Psychodynamic Therapy in San Francisco
Psychodynamic therapy is an evidence-supported form of talk therapy rooted in psychoanalytic theory about how unconscious thoughts, past experience, and interpersonal patterns shape present emotion and behavior. Through free association, attention to the therapeutic relationship itself, and interpretation of defenses, it works toward self-awareness and durable change. I use it when a symptom keeps returning in one recurring relational shape, and for some presentations of PTSD, when the useful question is what the pattern is protecting against. It is the slowest treatment I offer and the one I am most careful about recommending, because it asks for open-ended time.
At a Glance
- A 2023 umbrella review in World Psychiatry found psychodynamic therapy to be an empirically supported treatment for depressive, anxiety, personality, and somatic symptom disorders based on updated criteria[2]
- Research reviews show psychodynamic therapy produces meaningful improvements in both depression and anxiety compared to control conditions[2]
- Research suggests patients who receive psychodynamic therapy tend to maintain therapeutic gains and may continue to improve after treatment ends[3]
- When compared to other active therapies including cognitive behavioral therapy, psychodynamic therapy shows statistically equivalent outcomes for common mental disorders[2]
Overview
Psychodynamic therapy starts from the premise that unconscious mental processes, shaped by early experiences and relationships, significantly influence present thoughts, feelings, and behavior. Bringing these patterns into awareness is meant to address the sources of distress rather than symptoms alone.
The relationship with the therapist is both a source of information and part of the treatment. Through transference, you may unconsciously repeat patterns from earlier relationships with the therapist. Those patterns can then be examined and reworked in a safe setting.
This is less structured than many other forms of therapy. Sessions are guided in part by the thoughts and associations that come to you spontaneously. The therapist listens for recurring themes, contradictions, and emotional responses that may indicate unconscious conflicts, then helps you develop a deeper understanding of them.
Psychodynamic therapy is one of the earliest forms of talk therapy developed by psychiatrists.
What to Expect
- Initial assessment involves a comprehensive evaluation of current symptoms, personal history, family dynamics, relational patterns, and treatment goals to determine whether psychodynamic therapy is an appropriate approach.
- You and the therapist establish the therapeutic frame, including session frequency, duration, and expectations for the therapeutic relationship, creating a stable foundation for exploratory work.
- Early sessions focus on building a shared understanding of the work to be done and beginning to identify recurring themes in your emotional life, relationships, and behavioral patterns.
- You are encouraged to speak freely about thoughts, feelings, memories, and associations that arise, while the therapist listens for unconscious patterns, contradictions, and areas of emotional significance.
- As the therapy progresses over time, the therapist usually begins to offer interpretations that connect current difficulties to underlying patterns, past experiences, and the dynamics of the therapeutic relationship itself.
- With time, this work builds greater capacity for self-reflection and the ability to recognize and modify longstanding patterns that have contributed to psychological distress.
- The therapeutic relationship itself is regarded as a source of information about your relational patterns, with those dynamics explored collaboratively as they emerge in real time.
- The duration of treatment varies significantly from person to person. The termination of therapy is a planned, gradual process that involves reviewing progress, processing feelings about ending the therapy, and consolidating insights gained during treatment.
How does Psychodynamic Therapy work?
- Much of mental life occurs outside conscious awareness. Psychodynamic therapy examines how unconscious thoughts, desires, and memories influence behavior, emotions, and relationships.
- In free association, you speak spontaneously about whatever comes to mind. This allows the therapist to identify recurring themes, emotional patterns, and unconscious material that may be contributing to distress.
- Transference analysis looks at how feelings and relational patterns from formative relationships may be redirected onto the therapist. What happens in that relationship can provide a window into difficulties that also appear elsewhere in your life.
- The therapist also identifies and explores defense mechanisms. These are unconscious psychological strategies that protect you from anxiety but may also perpetuate patterns that are no longer useful.
- Interpretation means drawing attention to connections among current experiences, past events, and unconscious patterns. The aim is greater insight and emotional integration.
- The therapeutic experience itself can also play an important part in healing. It provides a consistent, nonjudgmental relationship that may differ from problematic relationships you have experienced before.
When It's Recommended
- Major depressive disorder and persistent depressive disorder
- Generalized anxiety disorder, social anxiety disorder, and panic disorder
- Personality disorders
- Somatic symptom disorders and psychosomatic conditions
- Chronic relational difficulties and attachment-related concerns
- Grief, loss, and adjustment difficulties
- Emotional processing difficulties and alexithymia
- Recurrent problematic life patterns that have not responded to shorter-term interventions or other forms of therapy
Have questions about this treatment?
Reach out to learn more from Mario A. Benitez-Lopez.
