Psychodynamic & Psychoanalytic Therapy

Part 1: The Western (International) Tradition

1. Origins and Historical Development

Psychodynamic therapy originates in Freud's psychoanalysis and has evolved over a century into a spectrum from classical analysis to modern dynamic psychotherapy. Its history is usually described in terms of successive developments.

In brief: psychoanalysis understands psychological suffering as the re-enactment of unconscious conflict, internal object relations, and early experience in the present. Treatment uses free association, transference analysis, and interpretation to help the client "re-know relationships within the relationship," and thereby work through, integrate, and grow.

2. Key Figures and Contributions

The development of psychodynamic therapy was shaped by remarkable scientists and clinicians. Each figure contributed a distinctive idea that still structures how it is taught and practiced.

3. Core Principles and Mechanisms

The Unconscious and Psychic Structure

• The unconscious holds motives, wishes, fears, and memories outside awareness that continually shape feelings, decisions, and symptoms.
• The structural model describes id, ego, and superego in conflict and coordination.
• A symptom is often a compromise formation among desire, fear, and defense.

Early Relationships and Internal Objects

• Object relations: early interactions with caregivers become internal "self–object" representations that serve as templates for later relationships.
• Projective identification: unmanageable parts are projected onto others, who are then induced to act accordingly.
• Attachment patterns influence relationship models and reflective capacity.

Defense Mechanisms

Repression, denial, projection, displacement, rationalization, reaction formation, intellectualization, isolation of affect, regression, undoing, splitting, projective identification, sublimation, and more.

The Therapeutic Relationship

• Transference: the client displaces feelings and expectations from early significant figures onto the therapist — living material for understanding inner relationships.
• Countertransference: the therapist's emotional reactions are important information to be noticed and reflected on.
• Working alliance: the sense of collaboration is a common factor; the therapist offers empathy, acceptance, and boundaries.

Mechanisms of Change

• Insight and interpretation — making the unconscious conscious so patterns are seen.
• Corrective emotional experience — experiencing different interaction in a safe relationship, revising internal representations.
• Integration and working through — accepting split-off and denied parts.
• Internalization — internalizing the therapist's stability and care to build healthier self-functioning.
• Mentalization — understanding one's own and others' minds, reducing misreading and impulsivity.

Core points: Psychodynamic therapy asks "why am I like this?" — unconscious conflict, internal object relations, defenses, and transference; the therapeutic relationship itself is the medium of change; mechanisms include insight, corrective emotional experience, integration, internalization, and mentalization.

4. Key Techniques and Methods

Classical Techniques

• Free association: expressing whatever arises without censorship, to approach the unconscious.
• Dream analysis: exploring the latent meaning behind the manifest dream.
• Interpretation: explaining resistance, defenses, transference, and content.
• Clarification and confrontation: gently clarifying ambiguity and pointing out contradictions and avoidance.
• Working through: repeatedly exploring the same conflict until it truly "lands."

The Treatment Frame

Frequency, duration, confidentiality, neutrality, abstinence, and anonymity form the frame, which is itself a "holding" and boundary; breaches (late arrival, early departure, fees) are often important clinical material.

Short-Term and Structured Dynamic Therapies

• Supportive–expressive therapy (Luborsky).
• Short-term dynamic psychotherapy (Malan, Sifneos): focus on a single core conflict, time-limited.
• Transference-focused psychotherapy (TFP): addresses splitting and projective identification in transference, for borderline personality disorder.
• Mentalization-based treatment (MBT): focuses on reflective function and attachment, widely used for borderline personality and self-harm.

Other

Child play therapy (Klein, Winnicott tradition), dynamic group therapy, and integrative orientations (attachment, interpersonal, emotion-focused).

5. Evidence and Indications

Shedler's (2010) meta-analysis, mainly of long-term psychodynamic therapy, found large effect sizes for depression and anxiety, with effects sustained or even strengthening at follow-up; short-term dynamic therapy shows medium effects. Other meta-analyses (e.g., Driessen 2015 for depression; Abbass 2013 for short-term dynamic RCTs) support its effectiveness, often comparable to CBT.

