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J. Connor Barnhart, MD

Psychodynamic Therapy in San Francisco

Also known as: Psychodynamic Psychotherapy, Insight-Oriented Therapy, Psychoanalytic Therapy, Depth Psychotherapy, Psychodynamic Counseling

4 min readLast updated: 2026-02-20
Reviewed by J. Connor Barnhart, MD

Psychodynamic therapy is an evidence-supported form of talk therapy rooted in longstanding psychoanalytic theory about how unconscious thoughts, past experiences, and interpersonal patterns influence current emotions and behavior. Through techniques such as free association, exploration of the therapeutic relationship, and interpretation of defense mechanisms, it aims to increase self-awareness and facilitate lasting psychological change.

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 is grounded in the principle that unconscious mental processes, shaped by early life experiences and relationships, significantly influence current thoughts, feelings, and behaviors. By bringing these patterns into awareness, the therapy aims to help individuals understand the root causes of their distress rather than focusing solely on symptom reduction.

Central to psychodynamic therapy is the therapeutic relationship itself, which serves as both a tool for understanding and a vehicle for change. Through the phenomenon of transference, patients may unconsciously re-enact relational patterns from their past with the therapist, providing an opportunity to examine and rework these patterns in a safe setting.

Unlike more structured approaches, psychodynamic therapy allows sessions to be guided in part by the patient's spontaneous thoughts and associations. The therapist listens for recurring themes, contradictions, and emotional responses that may point to unconscious conflicts, and guides the patient to develop deeper self-understanding.

Psychodynamic therapy is one of the earliest forms of talk therapy developed by psychiatrists.

What to Expect During Treatment

  1. 1Initial 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.
  2. 2The therapist and patient establish the therapeutic frame, including session frequency, duration, and expectations for the therapeutic relationship, creating a stable foundation for exploratory work.
  3. 3Early sessions focus on building a shared understanding of the work to be done and beginning to identify recurring themes in the patient's emotional life, relationships, and behavioral patterns.
  4. 4The patient is 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.
  5. 5As 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.
  6. 6With time, the patient develops greater capacity for self-reflection and begins to recognize and modify longstanding patterns that have contributed to psychological distress.
  7. 7The therapeutic relationship itself is regarded as a source of information about the patient's relational patterns, with these dynamics explored collaboratively as they emerge in real time.
  8. 8The duration of treatment varies significantly 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?

  • Psychodynamic therapy operates on the premise that much of mental life occurs outside conscious awareness, and that unconscious thoughts, desires, and memories significantly influence behavior, emotions, and relationships
  • Through free association, the patient speaks spontaneously about whatever comes to mind, allowing the therapist to identify recurring themes, emotional patterns, and unconscious material that may be contributing to distress
  • Transference analysis examines how the patient unconsciously redirects feelings and relational patterns from formative relationships onto the therapist, providing a window into interpersonal difficulties
  • The therapist identifies and explores defense mechanisms, which are unconscious psychological strategies that protect the individual from anxiety but may also perpetuate maladaptive patterns
  • Interpretation is a technique in which the therapist offers observations about connections between the patient's current experiences, past events, and unconscious patterns, facilitating insight and emotional integration
  • The therapeutic experience itself can serve an important role in healing, providing a consistent, nonjudgmental relationship that may differ from problematic relational patterns the patient has experienced previously

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

Conditions I Treat

Anxiety

Anxiety is a mental health condition that can involve persistent worry, nervousness, or unease about events with uncertain outcomes. Anxiety disorders...

Depression

Depression is a common and serious mental health condition involving persistent feelings of sadness, hopelessness, and loss of interest in activities....

Bipolar Disorder

Bipolar disorder is a mental health condition that causes significant shifts in mood, energy, activity levels, and thinking. People with bipolar disor...

Post-Traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder (PTSD) is a mental health condition that can develop after exposure to a traumatic event involving actual or threatened...

ADHD (Attention-Deficit/Hyperactivity Disorder)

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition marked by persistent patterns of inattention, hyperactivity, and imp...

OCD (Obsessive-Compulsive Disorder)

Obsessive-compulsive disorder (OCD) is a mental health condition in which a person experiences intrusive and recurring thoughts known as obsessions, e...

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

Cognitive Behavioral TherapyPsychotherapyMedication Management

Frequently Asked Questions

Psychodynamic therapy is a form of talk therapy that explores how unconscious thoughts, past experiences, and relational patterns influence current emotions and behavior. It aims to increase self-awareness and address the root causes of psychological distress rather than focusing only on symptoms. Compared with other forms of therapy, psychodynamic therapy is often less rigidly directed by the therapist and you are free to talk about whatever comes to mind.
Psychodynamic therapy involves exploring meaningful and sometimes painful experiences, which can bring up difficult emotions. This is a normal part of the process and typically leads to greater understanding and relief over time. The therapist provides a safe, supportive space for this work.
Psychodynamic therapy is generally considered safe when conducted by a trained mental health professional. Some temporary emotional discomfort may occur as part of the therapeutic process. See the safety section above for specific considerations.
Session count depends on the nature and complexity of presenting concerns. Short-term psychodynamic therapy typically involves 12 to 24 sessions, while longer-term treatment for more complex issues may continue for a year or more. Your therapist will collaborate with you on a treatment plan.
During a session, 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 explore patterns in your thoughts, feelings, and relationships. Sessions are confidential.
While CBT is a structured form of therapy that focuses on identifying and changing specific thought patterns and behaviors, psychodynamic therapy explores deeper emotional patterns, unconscious processes, and how past experiences shape current difficulties. Both approaches are evidence-based, and some therapists integrate elements of both approaches.
For current session rates and payment options, please visit my Services page or contact my office directly. Fees are prorated based on time spent on patient care.
Dr. Barnhart is out-of-network with all commercial insurance and Medicare Advantage plans. He is enrolled as a non-participating physician with Original Medicare Part B (limited slots). Superbills are provided for out-of-network reimbursement. HSA and FSA payments are accepted.
Dr. Barnhart's office is at 35 Vicente Street, in the West Portal neighborhood of San Francisco. In-person sessions are available on select days of the week (contact the office to learn more). Telehealth sessions are available throughout California, when appropriate, following an initial in-person session.
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. Barnhart in San Francisco to find out if Psychodynamic Therapy is right for you.

Your Practitioner

J. Connor Barnhart

J. Connor Barnhart, MD

Dr. J. Connor Barnhart is a board-certified psychiatrist and psychotherapist practicing in San Francisco. He completed his psychiatry residency at UCSF, where he trained in the Bipolar, LGBT, and Women's Mental Health specialty clinics and developed focused expertise in integrative psychiatry through a year-long rotation at the UCSF Osher Center. He attended medical school at the University of Pennsylvania's Perelman School of Medicine and graduated from Brown University with honors in Human Biology. His practice combines insight-oriented therapy, medication management, supplements, and lifestyle optimization to holistically address the root causes of mental health challenges including depression, anxiety, and difficulties with focus.

Medically reviewed by J. Connor Barnhart, MD · Last reviewed: 2026-06-22