Psychodynamic therapy · Carlsbad, Encinitas & Vista

Psychodynamic Therapy in North County San Diego

If the same thing keeps happening in your relationships, your work, or how you treat yourself, the pattern is worth understanding rather than managing. Psychodynamic therapy is the depth-oriented work of finding out where a pattern started and what it is still doing for you. It is how our doctoral-level team works in Carlsbad, Encinitas, and Vista, or online across California.

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Quiet therapy room with two facing chairs where clinicians provide psychodynamic therapy at the Coastal Therapy Group office in Carlsbad, North County San Diego

What it is

Depth therapy

Also called psychoanalytic or relational

Who practices it

All 15 clinicians

12 licensed psychologists, 3 postdoctoral fellows

Where

Three offices

Carlsbad, Encinitas, Vista, plus online

Start with

A free call

15 minutes, no pressure

The basics

What is psychodynamic therapy?

Psychodynamic therapy is a form of talk therapy that works with the patterns underneath a symptom rather than the symptom alone. It starts from the premise that anxiety, depression, and relationship trouble are not random. They make sense in the context of your history, your temperament, and the ways you learned to cope. Understanding that logic does not make change automatic, but it changes what you are working against.

The approach grew out of psychoanalytic theory, and it has become considerably more relational and collaborative than the couch-and-silence image many people still carry. You talk, your therapist responds, and together you pay close attention to what is happening between you in real time, because how you relate in the room usually mirrors how you relate everywhere else.

You will see the same work called depth therapy, psychoanalytic psychotherapy, or insight-oriented therapy. At Coastal Therapy Group we practice the relational version of it, which puts the therapy relationship at the center rather than treating the therapist as a neutral observer. It also shapes how we understand people in the first place: less as a list of symptoms to be coded, more as a whole person with a characteristic way of coping, which is what clinicians mean by psychoanalytic diagnosis.

The mechanism

How does psychodynamic therapy work?

Psychodynamic therapy works by bringing unconscious patterns into awareness, and it uses the therapy relationship itself as the primary instrument for doing it. That second part is what makes it different from approaches that rely mainly on what you report between sessions.

Here is what that means in practice. Everyone arrives with a set of expectations about what other people are like and what happens when you need something from them. Those expectations were learned somewhere, and they get quietly applied to new people, including your therapist. When that happens in the room it is called transference, and it gives you both something better than a memory to work with. It gives you a live sample.

The other half of the work is defenses, the automatic maneuvers that keep painful feelings at a distance. Defenses are not a flaw to be corrected. They were adaptive when you built them. But a strategy that protected you at fifteen can be running your relationships at forty, and noticing it is the first move toward having a say in it.

Inside the work

What psychodynamic therapy actually involves.

You show up and talk about whatever is most alive that day. Your therapist listens, but not passively. Some sessions bring relief and some are uncomfortable. Both are doing something. Underneath the ordinary conversation, six things are going on.

Seeing the pattern

You start noticing what keeps repeating: the same kind of partner, the same conflict at work, the same way of turning on yourself. Not just naming the pattern, but tracing where it started and what it was originally for.

Understanding your defenses

Defenses are the ways you protect yourself from feelings that once were too much. They are not flaws. They got you through something. The work is learning to catch yours in the act, whether that is projection, splitting, or simply going quiet, because noticing one as it happens is what gives you the option of doing something else.

Working inside the relationship

How you relate to your therapist tends to echo how you relate to everyone else. That makes the therapy relationship a live sample rather than a report from memory, and it is where change happens in real time.

Making the unconscious conscious

Not mystically. Practically. An automatic reaction, a hidden assumption, a feeling you have been steering around for years gets brought into the open, which is the point at which you finally get a choice about it.

Staying with hard feelings

Grief, anger, shame, fear. The work is not to think your way past them or reframe them into something more comfortable. It is to stay with them long enough to understand what they are telling you, and to find words for feelings that have never had any.

Building a capacity, not a technique

The aim is a way of reflecting on yourself that tends to stay with you after the work ends. That is the mechanism behind the research finding that people who do this work often keep improving once they stop, though that is a tendency across studies rather than a promise about any one person.

How it compares

Different approaches ask different questions.

Every approach below is effective and well-researched, and our clinicians are trained in several of them. What separates them is the question each one is built to answer, which question you want answered right now, and how long the answer tends to last.

