Relational Psychodynamic Therapy in Philadelphia

What Relational Psychodynamic Therapy Actually Is

Relational psychodynamic therapy is the contemporary form of the oldest tradition in psychotherapy, updated by six decades of research and clinical refinement into something that looks nothing like what most people picture when they think of “psychoanalysis.”

You are not lying on a couch. Your therapist is not silent. You are not analyzing dreams for hidden symbols. You are sitting across from another human being who is present, engaged, and trained to notice what is happening between the two of you in real time, because what happens between you is the material that matters most.

The approach rests on five core convictions:

• The relationship is the medicine. Across decades of psychotherapy outcome research, the single strongest predictor of whether therapy helps is not the brand of therapy but the quality of the relationship between you and your therapist. Relational psychodynamic therapy is designed around this finding. Your therapist is not a coach delivering a curriculum. They are a person who will become real to you, and you to them, and the texture of that relationship is itself how change happens.
• You are organized by your relational history, not by your symptoms. Depression, anxiety, chronic emptiness, self-sabotage, and relationship difficulty are usually not the problem. They are the visible expression of an underlying organization built from the relationships that formed you. Working at the level of symptoms can produce real relief, but it tends not to last when the underlying pattern remains intact. We work at the level of the pattern.
• The unconscious is real, and it is relational. Most of what runs your life is not in conscious words. It lives in implicit relational knowing: how you learned to expect to be received, what you learned to hide, what you learned was unsafe to need. Therapy brings that material into the room, where it becomes available for revision.
• The therapist’s subjectivity is part of the work. The classical analyst tried to be a neutral mirror. Decades of practice and research have shown that neutrality is neither possible nor therapeutic. A relational psychodynamic therapist is trained to notice their own reactions to you, to use those reactions as clinical information, and at carefully chosen moments, to share them. This is what clinicians mean by the therapist as participant-observer. The therapist is in the field with you, not above it.
• Patterns repeat in the room, and that is the point. The way you learned to manage closeness, the way you go quiet when something matters, the way you expect to be misunderstood or dismissed, all of it will eventually show up between you and your therapist. In a relational frame, this is not a problem to be analyzed from the outside. It is the moment the pattern becomes available to be lived through differently, together. This live, here-and-now work is what didactic and skills-based approaches cannot reach.

Where This Approach Comes From

Relational psychodynamic therapy did not appear from nowhere. It is the product of a 130-year lineage that began with Freud’s discovery of the unconscious and evolved decisively through four major developments.

Object relations theorists (W.R.D. Fairbairn, Donald Winnicott, Melanie Klein) argued in the mid-twentieth century that human beings are not primarily drive-seeking but relationship-seeking, in Fairbairn’s famous phrase, and that personality is built from internalized early relationships. Winnicott contributed the concepts of the holding environment (the reliable, attuned presence that allows a self to emerge), the true self and false self (the compliant facade that develops when a child’s authentic experience is not welcomed), and the good-enough mother (the insight that perfection is not the goal; healing happens through the rhythm of attunement, ordinary failure, and repair).

Heinz Kohut’s self psychology added that the self requires sustained mirroring (being seen and reflected), idealizing (having someone to look up to and draw strength from), and twinship (feeling a fundamental alikeness with others) across the entire lifespan. When these needs go unmet in childhood, the result is the chronic emptiness, shame, and hunger for validation that so many of our clients describe.

John Bowlby’s attachment theory provided the empirical scaffolding, demonstrating that the quality of early caregiving relationships creates internal working models that shape how we expect all relationships to function. Mary Ainsworth’s research operationalized this into observable attachment patterns, and Mary Main extended it to adults. The implications for therapy were profound: if relational patterns are formed in relationship, they can only be transformed in relationship.

The relational turn of the 1980s and 1990s was the decisive shift. Stephen A. Mitchell and Jay Greenberg proposed that all psychoanalytic ideas cluster into two incompatible models: a drive model (one-person psychology, the analyst as neutral observer) and a relational model (two-person psychology, the analyst as participant). Mitchell, Lewis Aron, and Jessica Benjamin, working primarily through the NYU Postdoctoral Program, built relational psychoanalysis into the dominant contemporary American school. Benjamin’s work on mutual recognition, Aron’s work on mutuality, and Robert Stolorow’s critique of “the myth of the isolated mind” reshaped how clinicians understand what happens in a session.

Philadelphia has its own institutional anchors in this tradition, including the Institute for Relational Psychoanalysis of Philadelphia and the Psychoanalytic Center of Philadelphia, which has trained clinicians since 1939. But few practices have translated this lineage into accessible, contemporary clinical care for everyday people seeking therapy. That gap is what Turning Leaf was built to fill.

How This Is Different From Other Approaches

People often ask how relational psychodynamic therapy compares to other forms of therapy. These comparisons matter because understanding the differences helps you choose what is right for your situation.

