Can Psychodynamic Therapy Help With Anxiety? What the Research and Clinical Practice Show
Anxiety is one of the most common reasons people seek therapy. Whether it shows up as persistent worry, sudden panic, social unease, or a vague but relentless sense of dread, anxiety can quietly take over a person's life — shaping decisions, straining relationships, and narrowing the world. Most people have heard of cognitive behavioural therapy (CBT) as a treatment for anxiety, but many patients and clinicians alike wonder: what does psychodynamic therapy have to offer?
The short answer is: quite a lot. A growing body of research, alongside decades of clinical experience, suggests that psychodynamic therapy addresses anxiety in a way that is both effective and meaningfully different from symptom-focused approaches — not by teaching people to think differently, but by helping them understand why they feel the way they do.
What Psychodynamic Therapy Actually Does
Psychodynamic therapy is rooted in the understanding that much of our emotional life operates outside conscious awareness. But this does not mean that the work involves simply taking anxiety as a topic and examining it directly. The process is more subtle than that — and, in many ways, more interesting.
It is worth pausing on what "outside conscious awareness" actually means — because it is a point that is often underestimated. Many people who seek therapy consider themselves to be self-aware. They have reflected on their patterns, read about psychology, and noticed certain tendencies in themselves. This kind of reflective capacity is genuinely valuable. But self-awareness, in the ordinary sense, operates within consciousness — it can only work with what is already available to the mind. The unconscious, by definition, is precisely what is not available. It cannot be retrieved through introspection alone, because introspection is itself one of the mind's ways of not going there.
This is why the presence of a trained analyst matters in a way that goes beyond having a thoughtful conversation.
The unconscious has its own logic, its own language — it speaks through dreams, slips, silences, the particular way a person tells a story, what they cannot quite say, the feelings that arise in the room between patient and analyst. Someone trained to attend to this language can hear things that the patient cannot hear in themselves. They can see the shape of what is being avoided, the pattern beneath the surface, the meaning that is present but unspoken. It is through this relationship — and specifically through the analyst's capacity to put the patient in touch with what lies beneath — that something becomes conscious that was not before. And it is that process, rather than reflection alone, that creates the conditions for real structural change.
What a psychodynamic therapist attends to is not primarily the anxiety itself, but the patient's whole way of thinking, experiencing, and making meaning. How does this person relate to their own inner states? How do they experience other people — as threatening, as unreliable, as impossible to reach? What patterns recur across different relationships and situations, often without the patient noticing? What gets avoided, idealised, split off?
Over time, these patterns become visible in the room itself — in the texture of what the patient brings, in what they cannot quite say, in how they experience the therapist. It is through this wider picture that anxiety begins to reveal what it actually is: not a free-floating symptom to be managed, but something with meaning, shape, and history. For one person, it may be bound up with a terror of dependency; for another, a defence against anger that has nowhere else to go; for another still, a faithful echo of an early environment in which uncertainty was the norm.
This kind of understanding — arrived at gradually, through the relationship — tends to produce change that is lasting, because it shifts something in the underlying structure of a person's inner life, not only the surface expression of their distress.
What the Research Shows
For many years, psychodynamic therapy lacked the volume of clinical trials that CBT accumulated. That gap has narrowed considerably, and the picture that is emerging is worth examining honestly — both for what it supports and where questions remain.
Effectiveness across anxiety presentations.
A comprehensive meta-analysis of 14 randomised controlled trials involving over 1,000 patients found that psychodynamic therapy was significantly more effective than control conditions for anxiety disorders, with a moderate-to-large effect size. Crucially, it did not differ significantly from other active treatments at the end of therapy or at follow-up — suggesting that it is a genuine alternative rather than a lesser option (Steinert et al., 2017).
Gains that continue after treatment ends.
One of the more clinically significant findings in the psychodynamic literature is that patients often continue to improve after therapy has concluded. A 2023 umbrella review in World Psychiatry (Leichsenring et al.) confirmed this pattern across multiple studies: psychodynamic therapy produces durable change in a way that suggests the work sets something in motion, rather than simply suppressing symptoms while it continues. This may reflect the nature of the work itself — when a person develops a different relationship to their own inner life, that capacity does not switch off when sessions end.
The evidence for psychoanalysis specifically.
Studying psychoanalysis presents methodological challenges — its intensity, length, and resistance to manualisation make randomised controlled trials difficult to design. The evidence base is consequently smaller, but not negligible. The Helsinki Psychotherapy Study, one of the few rigorous comparisons of short-term psychodynamic therapy, long-term psychodynamic therapy, and psychoanalysis, found that psychoanalysis produced slower gains initially but showed the strongest outcomes at five-year follow-up, particularly in personality functioning, social adjustment, and enduring remission. A separate ten-year follow-up of the same cohort found that patients who had undergone psychoanalysis continued to show greater gains in personality organization and social functioning than those in long-term psychodynamic therapy — a finding that points toward the depth and structural nature of the changes psychoanalysis may produce.
What the research cannot easily capture.
