Psychodynamic Therapy for Addiction Treatment: Techniques and Process

Last Updated: May 21, 2024

Ahmed Zayed, MD Authored by Dr. Ahmed Zayed
0 sources cited

Psychodynamic therapy is a type of in-depth psychoanalysis. It focuses on revealing an individual’s unconscious thoughts to alleviate mental tension and modify current behavior.

The psychodynamic model is based on the theory that a person’s past shapes their future. Thus, unconscious personal experiences have a profound effect on present mood and behavior and can potentially contribute to problems with self-esteem, relationships, and addiction.

The relationship between the client and therapist is of paramount importance in this form of treatment for drug addiction. Psychodynamic therapy techniques are adapted from psychotherapy; however, they are less intense in terms of frequency of visits. They are conducted in the individual, group, or family setting and at an institutional or organizational level.

Psychodynamic Theory Overview

The psychodynamic theory was first postulated by Sigmund Freud to better understand and explain the behavior of humans. This theory has been added to by other notable psychologists, such as Carl Jung, Anna Freud, and Erik Erikson.

The central element to the psychodynamic perspective is the notion that the behavior of humans is defined to a great extent by unconscious factors. The individual is unaware of these factors, yet they influence their emotions, their judgment, and the way they behave.

Man talking to his therapist during psychodynamic therapy.

The psychodynamic theory states that childhood experiences play a significant role in establishing these unconscious processes in the mind that stick around into adult life. It includes both positive and negative experiences as a child.

A concept called psychic determinism is included in this theory. It assumes that all behavior expressed in adult life has a cause or reason behind it, typically originating from childhood experiences.

The psychodynamic theory, while theoretical, also plays an immense role in psychotherapy. It can be utilized to treat mental health issues of patients, such as depression and anxiety symptoms.

What Does It Treat?

What is psychodynamic therapy used to treat? By teaching the addict to face underlying emotions, this form of therapy lowers the chances of relapse from addiction recovery.

In Addition to All Types of Addiction, It Is Also Helpful in Treating:

  • Adjustment disorders
  • Personality disorders
  • Post-traumatic stress disorder (PTSD)
  • Anxiety
  • Depression
  • Panic disorder

During sessions, the focus is on developing self-awareness by probing the inner psyche. The effects of the therapy on mental health can be felt even after the formal sessions have been discontinued. That is because recovering clients learn skills to evaluate their thoughts, look into their minds, and identify the reasons for current behaviors. This skill helps prevent substance abuse and relapse and also lead a generally happier and healthier life.

Psychodynamic Model of Addiction

Psychodynamic therapy is effective for people with substance abuse issues for many reasons. First, recovering addicts get in touch with unconscious feelings and emotions they are unaware of. The therapist uncovers feelings that are buried deep in the addict’s subconscious. The addict and the therapist work through the pain these feelings bring about. This psychotherapy teaches the addict skills to tolerate and cope with this pain.

Psychodynamic therapy session with a man.

This type of psychotherapy seeks answers to an addict’s current behaviors by delving into the past. The underlying principle of the psychodynamic model is that whether people are aware of it or not, the past influences the present. Past actions and the unconscious thought processes related to them can cause a recovering addict to perform harmful activities, which could, in turn, lead to a relapse of drug or alcohol use. By discovering the links between the past and the present, the therapist and client gain new insight into why certain behaviors occur at present.

Experiences in the client’s past, such as unresolved conflicts or problematic relationships, can manifest in the present without the person consciously realizing it. The therapy is helpful for people battling substance abuse because it identifies the underlying cause of addiction. During the sessions, the therapist works through the recovering addict’s emotions to reduce the chances of succumbing to alcohol or drugs. Deep-seated reasons for using illicit substances are uncovered. The addict is taught ways to manage the impulses that trigger abuse.

It teaches coping mechanisms for a healthier drug- or alcohol-free lifestyle. Several studies have shown that psychodynamic therapy is a valid and effective treatment for addiction with better outcomes than other therapies or no treatment.

Psychodynamic Therapy Techniques, Approaches & Principles

The key principle of the therapy is that unconscious maladaptive beliefs (inaccurate and unsupported thoughts) develop due to past experiences and cause behavioral difficulties in daily life. During sessions, the therapist attempts to reveal and resolve the unconscious conflicts that drive the triggers for substance abuse.

Some Techniques Used in Psychodynamic Therapy Include:

  • Interpretation: The therapist examines unconscious forces and thoughts from the psychodynamic perspective and discusses what they indicate. It helps a recovering addict interpret conscious thoughts and actions and their effect on addiction.
  • Free association: This is a Freudian technique where the client speaks for themselves instead of repeating the therapist’s ideas. A recovering addict is asked to talk about whatever comes to mind and encouraged to discuss psychological issues they feel strongly about. It helps develop trust between the client and the therapist.
  • Transference: This involves the redirection of unconscious emotions such as anger, shame, sadness, or dependency. Instead of remaining deeply buried in the addict’s psyche, feelings are transferred to the therapist. This is a unique approach that allows the therapist and the addict to analyze and explore emotions together.