Psychodynamic therapy vs. CBT

CBT asks what you are thinking, and works to change the thoughts and behaviors that keep a problem running. It is structured, present-focused, and usually shorter, and it can move a specific symptom quickly. Psychodynamic therapy asks why that thought became yours in the first place, and works on the emotional logic underneath it. That difference shows up after therapy ends: Shedler’s review in American Psychologist found that psychodynamic clients not only held their gains but kept improving once treatment stopped, because what this work builds is a capacity for self-understanding rather than a set of techniques you have to keep applying.

Psychodynamic therapy vs. DBT

DBT teaches concrete skills for surviving intense emotion: distress tolerance, emotion regulation, interpersonal effectiveness. When feelings are overwhelming right now, skills are what help right now, which is exactly why we run a DBT skills group at our Vista office. What skills are not built to do is change why the feeling arrives at that intensity in the first place. That is the psychodynamic question, and it is why a good number of people do these in sequence rather than instead of each other: skills to get steady, depth work to change what you are steadying yourself against.

Psychodynamic therapy vs. EMDR

EMDR is a structured eight-phase protocol for reprocessing specific traumatic memories, and it is among the best-researched trauma treatments available. Psychodynamic therapy works on a wider frame: how an experience shaped your relationships, your sense of who you are, and the defenses you built to get through it. These are complementary, not competing. Some of our clinicians use EMDR inside a psychodynamic frame, targeting a memory while the longer relational work continues around it.

Psychodynamic therapy vs. psychoanalysis

Psychoanalysis is the more intensive form of the same tradition: typically three to five sessions a week, often with the patient on a couch, oriented around free association. Psychodynamic psychotherapy applies the same theory at a workable frequency, usually once or twice a week, face to face. Almost everyone doing depth-oriented work today is in psychodynamic psychotherapy rather than full analysis.

The research

Is psychodynamic therapy evidence-based?

Yes. The idea that psychodynamic therapy lacks research support is out of date by a couple of decades, and the evidence has been tested with the same methods used to evaluate everything else.

Steinert and colleagues, 2017. A meta-analysis of 23 randomized controlled trials covering 2,751 patients, published in the American Journal of Psychiatry, used formal equivalence testing and concluded that psychodynamic therapy is equivalent in outcome to treatments already established in efficacy, both at the end of treatment and at follow-up.

Leichsenring and colleagues, 2023. An umbrella review in World Psychiatry assessed psychodynamic therapy against updated criteria for empirically supported treatments. It found high quality evidence in depressive and somatic symptom disorders and moderate quality evidence in anxiety and personality disorders, and concluded that psychodynamic therapy represents an evidence-based psychotherapy.

Shedler, 2010. A review in American Psychologist found effect sizes for psychodynamic therapy comparable to those reported for treatments routinely described as evidence-based, and reported something unusual: clients tended to keep improving after treatment ended. Shedler attributed that to the capacity for self-reflection the work builds, which does not depend on the therapist still being in the room.

Is this for you

Who psychodynamic therapy tends to fit.

This work suits anyone willing to look honestly at themselves, which is a lower bar than it sounds. In practice, people tend to arrive at our door for one of these reasons.

The same problem keeps coming back

You have done therapy before. It helped, and then the thing returned in a slightly different shape. That pattern usually means the symptom was addressed and whatever generates it was not.

Your relationships keep rhyming

Same kind of partner, same argument, same distance from people you actually love. When relationships repeat across very different people, the common factor is worth understanding rather than managing.

Something is off and you cannot name it

Nothing is technically wrong. You are functioning, often well. But there is a going-through-the-motions quality, or a sense that the life you built does not quite fit the person living it.

You want to understand it, not just reduce it

You are less interested in getting a difficult experience down to a manageable score and more interested in knowing what it did to you and how it still shapes the way you move through the world.

Therapy helped, but only so far

You liked your last therapist. The sessions were pleasant. You also had the recurring feeling that you were circling something without ever getting to it, and you would like to get to it.

Nothing is wrong and you are still curious

You do not need a crisis to qualify. Wanting to understand your own mind is a legitimate reason to start, and it tends to make for engaged, productive work.

We work psychodynamically with adults, teens, and children, and also offer couples therapy, group therapy, EMDR, and psychological testing.

