Why Do I Keep Repeating the Same Patterns? How Psychodynamic Therapy Uncovers the Roots of Your Struggles

Psychodynamic therapy is a phrase you’ve may have heard of and wondered what it looks like in practice. As an art therapist, psychodynamic theory is at the core of my training and is a framework I feel at home in. It seeks to understand what is driving our actions by bringing unconscious patterns into awareness. Once we understand those underlying forces, we can make different choices that lead to a more fulfilling life.

I’ve had a few helpful therapists, but one therapist specialized in psychodynamic therapy. The work we did was truly transformative by helping me understand my past experiences through a new lens. I am so much more aware of what’s happening in my inner world and can better handle my emotions when I’m feeling triggered. I can name them, take a breath, and respond to the situation from a much more grounded place.

Psychodynamic therapy explores your past and takes that information to help you make changes in your present life. Psychodynamic therapy is an approach I use in my Philadelphia-based practice to help LGBTQ folks understand the unconscious forces that shape their minds and actions. Once we name these underlying patterns, we can bring them into awareness and address the core messages they hold about who you are.

Understanding Why We Repeat Patterns

I’ve noticed that a lot of mental health struggles manifest in our relationships, whether familial or romantic. Perhaps you stay in relationships beyond their expiration date, because you keep hoping for the other person to change. When you zoom out, you notice that your past 3 relationships had the same issue.

Social norms can put pressure on us to act in ways that are not aligned with who you are.  When you combine that with early childhood experiences, you can get caught up in a cycle of anxiety and burnout. Maybe you applied for a high-profile job because it looks impressive and it’s what you’re “supposed” to do. Three months in, you’re burned out and depressed because it’s not what you want. Or maybe you avoid opportunities that you might enjoy because a part of you is afraid of facing rejection. Neither of these reasons is a conscious thought you have. Instead, you might be thinking “what is wrong with me?” and “why do I keep doing this?”

These repetitive patterns aren't signs of weakness or failure. They're your psyche's way of trying to work through unresolved experiences from your past. In psychodynamic therapy, we understand that much of what drives our behavior operates beneath our conscious awareness. The patterns you keep repeating often serve a purpose, even when that purpose no longer makes sense in your current life.

Relationships Heal

 Our past experiences carry pain, and that can manifest in our current relationships without us realizing it. This is exactly why the relationship that you and I create becomes the most important tool in our work together. Your relational patterns will ultimately come out in the interactions we have in the therapy room, which gives us so much valuable information. Psychodynamic therapy is truly a unique experience for each person that I work with. It’s not one size fits all because every relationship is different.

The Connection Between Patterns and Identity

For LGBTQ+ individuals, past experiences intersect with societal pressures and systems. Discrimination and daily microaggressions are taxing on a queer person’s psychological bandwidth. Unconscious patterns may also be survival tactics due to past trauma and emotional pain. Perhaps you learned to constantly scan for signs of disapproval, based on past experiences of rejection. Maybe you’re too afraid to correct someone who misgenders you because you don’t want to seem “difficult”.  Anti-trans legislation has forced you to suppress your needs in order to avoid being targeted.

Patterns and Eating Disorders

The connection between repetitive psychological patterns and eating disorders is particularly significant. Disordered eating behaviors often serve as a way to cope with overwhelming emotions, to feel a sense of control, or to express feelings that seem impossible to put into words. These behaviors can become deeply ingrained patterns that feel impossible to break, even when you understand intellectually that they're harmful.

I've found that psychodynamic therapy is a pathway to understanding the emotional needs that your eating disorder is trying to protect. Rather than simply focusing on food and eating behaviors, we explore the underlying feelings, beliefs, and relational patterns that drive these behaviors.

For queer and trans individuals, eating disorders often intersect with experiences of gender dysphoria and systemic oppression. Traditional eating disorder recovery approaches can sometimes feel alienating or miss these crucial connections. Psychodynamic therapy allows us to address these unique dimensions while still doing the deep work of understanding and transforming the patterns at the root of your struggles.

Here's what you can expect as we work together:

Building Awareness

In your first sessions, we’ll talk about what’s bringing you to therapy and what your hopes are for treatment. We’ll paint a vivid picture of how you want your life to feel, and we’ll expand beyond it. The first few sessions are a chance for us to build trust, so you can feel safe enough to open up in sessions.

