, and the complex presentations that don't fit neatly into any single category.
Sessions are 50 minutes, available in person in Thornbury and via telehealth. We offer a free Discovery Call for anyone wanting to understand whether relational psychodynamic therapy — and whether a particular practitioner — is a good fit for the work they want to do.
