Most therapists today are exposed to more than one way of thinking about patients. CBT, DBT, EMDR, trauma-focused therapies, family systems approaches, mindfulness-based treatments, and psychoanalytic therapies all offer useful ways of understanding psychological distress and facilitating change. Many clinicians integrate ideas and techniques from several traditions. This raises an important question for clinicians: What might psychoanalytic training offer a therapist who is already well trained and experienced in another modality?

The answer is not that psychoanalytic therapists listen more carefully, or work at greater depth. Good therapists from many traditions do these things. The differences have more to do with what clinicians are trained to notice, the questions they learn to ask, and how they understand what happens between therapist and patient. Research examining psychotherapy process has identified characteristics of psychodynamic treatment that include attention to affect, avoidance, recurring patterns, developmental experience, interpersonal relationships, the therapeutic relationship, and fantasy life (Blagys & Hilsenroth, 2000; Shedler, 2010). More recent research has strengthened the empirical support for psychodynamic therapies, including systematic reviews and meta-analyses demonstrating efficacy for depression and other clinical conditions and, in some studies, outcomes comparable to other established treatments (Wienicke et al., 2023; Smith & Hewitt, 2024; Trotta et al., 2024; Lilliengren et al., 2025). Against that background, five aspects of psychoanalytic thinking may be particularly useful to clinicians considering additional training.

1. Psychoanalytic Training Promotes Curiosity About What Is Outside of Awareness

Patients generally come to us with some understanding of what troubles them. They may recognize that they are anxious, perfectionistic, drawn to unhealthy relationships, or repeatedly unable to make changes they genuinely want to make. But knowing that a pattern exists does not necessarily tell us why it persists.

Psychoanalytic thinking encourages curiosity about motivations and conflicts that may not be immediately available to conscious awareness. Someone may long for intimacy yet repeatedly choose unavailable partners. Another patient may understand exactly what would improve their life and nevertheless find themselves unable to take the necessary steps. The idea that important mental processes occur outside awareness is not unique to psychoanalysis. Cognitive therapies address automatic thoughts and schemas, trauma therapies attend to implicit processes, and attachment theory describes internalized expectations about relationships. Psychoanalysis, however, makes sustained exploration of unconscious meaning a central feature of clinical work. This perspective can be especially useful when therapist and patient find themselves asking: “We understand the problem. Why does it keep happening?”

2. Paying Attention to What Happens Between Us

The importance of the therapeutic relationship is well established across psychotherapy orientations. Psychoanalytic work places particular emphasis on using the relationship itself as a source of clinical understanding. People tend to bring their characteristic ways of relating into the consulting room. A patient who anticipates criticism may hear criticism in a relatively neutral comment. A person accustomed to taking care of others may begin taking care of the therapist. The therapist is affected as well. We may find ourselves feeling unusually protective, anxious, or compelled to solve a particular patient’s problems. Psychoanalytic training teaches us to become interested in these experiences. Transference and countertransference provide a language for considering how familiar relational patterns may emerge in treatment. The therapeutic relationship becomes not only the setting in which therapy occurs, but one of the places where a patient’s relational world can become visible and potentially understood differently.

3. Asking What a Symptom Means, Not Only How to Change It

There is value in helping patients feel better. Techniques that reduce anxiety, improve emotional regulation, or help someone process trauma can be life changing.

Psychoanalytic thinking does not require us to choose between relieving a symptom and understanding it. It adds another question: What might this symptom mean for this particular person? A patient’s perfectionism, for example, may respond to strategies aimed at
changing rigid thinking and behavior. But it may also be useful to understand why making a mistake feels so dangerous. Does it evoke humiliation, fear of rejection, loss of control, or a sense of inadequacy. Understanding the psychological function of a symptom may help explain why it has been so difficult to relinquish. Contemporary research supports taking this approach seriously as a treatment option. A 2023 individual-participant-data meta-analysis found short-term psychodynamic psychotherapy effective for adult depression compared with control conditions (Wienicke et al., 2023). A 2024 meta-analysis comparing manualized psychodynamic therapy with CBT for adult depression found equivalent outcomes for depressive symptoms at the end of treatment (Smith & Hewitt, 2024). Recent reviews have also examined psychodynamic treatments in young adults and affect-focused experiential dynamic therapies across a range of disorders (Trotta et al., 2024; Lilliengren et al., 2025). The point is not that psychoanalytic treatment is superior to other established therapies. Rather, it has become increasingly difficult to maintain the old assumption that psychodynamic treatment sits outside the evidence-based psychotherapy literature.