How It Differs From CBT

Cognitive Behavioral Therapy is structured, agenda-driven, often manualized, and typically delivered in 12 to 20 sessions. It focuses on what: the thoughts you are thinking, the behaviors you are doing, the symptoms you are tracking. For circumscribed problems with a clear behavioral component, such as a specific phobia, an OCD ritual, or panic disorder, CBT works well and there is good reason to use it.

Relational psychodynamic therapy asks why. Why this thought, why now, what relational history gave rise to it, what it is doing for you, who it has belonged to before. Where CBT changes the thought, depth work understands what the thought is protecting and provides conditions for it to become unnecessary.

The claim that CBT is “the evidence-based therapy” and psychodynamic work is not has been formally retired in the research literature. Steinert et al. (2017, American Journal of Psychiatry) used a formal equivalence test across 23 randomized controlled trials and found psychodynamic therapy statistically equivalent to CBT and other established treatments. The 2023 Leichsenring et al. umbrella review in World Psychiatry concluded that psychodynamic therapy warrants a strong recommendation for depressive, anxiety, personality, and somatic symptom disorders. The evidence base is not the question. The question is which approach matches what you need.

How It Differs From Classical Psychoanalysis

Classical psychoanalysis means four to five sessions per week, on the couch, with an analyst trained to remain comparatively neutral, often for many years. Relational psychodynamic therapy is not that. Sessions are face to face, weekly or twice weekly, with a therapist who is present and engaged. The theoretical foundation is shared. The intensity and structure differ. Most contemporary depth work in the United States is psychodynamic psychotherapy, not classical psychoanalysis, and that is what we offer.

How It Relates to EMDR

EMDR is a structured eight-phase trauma processing protocol with strong evidence for single-incident PTSD. At Turning Leaf, EMDR is a tool used inside the relational psychodynamic frame, not a replacement for it. EMDR addresses what happened. Relational work addresses what it meant about you, about others, and about being in relationship. For complex trauma, the combination is what makes the difference between symptom reduction and genuine healing.

How It Relates to IFS

Internal Family Systems shares more with relational psychodynamic therapy than most people realize. Both honor a non-unitary self and the power of the unconscious. IFS “parts” map closely onto concepts from object relations theory: exiles correspond to wounded internalized self-states, managers and firefighters to protective defenses, and Self to something close to Winnicott’s true self. The difference is emphasis. IFS centers on intrapsychic self-leadership. Relational psychodynamic therapy centers on intersubjectivity, the live relationship between you and your therapist as the laboratory for change. Many of our clinicians integrate IFS techniques within the relational frame.

How It Differs From Skills-Based Approaches (DBT, ACT)

DBT was designed for severe emotion dysregulation and builds affect-regulation scaffolding. ACT builds psychological flexibility through acceptance and values clarification. Both are valuable and both manage symptoms. Relational psychodynamic therapy transforms the underlying organization that produced the symptoms. Some clients benefit from sequencing these approaches: stabilization through skills work, then depth work to address the root.

The Concepts Your Therapist Works With

You do not need to know any of this vocabulary to do the work. But seeing what we mean when we use these terms can help the process feel less opaque.

• Transference. The way your characteristic patterns of expecting and engaging others show up in real time with your therapist, who is part of how it shows up. You might begin to experience your therapist as critical, even when they are not being critical, because your nervous system learned to expect criticism from the people it depended on. That is not a distortion. It is information about how your relational world is organized.
• Countertransference. Your therapist’s full emotional response to you, used as clinical information rather than treated as an obstacle. If your therapist notices they feel careful around you, or protective of you, or subtly pushed away, those reactions often mirror the relational dynamics you produce in the world outside the room.
• Enactments. Moments when an old relational pattern gets played out between you and your therapist, often before either of you fully recognizes it. A client whose parents were dismissive may begin to dismiss the therapist’s observations. A client who learned to caretake may worry about their therapist’s wellbeing. Working through enactments is where some of the deepest change happens, because the unspoken pattern becomes shared, conscious, and revisable.
• Repetition compulsion. The unconscious tendency to repeat painful patterns in love, work, and family. People repeat what is familiar even when familiar is painful, because familiarity is a form of survival. Understanding why you keep recreating the same relational dynamics is the first step toward creating different ones.
• Defenses as adaptations. Hypervigilance, intellectualization, people-pleasing, withdrawal, perfectionism. These are not pathology. They are intelligent solutions a younger version of you found to a real situation. Therapy does not strip them away. It makes them understandable, lowers their cost, and makes other possibilities available.
• Rupture and repair. Research by Jeremy Safran and J. Christopher Muran has shown that successful repair of inevitable misattunements between client and therapist is one of the most reliable predictors of outcome. Therapy is not ruptureless connection. It is the experience that ruptures can be named, survived, and worked through together. For many clients, this is a genuinely new experience.
• The corrective emotional experience. Healing through the actual experience of being met, witnessed, and responded to in ways your early caregivers could not provide. In contemporary relational practice, this is not engineered by the therapist. It happens because a real, repeated, attuned relationship offers something the original ones did not.