Free association and transference help a recovering addict explore internalized problems and conflicts. Once the defense mechanisms are identified, the therapist helps the client work through them and develop insight to cope with triggers. The goal is to open up the individual’s psyche and develop a better understanding of how the past influences current actions.

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One of the key features of the psychodynamic model is to study the conflict between the conscious and unconscious mind. The idea is to work through painful memories and build strong alliances. Therapists help identify the defenses an individual has developed to avoid the unpleasant effects of this conflict. As the client-therapist relationship matures, past experiences re-emerge and can be analyzed.

Key Features of Psychodynamic Sessions

Establishing trust between the client and the therapist is essential to get to the root cause of addiction or other mental health problems. Recovering addicts who can develop a deep bond with their therapist usually obtain the best results. This treatment is highly interactive and is conducted over numerous sessions, typically over a long time.

It takes time for the therapist to discover the addict’s deepest thoughts. For this reason, treatment often takes longer than other types of psychotherapy. It is not unusual for a recovering addict to require up to three psychodynamic therapy sessions per week over several years.

Session Goals

The ultimate aim of each session is to teach the addict a new skill to eliminate the unconscious connections between past experiences and current-day triggers for substance abuse.

The therapist delves deep into the client’s psyche to reveal past-present associations. The path to recovery involves both client and therapist working together toward a life free from the influence of past conflicts. The goal is to get the addict to a point where they do not feel the need to use alcohol or drugs.

Therapist writing something while patient is lying on the couch.

During a session, a psychodynamic therapist sits facing the recovering addict and guides them through the recovery process. The conversation involves stepping into the client’s past and determining which unconscious thoughts affect current behavior and mental health problems. A vital component of the sessions is building a stable relationship where the recovering addict is relaxed and comfortable and able to share their deepest thoughts.

Pros And Cons Of The Psychodynamic Approach In Addiction Treatment

The psychodynamic approach has its followers and critics. They emit the following pros and cons:


  • Psychodynamic therapy techniques discover links between the client’s past and present
  • It gives a better understanding of the reason for present-day behaviors
  • It provides motivation to stop substance abuse
  • This treatment allows individuals to understand the root cause of their addiction
  • It is available through inpatient and outpatient rehab programs
  • Psychodynamic therapy teaches lifelong skills for staying sober and leading a fulfilling life


  • The psychodynamic approach belongs to long-term treatment, and it may take years for the effects to manifest
  • Standard insurance policies may not cover this form of psychotherapy, making it unaffordable for many substance abusers
  • Some individuals are not comfortable with the deeply personal nature of the treatment
  • It does not treat current symptoms. Instead, it focuses on the underlying reasons for drug or alcohol abuse
  • It does not eliminate the immediate risks that an addict may be putting themselves or those around them in

Choosing Psychodynamic Treatment

The psychodynamic model is different from other types of cognitive therapy or experiential therapy techniques. However, it comes with its benefits and can help recovering addicts deal with the causes of their drug use. Moreover, depression is a common symptom experienced after treatment for drug abuse. The psychodynamic approach can help deal not only with the addiction but with other unpleasant mental health problems that come with it.

A strong client-therapist relationship is critical because the procedure is only effective when the client feels comfortable in frankly and honestly sharing deep-seated emotions. This open, honest communication is vital to the success of psychodynamic therapy.

During times of the pandemic, many addicts may think they can’t get help. However, it is not true. Rehabs are open and ready to accept new patients and provide them with various forms of physical and psychological support. There will never be an appropriate time to start the recovery process, so the best time to start is now.

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Page Sources

  1. Boden, M. T., John, O. P., Goldin, P. R., Werner, K., Heimberg, R. G., & Gross, J. J. (2012). The role of maladaptive beliefs in cognitive-behavioral therapy: Evidence from social anxiety disorder. Behaviour research and therapy, 50(5), 287-291.
  2. Verma, M., & Vijayakrishnan, A. (2018). Psychoanalytic psychotherapy in addictive disorders. Indian journal of psychiatry, 60(Suppl 4), S485.
  4. Khantzian, E. J. (1986). A contemporary psychodynamic approach to drug abuse treatment. The American journal of drug and alcohol abuse, 12(3), 213-222.
  5. Deal, K. H. (2007). Psychodynamic theory. Advances in Social Work, 8(1), 184-195.
  6. Center for Substance Abuse Treatment. (1999). Brief interventions and brief therapies for substance abuse.

Published on: April 18th, 2018

Updated on: May 21st, 2024


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