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By Ali Psiuk, MFTI

The facts: Long-term psychodynamic psychotherapy, when studied in requirements of 40 or 50 sessions, has been shown to not only reduce or resolve unwanted symptoms and long standing difficulties such as depression or anxiety, but also to transform people’s lives.

Here at the Well Clinic, I and many of my colleagues are trained in psychodynamic psychotherapy.  According to the American Psychiatric Association, psychodynamic psychotherapy is a “…treatment to help patients understand themselves more fully. This approach may involve uncovering and learning to deal more effectively with unconscious conflicts. It may also involve assisting patients to understand how certain types of adverse childhood experiences have left them feeling incomplete, anxious, or plagued with low self-esteem that interferes with realistic adult functioning.”

long road psychodynamic psychotherapy

Psychodynamic psychotherapy originated in and is informed by psychoanalytic theory.  (Bring to mind an image of Freud sitting behind his patients as they lay on a couch free-associating a few times a week and you have classic psychoanalysis.) This work emphasized the recognition of childhood events that could potentially influence the mental functioning of adults, and viewed genetics and development as pre-deterministic of later experience. Sexual, aggressive, instinctual and biological drives were viewed as the primary motivators of one’s experience. Freud’s psychoanalysis was the original psychodynamic theory but the psychodynamic approach as a whole includes other theorists such as Jung, Adler and Erickson who based their work on Freud’s ideas.  In recent decades, feminists and post-modern thinkers have built upon and reformulated these ideas, creating a psychodynamic approach that is more relationally and interpersonaly oriented. Psychodynamic psychotherapy is based on a highly developed theory of human development and interaction and its goals in treatment are to raise one’s level of self-awareness and reveal the influence of the past on present behavior.  This work is also called insight-oriented therapy or depth psychology.

Insight and depth, as much as we would like, do not happen overnight.

They do not happen in one session.  Or sometimes, even in 10.


This is not to rule out all of those clarifying “ah ha!” moments we have when initially connecting and resonating with things our therapist has to say about our predicament.  Real insight, originating from within, occurs in the context of a safe environment, where there is trust in the therapeutic relationship and a real sense of bonding that the unconscious mind can begin to free, reveal and express itself.  This is why weekly contact in therapy is recommended and, when struggling, sometimes twice weekly for additional support.  Sound like a lot of work?  Your highly developed, complex and insight-craving self is worth it.

Regular therapy is like going to the gym.  It’s good to go regularly.  Even when you are not in crisis, you go to:

  1. Maintain aspects you’ve improved upon
  2. To continue to reach towards your fullest potential
  3. To prevent future challenges or injuries.

There is not always an “end date” for this model.

This is not to discount the benefits of a short-term, solutions-focused approach especially when there is a specific goal in mind (“I want to get over my fear of public speaking” or “I want to develop the communication skills necessary to ask for a raise”) If your struggle feels more vague or even elusive, there is probably some deeper work that is needing attention.

The deeper and more long-standing challenges you face in life require deeper and longer standing therapeutic work.  That’s just how it is.

Before you feel locked in for life, remember that longer-term therapy, when studied for treatment benefits, equated to 40 to 50 sessions.  This is roughly one year of treatment.   Long term psychodynamic psychotherapy or LTPP, is recommended for longer standing problems, such as chronic depression or anxiety, early relational wounding and trauma.  Here are some links to learn more about the inner workings of psychodynamic psychotherapy:

“Psychodynamic Therapy” —
“Psychodynamic Therapy 101” —


Ali Psiuk is a psychotherapist intern in San Francisco, California. When asked about her approach to psychotherapy, she replied: “I believe it is our birthright to be happy and to live a life in alignment with our deepest values. My hope in therapeutic collaborations is to help clients find ways to meet their needs and live life with a greater sense of buoyancy and authenticity.”



  • I absolutely love Well Clinic! From the beginning, my husband and I felt like we were in a comfortable and safe space.

    Our couple’s therapy bridged gaps in our relationship and helped us understand each other that much more.

    Ivette B

  • Well Clinic is an oasis, especially for busy professionals like me.

    It’s a relaxing and safe space, nothing like the stuffy or drab offices you’d expect when going to a therapist.

    Brianna S

  • Well Clinic’s inviting and professional design makes me feel comfortable and at ease, which probably benefits the work I am doing.

    In fact, it doesn’t really feel like a therapy clinic at all, which I find awesome.

    Jim M


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