The Comeback of Psychodynamic Psychotherapy

Author: ​Sabrina Lazzarato

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Is Psychodynamic Psychotherapy Making a Comeback?

Psychodynamic psychotherapy has long been associated with Freud and Jung’s ideas which once reigned as the primary direction for psychotherapy. For decades, psychodynamic theory and practice has faded from public favor and clinical practice as it has been labeled as unscientific, outdated, and inefficient. However, psychodynamic therapy may be having a revival. In Mauricio Cortina’s 2010 article “The Future of Psychodynamic Psychotherapy,” he explores the reasons why the field fell out of favor as well as how it is regaining relevance in modern mental health care, and more recent studies and meta-analyses seem to support his conclusion.

Why Did it Fall Out of Favor?
First, Cortina outlines two major reasons for the decline of psychodynamic psychotherapy: theoretical infighting and resistance to empirical testing. In terms of theoretical infighting, psychodynamic schools fractured into competing camps (e.g., Freudians, Jungians, ego psychologists) instead of evolving collaboratively. This intellectual infighting confused the public, alienated clinicians, and undermined the field’s coherence. Additionally, while other modalities (e.g., cognitive behavioral therapy) embraced empirical research and controlled trials, many psychodynamic theorists resisted quantifying and operationalizing their concepts. The reluctance to engage with modern scientific standards caused the therapy to be viewed as unmeasurable, unproven, and ultimately outdated.

Why is it Coming Back?
So how could one argue that psychodynamic therapy is now making a return? Cortina identifies several key forces behind the resurgence. The first is neuroscience validation. Recent discoveries in affective neuroscience support long-held psychodynamic concepts such as empathy, unconscious conflict, and emotional attunement now all have biological backing. The second is further attachment and developmental research. Decades of empirical work in attachment theory (e.g., by Ainsworth, Bowlby, and Sroufe) have shown that early relationships profoundly change personality and emotional resilience, which validates core psychodynamic principles. The third is that defense mechanisms have been revisited in contemporary research. Defense mechanisms were originally introduced by Freud and are now being scientifically studied and have been linked with physiological stress responses and adaptive functioning across the lifespan. The final reason, and perhaps most important step towards the revival of psychodynamic psychotherapy, is evidence-based practice. Recent meta-analyses and randomized control trials have shown that psychodynamic therapy is effective, especially for depression, anxiety, personality disorders, and somatic symptom disorders.

The Evidence:
Recent large-scale reviews and meta-analyses offer evidence of psychodynamic psychotherapy’s effectiveness across a range of mental health conditions and populations. 

    A 2017 meta-analysis conducted by Steinert et al. analyzed 23 randomized controlled trials comparing psychodynamic therapy with CBT or other empirically supported treatments. The results identified that psychodynamic therapy was found to be statistically equivalent in effectiveness. When reaching the post-treatment phase, the effect size was g = -0.15 and at follow-up had narrowed to g = -0.05, which indicates lasting therapeutic benefits that match the outcomes of other empirically based treatments (Steinert et al., 2017).

    Beyond reducing symptoms of disorders, psychodynamic therapy has also been shown to have a reduction effect for patients at risk for suicide or self-injury (Briggs et al., 2019). A 2019 systematic review and meta-analysis (Briggs et al.) evaluated 17 studies that involved patients at risk for suicide or self-injury. Researchers found that psychodynamic and psychoanalytic therapies significantly reduced suicide attempts and improved psychosocial functioning and quality of life. 

    Psychodynamic therapy is also showing promise with younger populations. In 2024, Trottal et al. published a meta-analysis examining the effectiveness of psychodynamic psychotherapy for young adults (ages 18 to 25). This age group is often under-represented in psychotherapy research. The analysis included 21 studies and found large effect sizes for symptom reduction. When compared to active treatments like CBT, psychodynamic psychotherapy produced equivalent outcomes, further confirming its relevance for treating anxiety, depression, and relational distress in emerging adulthood. 

What's Different About Psychodynamic Therapy Today?
Psychodynamic therapy has undergone significant modernization, and it is not the same as when Freud first lectured or when Jung first established theories. The field has begun to utilize short-term structured formats that make the treatment both more accessible and affordable. It has integrated with neuroscience and cognitive science, which allows for a holistic brain-based approach. Psychodynamic therapy today also uses outcome tracking and process research embedded in many training programs to define clients’ progress. Additionally, it has less dogma and is more centered on dialogue. Modern practitioners have become less focused on theoretical purity and more on what actually works for people in real clinical settings.

The Future
Although Cortina's article was written in 2010, it is remarkably future-oriented. He recognized that for psychodynamic therapy to survive, it needed to embrace scientific inquiry, interdisciplinary collaboration, and actual clinical and empirical effectiveness. Today’s research shows that this is exactly what’s happening. With support from meta-analyses, studies, and outcome data, psychodynamic psychotherapy is reclaiming its seat at the table through clinical innovation. Overall, the resurgence of psychodynamic psychotherapy isn't a return to the past, but rather a progression towards a more integrative, evidence-based, informed future for mental health care.

Works Cited
Briggs, S., Netuveli, G., Gould, N., Gkaravella, A., Gluckman, N. S., Kangogyere, P., Farr, R., Goldblatt, M. J., & Lindner, R. (2019). The effectiveness of psychoanalytic/psychodynamic psychotherapy for reducing suicide attempts and self-harm: systematic review and meta-analysis. The British journal of psychiatry : the journal of mental science, 214(6), 320–328. https://doi.org/10.1192/bjp.2019.33

Cortina M. (2010). The future of psychodynamic psychotherapy. Psychiatry, 73(1), 43–56. https://doi.org/10.1521/psyc.2010.73.1.43

Steinert, C., Munder, T., Rabung, S., Hoyer, J., & Leichsenring, F. (2017). Psychodynamic Therapy: As Efficacious as Other Empirically Supported Treatments? A Meta-Analysis Testing Equivalence of Outcomes. The American journal of psychiatry, 174(10), 943–953. https://doi.org/10.1176/appi.ajp.2017.17010057

Trotta, A., Gerber, A. J., Rost, F., Robertson, S., Shmueli, A., & Perelberg, R. J. (2024). The efficacy of psychodynamic psychotherapy for young adults: a systematic review and meta-analysis. Frontiers in psychology, 15, 1366032. https://doi.org/10.3389/fpsyg.2024.1366032