Psychodynamic therapy

At a glance

Compared with waiting

Better than waiting. In a combined analysis of 101 trials, the difference was moderate.

Compared with other treatments

In a German trial of 495 people, it did a little less well than CBT at the end of treatment. Two years later the two were about equal.

How many get better

26 in 100 were in remission at the end of treatment, compared with 36 in 100 after CBT and 9 in 100 after waiting.

Does it last

Two years after therapy, about 70 in 100 had responded and nearly 40 in 100 were in remission, the same as with CBT.

What it takes

Weekly sessions with a therapist for several months. A Swedish online version also exists.

What it is

Psychodynamic therapy is a talking therapy. It looks at how your past and your relationships shape the way you feel now. For social anxiety, the short-term version used in trials focuses on:

• The core conflict. For example, wanting to be close to people while expecting to be rejected or shamed.
• Patterns that repeat. How the fear plays out with friends, at work and even with the therapist.
• Where it comes from. Early experiences of criticism, shame or being left out, and how they still colour what you expect.
• Trying something different. The therapist also encourages you to face situations you avoid.

It is less structured than CBT. There are fewer worksheets and more open conversation.

Why people choose it

• You want to understand why, not just change what you do.
• Your social anxiety is tied up with shame or self-worth. On Reddit, some people say a change in how they saw their own worth was their turning point. That is what people report, not a trial result.
• CBT did not suit you, or it helped but left something unresolved.

What the evidence shows

• The largest trial. In a German trial of 495 people, called SOPHO-NET, both psychodynamic therapy and CBT helped much more than waiting.
  • At the end of treatment, 26% were in remission after psychodynamic therapy, 36% after CBT, and 9% after waiting. Remission means the symptoms dropped below the level of the disorder.
  • About half (52%) had a clear improvement (response) after psychodynamic therapy, compared with 60% after CBT and 15% after waiting.
  • The differences between the two therapies were small. The CBT in this trial followed the same model as cognitive therapy made for social anxiety.
• Two years later, they were level. In the follow-up, about 70% had responded and nearly 40% were in remission in both groups. Gains held or grew. There were no clear differences after 6 months.
• The big comparison. A study that combined 101 trials found a moderate difference between psychodynamic therapy and waiting. Individual CBT had a larger effect.
• An online version helped in Sweden. In a trial of 181 people, guided internet psychodynamic therapy helped much more than waiting, with a large difference. An unguided version helped too, but less.

What the trials have not answered

• Most of the evidence comes from one large trial in Germany and one online trial in Sweden.

How to get it

Psychodynamic therapists are common in many countries, but few have training in the short-term approach for social anxiety. Ask:

• “Have you treated social anxiety before?”
• “Is this a time-limited therapy with a clear focus?”
• “Will we also work on the situations I avoid?”

If you have a free choice, CBT made for social anxiety has more evidence. If psychodynamic therapy is what you are drawn to, it is a reasonable, tested option.