4. Taking the Therapist Seriously as Part of the Process

One of the distinctive emphases of psychoanalytic training is the recognition that the therapist is never simply an outside observer. Who we are enters the room. We bring our histories, cultural assumptions, and characteristic ways of relating to our patients. Different therapists may experience the same patient differently, and we ourselves may have different reactions to different patients.
Many contemporary therapies recognize the importance of therapist self-awareness. Psychoanalytic education makes ongoing examination of the therapist’s experience a particularly important part of training through personal treatment, and detailed discussion of clinical work. The clinician learns to ask not only, “What should I do?” but also, “What is happening between us? Why am I having this reaction, and might it help me understand something about this therapeutic relationship?”

5. Becoming More Comfortable with Not Knowing

Clinicians are trained to formulate problems and intervene. Patients understandably expect us to be helpful, and there are many situations in which a clear recommendation or specific intervention is exactly what is needed. There are also moments when understanding too quickly can get in the way. People are complicated. We can love and resent the same person, long for intimacy and retreat when we find it, want to change yet experience it as threatening. Psychoanalytic training asks clinicians to become more comfortable holding these contradictions without immediately resolving them. This is not passivity or withholding help. It is an effort to remain curious long enough to recognize that our first explanation may not be the only one. Sometimes “I don’t quite understand this yet” is not a failure of clinical knowledge. It is the beginning of another kind of inquiry.

What Does This Add to the Therapist You Already Are?

None of these ideas requires clinicians to give up approaches they already value. A CBT therapist might become interested not only in changing a belief but in why it carries such emotional force for this particular patient. A trauma therapist might use psychoanalytic thinking to consider how early relationships continue to shape present expectations. A couples therapist may find concepts such as projection, repetition, and enactment useful in understanding why two people recreate the same painful interaction despite consciously wanting something different. Psychoanalytic clinicians, in turn, have learned much from other traditions.
Attachment research, trauma theory, neuroscience, systemic thinking, and other developments have changed contemporary psychoanalytic practice. Perhaps the most useful question, then, is not whether one therapy is better or “deeper” than another. It is: What does each perspective allow us to notice that another might not? Psychoanalytic training offers sustained attention to unconscious meaning, recurring relational patterns, what unfolds between therapist and patient, the therapist’s own participation in the work, and the complexity of human motivation. For therapists who already have effective ways of helping their patients,
psychoanalytic training need not replace what they know. It can give them another way to understand what they are already encountering every day in their consulting rooms.

And sometimes, another way of seeing a patient changes what becomes possible in the treatment.

References
Blagys, M. D., & Hilsenroth, M. J. (2000). Distinctive features of short-term psychodynamic-interpersonal psychotherapy: A review of the comparative psychotherapy process literature. Clinical Psychology: Science and Practice, 7, 167–188.

Lilliengren, P., et al. (2025). The efficacy of experiential dynamic therapies: A 10-year update meta-analysis.

Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2), 98–109.

Smith, M. M., & Hewitt, P. L. (2024). The equivalence of psychodynamic therapy and cognitive behavioral therapy for depressive disorders in adults: A meta-analytic review. Journal of Clinical Psychology.

Wienicke, F. J., et al. (2023). Efficacy and moderators of short-term psychodynamic psychotherapy for depression: A systematic review and meta-analysis of individual participant data. Clinical Psychology Review, 101, 102269.