Recovery & Aftercare
- Emotional processing may continue between sessions, and patients may notice increased self-awareness and emotional sensitivity as treatment progresses
- Skills in self-reflection and emotional understanding typically develop gradually and become more natural with practice over time
- Treatment duration varies from short-term formats to longer-term therapy lasting a year or more, depending on the complexity of presenting concerns
- Research suggests that therapeutic gains from psychodynamic therapy tend to persist after treatment ends, with some evidence of continued improvement following termination
Alternative Treatments
- Cognitive behavioral therapy (CBT) for structured, goal-oriented treatment
- Dialectical behavior therapy (DBT) for emotion regulation and interpersonal effectiveness
- Acceptance and commitment therapy (ACT) for psychological flexibility
- Psychiatric medication management for pharmacological support
- Mindfulness-based cognitive therapy (MBCT) for recurrent depression
Related Treatments
Frequently Asked Questions
- Psychodynamic therapy is a form of talk therapy that examines how unconscious thoughts, past experiences, and relational patterns influence current emotions and behavior. It aims to increase self-awareness and address the sources of psychological distress rather than symptoms alone. Compared with more structured therapies, it is less rigidly directed by the therapist, and you are free to talk about whatever comes to mind.
- It can be. Exploring painful experiences and emotionally important relationships may bring up difficult feelings. This is a normal part of the process and typically leads to greater understanding and relief over time. The therapist provides a safe, supportive setting for the work.
- Psychodynamic therapy is generally considered safe when conducted by a trained mental health professional. Temporary emotional discomfort may occur during the process. The Risks section lists the specific considerations.
- The number depends on the nature and complexity of the concerns being treated. Short-term psychodynamic therapy typically involves 12 to 24 sessions. Longer-term treatment for more complex concerns may continue for a year or more. Your therapist will collaborate with you on a treatment plan.
- You meet with your therapist in a private setting for approximately 45 to 50 minutes. You are encouraged to speak freely about whatever comes to mind, and the therapist helps you examine patterns in your thoughts, feelings, and relationships. Sessions are confidential within limits explained at the outset: imminent risk of serious harm to you or someone else, suspected abuse or neglect of a child or vulnerable adult, and a court order.
- CBT is structured and focuses on identifying and changing specific thought patterns and behaviors. Psychodynamic therapy examines deeper emotional patterns, unconscious processes, and the ways past experiences shape current difficulties. Both approaches are evidence-based, and some therapists integrate elements of both.
- It can be, and it is one of the routes I use for trauma alongside exposure-based work. The fit depends on the presentation. When the problem centers on a specific set of memories and the avoidance built around them, exposure therapy has the stronger evidence and I go there first. When trauma has shaped how someone relates to people more broadly, and the same rupture keeps recurring with different partners or bosses, psychodynamic work has more to say about it.
- Care is cash-pay and by appointment. I do not bill insurance directly, and fees are settled between us. Because psychodynamic therapy is open-ended, I would rather you know the arrangement before starting than discover it three months in. Ask me during the first conversation and I will be specific.
- Psychodynamic Therapy is commonly recommended for individuals experiencing major depressive disorder and persistent depressive disorder, generalized anxiety disorder, social anxiety disorder, and panic disorder, personality disorders, somatic symptom disorders and psychosomatic conditions. Schedule a consultation with Dr. Benitez-Lopez in San Francisco to find out if Psychodynamic Therapy is right for you.
What are the risks of Psychodynamic Therapy?
Who should avoid this
- Active psychosis without adequate pharmacological stabilization, as the individual may not be able to engage meaningfully in exploratory therapeutic work
- Active suicidal crisis requiring a higher level of care, such as inpatient hospitalization or crisis stabilization, before outpatient therapy can proceed safely
- Severe cognitive impairment that prevents meaningful participation in reflective and verbal therapeutic processes
- Active substance intoxication during sessions, which impairs the capacity for self-reflection and emotional processing
- Situations requiring immediate behavioral crisis intervention where structured, directive approaches may be more appropriate initially
Possible risks
- Temporary increase in emotional distress as previously unconscious material becomes conscious and is processed
- Exploring painful memories and relational patterns may initially intensify feelings of sadness, anger, or anxiety before improvement occurs
- Interpersonal disruption when therapy-related insights prompt changes in relational patterns that may temporarily strain existing relationships
- Rare but possible feelings of frustration if progress feels slower than anticipated, as psychodynamic change often occurs gradually
Your practitioner
Mario A. Benitez-Lopez, MD
I am a board-certified adult psychiatrist and the founder of San Francisco Concierge Psychiatry. I completed my psychiatry residency at the University of Washington and hold a master's in clinical research from Stanford. I offer bilingual (English and Spanish) care in a concierge model built around small panels and longer sessions, spanning medication management, deprescribing, and evidence-based individual and couples therapy.
Sources & references
This article draws on 5 sources, including government health agencies, peer-reviewed research, leading medical institutions.
Government & research
Medical institutions
Medically reviewed by Mario A. Benitez-Lopez, MD · Last reviewed: 2026-08-31