Worth saying plainly

What this work asks of you.

It seems only fair to say what psychodynamic therapy requires, because not everyone wants it, and that is a reasonable thing to work out before you spend money finding out.

It asks for time. Change of this kind is usually measured in months, sometimes longer, and the early sessions often raise more questions than they settle. It asks you to keep coming during the stretch where you can see a pattern clearly and cannot yet do anything about it, which is the most frustrating part of the process and also where most of the work is quietly getting done. And it asks for a specific kind of honesty, including about how you feel toward your therapist, which is a stranger thing to be asked than it sounds.

There are also people we are not the right answer for. If you are in acute crisis, if you need a particular fear or compulsion to shift by a certain date, or if what you want is a set of tools rather than an understanding of yourself, another approach will serve you better. We would rather tell you that on the first call than six sessions in, and we will point you toward what is likely to help.

Psychodynamic therapy, answered

Straight answers to common questions.

What is psychodynamic therapy?

Psychodynamic therapy is a form of talk therapy that works with the patterns underneath a symptom rather than the symptom alone. It treats anxiety, depression, and relationship difficulty as things that make sense in the context of a person’s history, temperament, and the ways they learned to cope, and it uses that understanding, along with the therapy relationship itself, as the route to lasting change.

What is the difference between psychodynamic therapy and CBT?

CBT identifies and changes the thoughts and behaviors that keep a problem running, and is structured, present-focused, and usually shorter-term. Psychodynamic therapy explores why those patterns formed and what emotional purpose they serve, using the therapy relationship as a live example. The two test comparably at the end of treatment, but they diverge afterward: Jonathan Shedler’s 2010 review in American Psychologist found that psychodynamic clients kept improving after therapy ended, because the work builds a capacity for self-understanding rather than a set of techniques that need maintaining.

Is psychodynamic therapy the same as psychoanalysis?

No, though they share a theoretical tradition. Psychoanalysis is more intensive, typically three to five sessions a week, often with the patient on a couch. Psychodynamic psychotherapy applies the same principles once or twice a week, face to face, in ordinary conversation. Most people seeking depth-oriented therapy today are doing psychodynamic psychotherapy rather than full psychoanalysis.

What does "relational" mean in relational psychodynamic therapy?

Relational psychodynamic therapy holds that the therapist is a real participant in the room rather than a blank screen, and that what happens between client and therapist is itself the material worth examining. In practice it means your therapist will notice and talk about the dynamic between you, because the way you relate to them usually reflects the way you relate to the people who matter to you.

Meet the team

Our psychodynamic therapists.

Most practices list psychodynamic therapy as one option on a menu. It is the whole orientation here. Twelve of the fifteen are licensed psychologists and three are postdoctoral fellows; every one of them holds a doctorate in psychology and is trained to work with what sits underneath the symptom, which means the question is not whether someone is available who works this way. It is which of them is the right fit for you.

Reid Kessler, PsyD

Co-owner & CEO

Teens + Adults + Couples | Specializes in: men's issues, depression, personal growth. Encinitas & Vista

Psychodynamic Therapy in North County San Diego

What is psychodynamic therapy?

How does psychodynamic therapy work?

What psychodynamic therapy actually involves.

Seeing the pattern

Understanding your defenses

Working inside the relationship

Making the unconscious conscious

Staying with hard feelings

Building a capacity, not a technique

Different approaches ask different questions.

Psychodynamic therapy vs. CBT

Psychodynamic therapy vs. DBT

Psychodynamic therapy vs. EMDR

Psychodynamic therapy vs. psychoanalysis

Is psychodynamic therapy evidence-based?

Who psychodynamic therapy tends to fit.

The same problem keeps coming back

Your relationships keep rhyming

Something is off and you cannot name it

You want to understand it, not just reduce it

Therapy helped, but only so far

Nothing is wrong and you are still curious

What this work asks of you.

Straight answers to common questions.

What is psychodynamic therapy?

What is the difference between psychodynamic therapy and CBT?

Is psychodynamic therapy the same as psychoanalysis?

What does "relational" mean in relational psychodynamic therapy?

Our psychodynamic therapists.

Frequently asked questions about psychodynamic therapy.

How do you show up in close relationships?

You can stop managing the pattern.

Psychodynamic therapy in Carlsbad, Encinitas, and Vista.