Exploring the Origins of Your Struggles

Psychodynamic therapy involves you talking about past and present experiences. Together, we’ll create a timeline of your relationships, career struggles, and mental health concerns. I’ll help you narrow down 1-2 issues that feel the most important right now so we can create goals that feel aligned.

Listening Closely

When you share, I listen to what is being said and what’s not being said. Our minds want to protect us, and some of my clients avoid certain topics and get stuck on surface-level issues that prevent us from going deeper. My job is to notice when that happens and gently bring us back to the core issues. You might say something important and I might have us backtrack to and expand on it some more. I’ll ask questions and help you make connections between your past experiences and your current struggles.

Slowing Down and Tuning In

Psychodynamic therapy helps look inward and notice how we’re feeling in the present moment. The emotions that you experience in our therapy sessions are the clues to what is happening in your unconscious mind. I help you bring that into awareness by having you pause and name the emotions you’re feeling in that moment. My favorite questions to ask are “What do you notice as you share that with me right now?” and “How does it feel to say that aloud right now?” As you become more present in your mind and body, you gain more insight into your past.

If you struggle to notice feelings, I may ask you to notice sensations that you feel in your body, if that feels safe for you. Art therapy is a great way to tap into some of these experiences if naming emotions or body sensations doesn’t work for you.

Okay you have more insight. Now what?

Insight is great, but the work doesn’t stop there.  We’ll work on helping you make changes in your life based on your new awareness. Because psychodynamic therapy is relational, much of the healing happens by allowing yourself to experience the feelings you were previously closed off to. Our sessions can provide a safe container to experience those emotions and gradually experience vulnerability in a relationship. I can be the witness to that vulnerability and attune to your emotions in those moments. The next step is to take what you learned from our sessions and practice it with the people in your life.

Is Psychodynamic Therapy Right for You?

Psychodynamic therapy may be a good fit if you’re looking to understand your past more and find yourself repeating patterns that you can’t break. If skill-based therapies haven’t worked for you, or you’re looking for a different approach, psychodynamic therapy may be worth a try. Research shows that psychodynamic therapy can help with anxiety, depression, trauma, and some eating disorders.

Psychodynamic therapy requires commitment to the process. Change happens gradually, through consistent sessions over time. It's not always comfortable. Bringing unconscious material into awareness can stir up difficult feelings. But if you're ready to do this deeper work, the rewards can be profound.

Beginning Your Journey

If you're curious about psychodynamic therapy, I’d love to hear from you. This is an opportunity for us to connect, for you to ask questions, and for us both to get a sense of whether we'd be a good fit for working together.

You can book your consultation directly through my website. If we decide to move forward, we'll schedule your first session, and I'll send you information on setting up your client portal and completing the intake paperwork. In that first session, we'll talk about what's bringing you to therapy, what you hope to achieve, and begin to explore your story together.

Frequently Asked Questions About Psychodynamic Therapy

What makes psychodynamic therapy different from other types of therapy?

Psychodynamic therapy focuses on understanding the unconscious roots of your current struggles rather than primarily addressing surface-level symptoms. This approach explores how your past experiences, particularly early relationships and formative events, continue to influence your thoughts, feelings, and behaviors today. The goal is lasting change that comes from genuine insight and emotional processing, not just learning new coping techniques or thought patterns.

How long does psychodynamic therapy typically take to see results?

Psychodynamic therapy is generally a longer-term approach because meaningful change takes time when you're addressing deep-seated patterns. Many clients begin noticing increased self-awareness and subtle shifts within the first few months, while more substantial transformation often unfolds for over a year or more.The timeline varies based on individual circumstances, and we'll regularly check in about your progress and goals together.

Can psychodynamic therapy help with eating disorders?

Psychodynamic therapy can be a valuable approach for eating disorder recovery because it explores the underlying emotional needs and relational patterns that drive behaviors. Rather than focusing solely on food and eating, I’ll help you understand the past experiences that may be triggering your ED behaviors. I often integrate psychodynamic work with other modalities to provide comprehensive support for eating disorder recovery.