What the Evidence Shows

The claim that psychodynamic therapy lacks empirical support is no longer credible. The following findings represent the strongest evidence in the field.

• Jonathan Shedler’s landmark 2010 review in the American Psychologist found that psychodynamic therapy produces effect sizes of 0.97 at termination, growing to 1.51 at long-term follow-up. This growth after therapy ends is called the sleeper effect: patients continue to improve after psychodynamic therapy concludes, in a way not consistently observed after symptom-focused treatments. For comparison, the typical effect size for antidepressant medication is approximately 0.31.
• The Tavistock Adult Depression Study (Fonagy et al., 2015, World Psychiatry) tested long-term psychoanalytic psychotherapy for treatment-resistant depression, patients who had been depressed for at least two years and failed at least two prior treatments. At the 42-month follow-up, partial remission rates were 30 percent in the psychoanalytic group versus 4.4 percent in treatment as usual. For a population that conventional approaches had already failed, these results are remarkable.
• Driessen et al. (2010, 2015, Clinical Psychology Review) found short-term psychodynamic psychotherapy significantly more effective than control conditions for depression, with within-group effect sizes of 1.34, and concluded that it does not differ from other psychotherapies on depression outcomes.
• Leichsenring and Rabung (2008, JAMA; 2011, British Journal of Psychiatry) demonstrated that long-term psychodynamic psychotherapy is superior to less intensive forms of psychotherapy for complex mental disorders, including personality disorders and chronic depression.
• Steinert et al. (2017, American Journal of Psychiatry) conducted a formal equivalence test across 23 randomized controlled trials and found psychodynamic therapy statistically equivalent to CBT and other established treatments.
• Leichsenring et al. (2023, World Psychiatry) published an umbrella review using updated empirically supported treatment criteria and concluded that psychodynamic therapy warrants a strong recommendation for depressive, anxiety, personality, and somatic symptom disorders.
• The APA’s 2012 Resolution on Psychotherapy Effectiveness, adopted by the Council of Representatives, explicitly recognizes that therapy benefits “often endure, but continue to improve following therapy completion,” citing Shedler’s work.
• When patients are given a real choice, they often choose depth. Markowitz et al. (2016) found that 50 percent of chronic PTSD patients preferred a relationally oriented treatment versus 26 percent who preferred a CBT-based exposure protocol. People who understand their options often choose the relationship.

What Sessions Actually Look Like

Sessions are 50 minutes, weekly or twice weekly, face to face, in our Old City office at 123 Chestnut Street, Suite 304, or via secure telehealth for anyone in Pennsylvania. There is no homework. There are no worksheets. There is no agenda we hand you at the door.

You begin with what is on your mind. Your therapist follows. They listen for what is being said, what is not being said, what shows up in the texture of how you are speaking, what arises between you. Over time, themes appear. Patterns become visible. Material that has been outside your awareness comes forward. Your therapist names things, asks questions, sometimes shares their own reaction to what is happening. The work is conversational, but the listening underneath is trained and specific.

The therapy is open-ended. Most depth work runs from one to several years. Some clients with more contained presentations finish in less. We do not promise an arbitrary number of sessions because the goal is not symptom suppression on a deadline. The goal is structural change in how you are organized, change that, on the evidence, tends to deepen after therapy ends.

Why does it take longer than 12 sessions? Because the patterns that brought you here were learned over years inside relationships that mattered, and the new patterns will be learned the same way. Character is not built in eight sessions and does not reorganize in eight sessions.

Why This Approach, Why Now

Something has shifted in the broader culture around therapy. Bessel van der Kolk’s The Body Keeps the Score has spent over 376 weeks on the New York Times bestseller list and sold more than three million copies, teaching a generation that trauma lives in the body and implicit memory, not in the rational mind. Lori Gottlieb’s Maybe You Should Talk to Someone showed the public what depth therapy actually looks like from the inside. Attached by Levine and Heller, No Bad Parts by Richard Schwartz, and Pete Walker’s Complex PTSD are perennial bestsellers. Attachment theory, inner child work, parts work, and “why am I like this” content have generated hundreds of millions of views on social media.

The vocabulary the public has absorbed (attachment, parts, the unconscious, intergenerational trauma, the therapeutic relationship) is psychodynamic vocabulary. The frameworks people are searching for are the ones this tradition has been refining for over a century.

At the same time, there is growing dissatisfaction with manualized, short-term, “toolbox” therapy. Many of the clients who walk through our door arrive having tried something else first. They did CBT and found the worksheets did not reach the deeper thing. They read every attachment book and watched every video and still cannot change the pattern. They want therapy that takes them seriously as people with histories, not as disorders with protocols.

That is what we do here.