Evidence supports its use for borderline personality disorder (TFP, MBT), depression, anxiety, and psychosomatic symptoms. Criticisms include heterogeneity due to fewer manuals, fewer trials than CBT, and concerns about quality and observer bias.

Indications (approximate): depression, GAD, panic, social anxiety, personality disorders (especially borderline via TFP/MBT), eating disorders, psychosomatic symptoms; possibly trauma/PTSD (with trauma-informed or exposure components), substance use, chronic pain; caution with severe acute psychosis, severe mania, or high suicide risk, where stabilization and medication/crisis management come first.

6. Applications and Special Populations

Children and adolescents (play therapy, parent involvement, attachment and mentalization); borderline and personality disorders (TFP, MBT); adult depression and anxiety; older adults (bereavement, chronic illness, meaning); perinatal (postpartum emotion and attachment); chronic physical illness (psychosomatic and illness adaptation).

7. Training, Certification, and Career (International)

Dynamic training typically includes personal analysis, supervision, and systematic theory/clinical courses. In practice:

• Personal analysis: a serious psychodynamic/psychoanalytic path almost always requires your own personal analysis, often hundreds of hours (50-minute sessions, usually multiple times per week), before and during training.
• Supervision: extensive supervision of your own cases, often with several supervisors, over a sustained period; the number of supervised cases and hours is a key criterion.
• Coursework and examination: systematic theory and clinical seminars plus a case-based examination. The International Psychoanalytical Association (IPA) member path, for instance, requires hundreds of hours of personal analysis and supervision and a formal case examination.
• Frameworks and duration: psychoanalytic institutes and clinics in Europe and the US (e.g., Tavistock, Anna Freud Centre, IPA-affiliated institutes) are mature but typically take many years. Credentialing is decentralized — professional identity often rests on "trained analyst + society membership + ongoing supervision."

Career settings: long-term outpatient private practice, psychoanalytic institutes and clinics, child/adolescent or parent-infant work, and some hospital or community settings. Unlike manualized CBT, dynamic work is harder to scale into brief, digital, or stepped-care programs; it depends more on the practitioner's personal capacity and reputation.

8. Further Resources (International)

Classics: Freud's Interpretation of Dreams, Studies on Hysteria, Introductory Lectures; Winnicott's Playing and Reality; Kohut's The Analysis of the Self; Kernberg's Object Relations Theory and Clinical Psychoanalysis; McWilliams' Psychoanalytic Diagnosis and Psychoanalytic Psychotherapy; Bateman & Fonagy's Mentalization-Based Treatment for Personality Disorders; Gabbard's Long-Term Psychodynamic Psychotherapy.

Journals: Journal of the American Psychoanalytic Association; International Journal of Psychoanalysis; Psychoanalytic Psychology; Psychodynamic Psychotherapy.

Organizations: IPA (ipa.org); APsaA (apsa.org); APA Division 39; Anna Freud Centre; Tavistock.

Evidence sources: PubMed, Cochrane, APA Division 12.

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Part 2: The Development in China

Psychoanalysis entered China in the early 20th century as a cultural current, without forming an institutionalized clinical discipline; after the reform and opening, it gradually moved toward clinical practice and systematization through localization and international training.

1. Introduction in the Republican Era

In 1914, Qian Zhixiu published "The Study of Dreams" in Eastern Miscellany, one of the earliest Chinese articles on psychoanalysis. Gao Juefu (1896–1993) was the pioneer of systematic translation: in 1925 he translated Freud's Clark lectures as The Origin and Development of Psychoanalysis, and in 1930 and 1936 he translated Introductory Lectures on Psychoanalysis and New Introductory Lectures. In the 1930s, Zhang Shizhao and Zhu Guangqian also promoted Freud's ideas. This period was mainly academic translation, with no clinical practice system.

2. 1949–1978: The Interruption

After 1949, under ideological transformation and full Sovietization of academia, psychoanalysis entered nearly 30 years of stagnation, divided into three stages.