It is worth being transparent about the limits of the evidence. Most trials study short-term psychodynamic therapy — manualized, time-limited, and focused. This is not the same as open-ended psychodynamic work or psychoanalysis, and outcomes measured over weeks or months miss much of what the longer work produces. Standard outcome measures — symptom checklists, anxiety inventories — may also be too crude to capture what changes in psychoanalytic treatment: shifts in the capacity to think, to tolerate complexity, to relate differently to oneself and others. The research offers meaningful support, but clinical experience and individual case complexity remain essential guides alongside it.
The Clinical Picture: What This Looks Like in Practice
Research findings, while important, can feel abstract. What does this actually look like when a person comes to therapy struggling with anxiety?
Consider someone who presents with what they describe as "free-floating worry" — anxiety that seems to attach itself to one concern, then another, never fully resolved. In a symptom-focused approach, the work might centre on identifying and challenging anxious thoughts, or building tolerance for uncertainty. These are legitimate and helpful strategies.
In psychodynamic work, the therapist might also wonder: What is this person's relationship to uncertainty? What happens in the room when we encounter an unknown together? Is the anxiety present with me, and if so, when does it spike? Over time, the patient may come to recognise that their worry is connected to issues specific to the patient’s particular psychological make-up. The anxiety begins to make sense. And when something makes sense, it tends to lose some of its grip.
This is not a quick process, and it is not meant to be. Psychodynamic therapy asks for patience and a willingness to sit with uncertainty rather than immediately resolve it. For many patients, that very process — learning to tolerate and explore rather than escape — is itself transformative.
What Psychodynamic Therapy Offers That Other Approaches May Not
This is not to position psychodynamic therapy against other effective treatments. Many patients benefit from integrative approaches, and a skilled clinician draws on a range of frameworks. But psychodynamic therapy brings some specific strengths to the treatment of anxiety:
It works with the whole person, not just the symptom. Anxiety rarely exists in isolation. It is entangled with identity, relationships, history, and meaning. Psychodynamic therapy holds all of this.
It takes the unconscious seriously. Many people know cognitively that their anxiety is disproportionate, but knowing this does not make it go away. Psychodynamic work explores why the anxiety persists despite rational understanding.
It is well-suited to complex presentations. When anxiety is accompanied by depression, relational difficulties, trauma, or long-standing personality patterns, psychodynamic therapy is particularly well placed to address the full picture.
It offers insight, not just relief. Many patients come not only wanting to feel better, but to understand themselves. Psychodynamic therapy takes that wish seriously.
Who Might Benefit?
Psychodynamic therapy tends to be a good fit for people who:
Experience anxiety that feels connected to their history or relationships
Have tried symptom-management approaches and found relief to be partial or short-lived
Are curious about themselves and drawn to self-reflection
Are dealing with anxiety alongside other emotional difficulties
Want more than symptom reduction — they want to understand why they feel as they do
It is worth noting that psychodynamic therapy can be offered in both short-term and longer-term formats. Brief psychodynamic therapies (typically 16–30 sessions) have strong evidence for anxiety and are appropriate for many patients. For those with more complex or longstanding difficulties, open-ended work may be more suitable.
A Note on Finding the Right Therapist
The evidence is clear that the therapeutic relationship is one of the strongest predictors of good outcomes in any form of therapy. But it is worth being honest about what that relationship actually involves — because "find a therapist you feel safe with" can be a misleading starting point.
Safety in therapy is not something a patient arrives with, or something a therapist simply radiates. It is built gradually, through experience — through turning up week after week, through moments of misattunement and repair, through the slow accumulation of evidence that difficult things can be brought into the room and survived. A patient may feel relieved after a first session, or uncertain, or both at once. None of that reliably predicts whether the relationship will become one in which real work is possible.
It is also worth noting that exploring the roots of anxiety is not, in itself, a comfortable process. Moving toward the material that underlies chronic worry or panic — early loss, relational injury, conflicts that were never resolved — asks something of a patient. A good psychodynamic therapist is not someone who makes that journey feel safe in a reassuring sense, but someone who can be honest about its difficulty, remain steady when things become hard, and help the patient understand what is happening when they do.
When looking for a therapist, it may be more useful to ask not do I feel safe? But, instead, does this person seem genuinely curious about me? Can they tolerate what I bring without moving too quickly to resolve it? That quality of engaged, unhurried attention — more than any immediate sense of comfort — tends to be what makes the work possible over time.
In Summary
Anxiety is not simply a bad habit or a chemical imbalance to be corrected. It is, often, a deeply human response to experiences that have never been fully understood or processed. Psychodynamic therapy offers a thoughtful, evidence-supported path to that understanding — and with it, lasting relief.
Start Psychodynamic Therapy in Washington, DC
If you are struggling with anxiety and wondering whether this approach might be right for you, I would encourage you to reach out. The research is encouraging, but what matters most is what happens in the particular space between therapist and patient — and that begins with a conversation. You can start your therapy journey with Nina Van Sant, LICSW by following these simple steps:
Meet with a psychodynamic therapist
Start finding lasting anxiety relief!
Other Services Offered with Nina Van Sant, LICSW
Psychodynamic therapy is not the only service offered at Nina Van Sant, LICSW. I’m happy to offer multiple services to support clients in better self-understanding and lasting healing. Other services offered include psychoanalysis, infertility-related stress, postpartum therapy, and therapy for teens and older adults at different developmental stages. I also work with expats and international professionals who are managing cultural adjustment, relocation stress, and the emotional weight of significant life changes.