An attentive listening to what eludes you, within a setting that makes speech possible
Psychodynamic and psychoanalytic psychotherapies share a core conviction: much of what shapes our experience — our choices, our recurring patterns in love and work, the symptoms that bring us to therapy — happens outside our awareness. The work consists in giving these hidden movements a place where they can be spoken, heard, and gradually understood.
The two terms are related but not identical. Psychoanalysis, in its classical form, is the most intensive expression of this work: usually several sessions per week, often with the patient on the couch, over a substantial period of time. Psychodynamic psychotherapy applies the same fundamental ideas in a more flexible format — often once or twice a week, face-to-face — and remains deeply attentive to the unconscious life of the patient.
What unites them is less a technique than a way of listening: one that takes the patient’s words seriously, including the ones that surprise them.
It would be reasonable to ask: with the pace of contemporary life, with so many efficient and well-researched approaches available, why undertake something that asks for time and reflection?
We would answer it the other way around. Because of the pace, the noise, and the constant demands for performance and self-presentation, many people find that quick interventions help them function but do not help them feel. The symptoms recede and return, sometimes in a different form. Something has been managed but not understood.
We hold this view alongside a sincere respect for other approaches. Cognitive, behavioural, humanistic, and systemic therapies all have their place and have helped many people. We are simply not pursuing the same goals or asking the same questions. Where another approach might focus on modifying a specific behaviour, we tend to ask what that behaviour is doing for the person, what it is saying, and what would need to be in place for it to be no longer necessary.
Psychodynamic psychotherapy was, for several decades, less systematically studied than some other approaches. That has changed substantially over the past twenty years. A large and growing body of randomised controlled trials and meta-analyses now demonstrates that psychodynamic and psychoanalytic psychotherapies are effective treatments for the most common mental health difficulties — depression, anxiety disorders, personality disorders, somatic conditions, and complex relational problems.
A 2023 umbrella review published in World Psychiatry — the official journal of the World Psychiatric Association and the most highly regarded in our field — concluded that psychodynamic therapy meets contemporary criteria as an empirically supported treatment for major mental disorders, with effect sizes comparable to those of other established psychotherapies. Systematic reviews of dozens of meta-analyses converge on the same essential finding: at the end of treatment, the great majority of studies do not show any difference in efficacy between psychodynamic therapies and other recognised psychotherapies.
But there is more. The more distinctive finding concerns what happens after treatment ends. A consistent observation across follow-up studies is that the benefits of psychodynamic work tend not only to be maintained, but in many cases to deepen over the months and years that follow. Patients continue to mature, to integrate what they have understood about themselves, and to make use of the work long after the last session. This is consistent with the underlying clinical aim: not to suppress symptoms, but to set in motion an ongoing process of psychological development.
For more complex or long-standing difficulties — chronic depression, personality disorders, profound relational suffering — longer treatments (often a year or more, with weekly or more frequent sessions) show meaningful advantages over briefer ones. This too is consistent with clinical experience: deeper changes ask for the time they ask for.
We share this evidence not to promote one approach over others, but to reassure: choosing this kind of work today is not a romantic preference for an older method. It is a clinically defensible choice, supported by a substantial and converging body of contemporary research.
In a psychodynamic or psychoanalytic psychotherapy, the patient is invited to speak as freely as possible — about what brings them, about whatever comes to mind, about the dreams, memories, and small daily incidents that might at first seem unworthy of mention. The psychologist listens with a particular kind of attention and offers, at the right moments, interventions that help the patient hear themselves differently.
This may sound simple. In practice, it is one of the most demanding and most liberating experiences available — precisely because it does not happen anywhere else in ordinary life.
Sessions take place at regular times, of regular duration, with the same psychologist. This stability is itself a working tool. Within a reliable frame, the patient can risk saying things they have never said, and patterns of relating that are usually invisible begin to appear in the relationship itself, where they can finally be examined.
In psychoanalysis proper, the patient generally lies on a couch, with the analyst out of direct sight. Far from being a relic, this arrangement has a precise function. Freed from monitoring the analyst’s face, the patient can speak more freely, follow their associations more deeply, and let their inner life surface with less self-censorship. Many patients are surprised to discover how different — and how much more honest — their speech becomes in this setting.
In face-to-face psychodynamic work, the couch is not usually used. Some curious patients do request it, however, and find it beneficial. Whatever the setting, the same orientation — toward free speech and careful listening — is preserved.
Patterns that have organised a life over decades — ways of loving, of working, of avoiding, of suffering — do not unravel in a few sessions. The first weeks of a therapy may bring real relief, sometimes considerable. But what we are working toward is a more durable change: not only feeling better, but understanding oneself well enough that one is no longer at the mercy of the same repetitions.