Is psychodynamic therapy effective for LGBTQ+ individuals?

Psychodynamic therapy can be particularly meaningful for LGBTQ+ individuals because it provides space to explore how identity, early experiences, and internalized messages have shaped your patterns. Many queer and trans people have developed protective mechanisms in response to living in a society that may not have affirmed their identity, and psychodynamic therapy helps bring these adaptations into awareness so they can be examined and transformed.

What happens during a psychodynamic therapy session?

Sessions typically involve open-ended conversation where you share whatever is on your mind, including recent experiences, memories, dreams, or feelings that arise in the moment. I listen for patterns, underlying emotions, and connections between past and present. I might offer reflections, draw attention to themes I notice, or explore what's happening in our therapeutic relationship. The process is collaborative and unfolds based on what emerges organically.

How is psychodynamic therapy different from psychoanalysis?

While psychodynamic therapy shares roots with psychoanalysis, it's generally more flexible and accessible. Psychoanalysis traditionally involves multiple sessions per week and can continue for many years, while psychodynamic therapy typically meets once weekly and can vary in duration. Both approaches value exploring the unconscious and understanding how the past influences the present, but psychodynamic therapy is adapted for contemporary needs and settings.

What if I don't remember much about my childhood?

Many people don't have clear memories of their early years, and that's perfectly normal. Psychodynamic therapy doesn't require detailed recall of your past. Instead, we work with what emerges naturally such as patterns in your current relationships and emotions that come to the surface in therapy. While we do discuss the past, the work centers on what you’re experiencing in the present moment.

Can psychodynamic therapy be combined with other therapeutic approaches?

Psychodynamic therapy provides a foundation that can be integrated with other modalities. In my practice, I often combine psychodynamic exploration with Internal Family Systems and art therapy. I use it to help LGBTQ people navigating eating disorder recovery, complex trauma, identity-related issues, and body image.

What should I look for in a psychodynamic therapist?

Finding the right therapist involves both professional qualifications and personal fit. Look for someone with specific training in psychodynamic approaches and experience working with concerns similar to yours. Equally important is feeling a sense of safety and connection with your therapist, as the therapeutic relationship is central to this work. I offer a free 20-minute consultation so we can both assess whether we'd be a good fit before committing to working together.

What are the pros and cons of psychodynamic therapy?

Psychodynamic therapy involves exploring past relationships and patterns, which can help build healthier connections with people in your current life. Psychodynamic therapy is holistic where we explore your whole self, rather than focusing on symptom management. It can lead to more self-awareness which can help you make decisions from a place of clarity. Psychodynamic therapy gets to the root of your struggles, which can lead to lasting change.

Psychodynamic therapy can be emotionally taxing because it can stir up memories and feelings that you weren’t previously aware of. This can create more distress in the short term and can feel uncomfortable. Psychodynamic therapy is a less structured approach where it relies on you talking, which may not work if you prefer more skills-based work.

Is psychodynamic therapy good for CPTSD?

Yes, psychodynamic therapy can be helpful for Complex PTSD and Attachment Trauma. Psychodynamic therapy addresses relational patterns that may have formed due to early childhood trauma and neglect. Attachment trauma can make it hard to feel safe in relationships, trust people, and maintain healthy boundaries. The relationship between you and your therapist becomes the tool through which you explore a safe, secure attachment. The therapeutic relationship becomes a container for you to recognize your patterns and work on making changes to implement in your personal relationships.

Psychodynamic therapy is also helpful in addressing low self-esteem associated with CPTSD. Therapy can help you address the origin of your negative self-talk and explore the core messages associated with it. Your inner critic may have originated from early traumatic experiences and making that connection can help you separate yourself from it.  

Which is better, CBT or psychodynamic?

Neither is better and it all depends on your specific goals. If you’re looking for structured, short-term work that targets current symptoms, then CBT may be right for you. CBT often involves homework in between sessions. CBT is known to be helpful for anxiety, phobias, and OCD.

Psychodynamic is a good fit if you’re experiencing relationship-based issues, complex trauma, or have a personality disorder. These concerns benefit from a relational approach like psychodynamic therapy. Psychodynamic therapy is a good fit if you prefer a less structured flow in sessions.