Relational psychodynamic therapy in Philadelphia

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What relational psychodynamic therapy involves

Psychodynamic therapy explores emotions, recurring patterns and experiences that may be difficult to recognize or put into words. The relational approach also pays close attention to what happens between you and your therapist.

You might notice that you apologize for needing help, assume a question is criticism or hesitate to disagree. These moments can be discussed alongside what is happening outside therapy. Your therapist should be curious about your experience and willing to hear when their understanding is wrong.

This approach does not require treating every symptom as a hidden message or every difficulty as a childhood injury. Current relationships, health, work, culture and material pressures matter too. We can work toward relief now while exploring patterns you want to understand.

Research consistently links a good working alliance with better therapy outcomes across approaches. That supports taking the relationship seriously; it does not show that the relationship is the sole cause of improvement or that techniques do not matter.

Sources: Institute for Relational Psychoanalysis of Philadelphia: approach · Flückiger et al., 2018: therapeutic alliance and outcomes

Where the approach comes from

The approach developed from psychoanalysis and later traditions that gave greater attention to relationships. These are ways of thinking about experience, not settled explanations of every mind.

Relationships, self and attachment

Object-relations writers, including Melanie Klein, W. R. D. Fairbairn and D. W. Winnicott, explored how experiences with important people shape expectations of self and others. Winnicott's ideas about a holding environment and the capacity to feel real remain influential.

Heinz Kohut's self psychology emphasized recognition, belonging and the experience of being understood. Attachment theory, associated with John Bowlby, Mary Ainsworth and Mary Main, offers another perspective on closeness and security. These traditions overlap, but their concepts are not interchangeable or proof that early experiences determine a person's future.

Sources: Relational Psychoanalysis: The Emergence of a Tradition · APA dictionary: self psychology

The relational turn

Jay Greenberg and Stephen Mitchell's work helped organize the relational turn in the 1980s. Writers such as Lewis Aron and Jessica Benjamin further explored mutual influence and recognition; intersubjective theorists such as Robert Stolorow emphasized experience in context.

A practical implication is that the therapist is a participant, not an entirely neutral observer. Their choices and responses affect the conversation. That makes boundaries, accountability and attention to your perspective especially important. Philadelphia has a local training community, including the Institute for Relational Psychoanalysis of Philadelphia.

Sources: Institute for Relational Psychoanalysis of Philadelphia: approach · Relational Psychoanalysis: The Emergence of a Tradition

Attachment therapy →

Comparing approaches without ranking them

Different approaches offer different ways into a problem. Your preferences, the concern being treated, the evidence for that concern and the clinician's skills all matter.

Cognitive behavioral therapy

CBT often uses explicit goals, attention to thoughts and behavior, and practice between sessions. Psychodynamic work tends to spend more time exploring emotions, personal meaning and recurring relationship patterns. There is overlap: CBT can address history and beliefs, and psychodynamic therapy can be structured and focused. Research does not support dismissing CBT as a surface fix.

Sources: Steinert et al., 2017: comparative treatment evidence · Driessen et al., 2015: psychodynamic therapy for depression

Psychoanalysis

Psychodynamic therapy and psychoanalysis share a history. Psychoanalysis is generally more intensive and may involve more frequent sessions or use of a couch, but contemporary practice varies. Our usual individual appointments are face to face or by video, weekly or twice weekly as agreed.

EMDR and IFS

EMDR is a structured, memory-focused treatment with substantial PTSD evidence. Internal Family Systems uses parts language to explore inner conflict; its research base is still developing. Either may be incorporated by a clinician with relevant experience, when it fits your needs. They are distinct approaches, not simply renamed versions of psychodynamic concepts.

Source: VA: overview of psychotherapy for PTSD

EMDR therapy →Internal Family Systems →

DBT and ACT

Dialectical Behavior Therapy includes skills for handling intense emotions and relationships. Acceptance and Commitment Therapy works with psychological flexibility and values-guided action. Skills, behavior change and exploration of personal meaning can complement one another. Your therapist can explain why they suggest a particular element rather than treating it as a less meaningful stage of therapy.

Ideas you may encounter in sessions

You do not need to know the terminology. These ideas are useful only if they help make sense of your experience.

Transference and countertransference

Transference is a way of describing how expectations and feelings from other relationships may enter therapy. If you expect criticism, for example, you and your therapist can explore both that expectation and what the therapist actually said. A concern should not be dismissed as merely a reaction to your past.

Countertransference refers to the therapist's responses, which can include their own history and assumptions. They need to reflect on these responses and use supervision when appropriate. Their feelings are not proof of what you are like or how everyone else experiences you.

Source: APA: managing countertransference

Patterns and protective habits

Sometimes a familiar dynamic takes shape in the room: you might care for the therapist's feelings while leaving your own needs unspoken. Therapists may call this an enactment. It can be explored without making you responsible for the therapist's needs.

Repetition and defenses are terms for patterns and ways of managing difficult feelings. Perfectionism, people-pleasing, withdrawal or analyzing feelings from a distance may have served a purpose. We can ask whether that description fits, where the habit came from and what it costs now. It is not evidence that every such habit arose from trauma.

Misunderstandings, repair and new experiences

A therapist may misunderstand you, miss something or suggest a goal that does not fit. Discussing that strain can help clarify what needs to change. Research associates successful repair with better outcomes, but a difficult relationship is not automatically therapeutic.