This takes time because it involves the whole person, not a targeted skill. It is closer to learning a language, or recovering from a long fatigue, than to fixing a specific malfunction.
That said, “taking time” does not mean “going on forever.” Every therapy has its own rhythm, its own questions, and its own end. We prepare for that end from the very first session.
Patients sometimes ask whether a session every two weeks would be enough. We try to be honest with them: most of the time, it is not.
A psychodynamic process depends on a certain continuity of thought between sessions. The patient leaves a session, something continues to work in them — a memory surfaces, a dream comes, a connection is made — and they bring this back the following week. With weekly sessions, this rhythm holds. With sessions every two weeks, much of the material in between is lost or smoothed over by ordinary life, and the sessions tend to become updates rather than working sessions.
For some patients, and for psychoanalysis in the strict sense, several sessions per week are appropriate. The increased frequency is not about doing “more therapy”; it allows unconscious processes to come closer to the surface and to be worked with as they appear, rather than only after they have been domesticated by reflection. For others, once a week is the right rhythm. We discuss this with each patient, based on what they are seeking and what the work itself is asking for.
It would be dishonest to promise a particular outcome — every patient’s path is their own. But certain things tend to emerge from a serious psychodynamic or psychoanalytic psychotherapy:
These are not slogans. They describe, in our experience, what tends to be there at the end of this work.
In psychodynamic and psychoanalytic psychotherapy, one never finishes learning. The clinical situations we encounter are too singular, and the human mind too inexhaustible, for any psychologist to consider their formation complete.
For this reason, the psychologists at Regroupement Psychologues Montréal are committed to continuous training: regular reading and study groups, ongoing personal supervision with senior colleagues, peer intervision among ourselves, participation in scientific events, and — for many of us — a personal analysis or psychotherapy. This is not an optional extra. It is part of what it means, for us, to take a patient seriously: to ensure that the listening they receive comes from someone who has done, and continues to do, that work themselves.
No. Many patients arrive with a clear concern — anxiety, depression, a relationship in crisis, an unbearable repetition. Others come because something feels off without being nameable, or because they want to understand themselves more deeply. Both are legitimate starting points. The work begins with whatever you bring.
In psychodynamic psychotherapy as we generally practise it, no — sessions are conducted face-to-face. The couch is specific to psychoanalysis proper, and is something that may be proposed and discussed at a particular point in the work, when both you and your psychologist consider it useful. It is never imposed.
Many people start with that doubt, and the work does not require that you adopt any particular theory. What matters is that you allow yourself to speak freely and to listen to what comes out. The unconscious is not an article of faith; it is, more modestly, the name we give to what shows up in our speech when we stop steering it. Most people discover this for themselves, on their own terms, in the course of the work.
Travel, illness, parental leave, financial pressures: these situations come up, and it matters to talk them through with your psychologist. A few missed sessions can usually be planned around easily. A longer pause calls for an agreed plan to resume. And sometimes, what at first looks like a simple external obstacle turns out, in the work, to be tied to something else — a moment of the therapy that is becoming harder, for example — and that, too, is something we can think about together. Your psychologist will help you sort it out.
Yes. Some patients begin once a week and, as the work deepens, find that an additional session would serve them. Others begin at a higher frequency and reduce it as a treatment moves toward its end. These adjustments are made together, in light of what the work seems to be asking for.
This is something you and your psychologist work toward together, and recognise together. There is no fixed criterion, but a sense usually emerges: the questions that brought you have settled into something more livable, or have been replaced by other questions that no longer require this particular setting to be addressed. Endings are themselves an important part of the therapy, and we give them the time and care they deserve.
Psychodynamic psychotherapy can be a valuable part of the treatment of severe difficulties, often in coordination with psychiatric care, medication, or other resources. In acute crisis, however, what is most needed first is stabilisation and safety. Your first contact with us will help determine whether psychodynamic work is the right starting point for you, or whether another step is more appropriate first. We will be honest with you about this.
For readers who would like to explore these ideas more deeply, here are a few starting points.
If something in these pages resonates — if you sense that what you are looking for is not a quick adjustment but a genuine conversation about your life — we would be glad to hear from you. A first meeting is an opportunity to ask your questions and to see whether this kind of work, and the psychologist who would meet you, feel right for you.
Phone: 514 - 497 - 8014
Email: info@psychologues-montreal.net
Address: 120-2222, René-Lévesque W, Montreal, H3H 1R6
Le Regroupement Psychologues Montréal inc. – Psychotherapists trained in the psychoanalytic approach, dedicated to your wellbeing.