A corrective emotional experience is the idea that something different can happen in a familiar situation: you disagree and are taken seriously, or ask for help without being shamed. This is a possible experience to work toward, not a guaranteed result or a reason to tolerate harmful treatment.

Source: Eubanks et al., 2018: alliance rupture and repair

What the evidence shows

Psychodynamic therapies have evidence for a range of adult concerns. A 2015 review supported short-term psychodynamic psychotherapy for depression. A 2017 analysis of 23 randomized trials found manual-guided psychodynamic treatments equivalent to established comparison treatments within the study's predefined margins. A 2023 umbrella review also found support across several common adult disorders.

Some studies find that improvement continues after treatment ends. That is encouraging, but it does not establish that psychodynamic gains always deepen or that this happens only with psychodynamic therapy. Studies vary in the treatment delivered, condition, comparison group and follow-up period.

One example is the Tavistock trial of 129 people with treatment-resistant depression. Long-term psychoanalytic psychotherapy was added to usual care. At the 42-month assessment, 30% of that group met the study's partial-remission threshold, compared with 4.4% receiving usual care alone. That was partial remission, not a cure rate, and the findings cannot predict an individual's outcome.

The evidence concerns particular therapies and populations. It does not mean every form of open-ended relational work has been tested, or that a longer course is always better. We should review whether your treatment is helping with the goals that matter to you.

Sources: Driessen et al., 2015: psychodynamic therapy for depression · Steinert et al., 2017: comparative treatment evidence · Leichsenring et al., 2023: review of psychodynamic evidence · Fonagy et al., 2015: treatment-resistant depression trial

What sessions can look like

Our individual sessions are 53 minutes. Weekly or twice-weekly meetings may be considered depending on your goals, clinical needs, schedule and payment arrangements. You can meet in our Old City office or ask about eligible video options.

You might begin with a recent argument, a dream, an uncomfortable feeling or something you have not been able to stop thinking about. Your therapist listens, asks questions and may offer a connection or interpretation for you to consider. You do not have to accept an interpretation because a therapist suggested it.

Sessions often leave room for what arises rather than following a fixed worksheet. Structure or practical exercises can still be useful when agreed together. We can work on immediate concerns without requiring that you first explain your whole history.

Treatment may be focused or open-ended. Some people want a shorter piece of work; others choose months or longer. You should understand what you are working toward and have opportunities to review progress, cost, frequency and whether another approach would help. Feeling worse or stuck is a reason to revisit the plan.

Telehealth details →Old City office →

When you know the pattern but still want help

Books, podcasts and social media may have given you words such as attachment, parts or emotional neglect. That language can help you describe a concern, but knowing a term does not tell you which treatment will be useful.

You may have benefited from previous therapy and want to continue in another direction. Or something about that treatment may not have fit. We can listen to what helped, what did not and what you want to be different this time, without assuming another approach was shallow or that you failed to use it correctly.

Our aim is a thoughtful, collaborative space in which you can understand yourself, address distress and make changes that matter outside the session. You do not need to commit to years of therapy to have that first conversation.

Getting started

1. Tell us what you are looking for. Our adaptive form asks about your concerns, schedule, in-person or video preference, and insurance or self-pay plans.
2. Talk through a therapist match. Our intake team reviews your request and follows up about fit, scheduling and payment. You can name a therapist you are interested in or ask us to help you choose.
3. Arrange your first appointment. Once a suitable match and appointment time are confirmed, you will receive the information you need to begin.

We aim to reply within 1 to 2 business days. A reply is the start of the conversation; the timing of a match and appointment depends on fit and current availability.

The first session is a clinical consultation to discuss what brings you in, ask questions and decide on a plan together.

How getting started works →Plan your office visit →

Costs and insurance for relational psychodynamic therapy

Individual-therapy fees generally range from $130 to $200 per session. Confirm your appointment fee with intake. With insurance, your cost depends on the specific plan, clinician, service and any deductible, copay or coinsurance.

Turning Leaf works with select Aetna, Blue Cross Blue Shield, UnitedHealthcare and Optum plans. The Blue Cross plans listed on our site include Highmark, Capital, Anthem, Anthem New York (formerly Empire), FEP and Horizon NJ. A carrier name alone does not confirm that an appointment is covered. Intake can help check your expected benefits and costs.

These approaches are provided within psychotherapy appointments. Coverage still depends on your plan, the proposed clinician, the service and any medical-necessity or authorization requirements. We commonly see copays of $15 to $50, but that practice-reported range is not a quote for your appointment; a deductible or coinsurance can change what you owe.

Independence Blue Cross, including Keystone Health Plan East, and Cigna are out of network. If your commercial plan has out-of-network benefits, we can provide a superbill on request. Ask your insurer about reimbursement rules and your share of the cost. Pennsylvania VCAP is a separate victim-compensation program; ask intake about using approved assistance for therapy.

We are not accepting new clients enrolled in Medicare or Medicaid, including Medicare Advantage, Pennsylvania Medical Assistance and NJ FamilyCare, even if they wish to pay privately. Please ask your plan for participating therapists. Existing clients whose coverage changes should contact their therapist and intake team.

Plans and coverage details →Rates and payment options →Pennsylvania VCAP →Medicare and Medicaid policy →

Frequently Asked Questions