1949–1965: ideological criticism and marginalization. Psychology and psychiatry followed Marxism-Leninism and Pavlov's higher-nervous-activity theory. Freud's psychoanalysis was labeled bourgeois idealism and "pan-sexualism" and was systematically criticized and expelled from mainstream academia and clinic. In the late 1950s, psychiatry developed a "rapid composite therapy" for neurasthenia (medication, exercise, group education, supportive intervention) grounded in Pavlovian theory. A few psychiatrists with early exposure to psychoanalysis (e.g., Zhong Youbin, Wang Jingxiang) privately tried psychoanalytic-oriented treatment of neurosis in the early 1960s, without large-scale public practice.

1966–1977: the Cultural Revolution blank. Psychology was labeled a pseudoscience; university departments were abolished, courses stopped, research institutes dissolved, and most professionals were sent to labor. Clinical work turned entirely to the biomedical model and political work; psychotherapy was wholly negated; 1966–1977 saw published psychoanalytic papers and books almost vanish, with institutional research and practice fully halted (except a few internal materials). In the mid-1970s, Zhong Youbin and others secretly continued psychoanalytically based treatment, preserving a seed for recovery.

Recovery from 1978. Psychology departments were restored and translations republished. In 1981 Zhong Youbin opened a psychological clinic at Shougang Hospital; in 1988 Chinese Psychoanalysis: Cognitive Insight Psychotherapy was published, marking the maturity of a localized psychoanalytic approach; the same year the first Sino-German psychotherapy workshop was held in Kunming, opening international training.

3. Overview of International Training Programs

The so-called "China-X classes" are continuous, systematic programs led by psychoanalysts from the corresponding country and following IPA standards.

4. Sino-British Child & Adolescent Program

This college-style, three-year (six-phase) program follows the British Psychoanalytic Association training system and focuses on child/adolescent psychoanalysis and mentalization. Lead organizers: National Foreign Experts Bureau "psychoanalysis demonstration unit," Beijing Anding Hospital, Chinese Mental Health Association, Peking University Student Mental Health Center, and Capital Medical University clinical psychology department. International partners: the Anna Freud Centre and Birkbeck, University of London. Cohorts: 1st (2012–2015), 2nd (2015–2018), 3rd (2019–2021), 4th (2022–2025; some sources note 2023–2025 due to the pandemic). Related programs include infant observation, child/adolescent mentalization, Klein, and Winnicott workshops.

5. Sino-American Programs: Two Systems

Wuhan Sino-American advanced psychoanalytic training. Initiated in 2011 by Tong Jun of Wuhan Mental Health Center with Arnold and Arlene Richards; hosted by Wuhan Mental Health Center with academic support from the Chinese Mental Health Association psychoanalytic committee; partners include Columbia, the Horney Institute, Chicago Institute, and Washington psychoanalytic institutes. Model: three years, four sessions, eight days each, with self-psychology, object relations, female psychoanalysis, and supervision tracks. Seasons: 1st (2012–2015), 2nd (2015–2017), 3rd (2018–2021), 4th (2022–2025), 5th (2026–2029).

CAPA (Chinese American Psychoanalytic Alliance). Operates the earliest systematic Sino-American training; originated with Elise Snyder's 2001 visit, formally founded in the US in 2008 and entered China, with the CAPA China Committee (CIC) established in 2017. Layered training: two-year basic (from 2008), two-year advanced (first graduates 2013), "Marching Towards 1,000 Hours" (one-year, four cohorts), "Marching Towards 3,000 Hours" (two-year, three cohorts), plus infant observation, supervision, and teaching-assistant programs. Academic meetings: first CAPA-in-China conference in Chengdu (2023), second in 2025. (Cohort counts as of 2025, dynamic; confirm with the program.)

Other vertical Sino-American programs exist, e.g., dynamic couple and family therapy (3rd cohort 2013–2015, taught by the Scharffs).

6. Localized Therapy and Key Figures

Zhong Youbin's cognitive insight therapy (Zhong's Insight Therapy), explored from the 1960s and systematized in the 1980s, is regarded as a localized adaptation of psychoanalysis: it retains the ideas of the unconscious and defense mechanisms but combines them with Chinese social and life realities; through explanation, the client gains insight into and corrects the irrationality of symptoms.

7. Institutions and Regulation

The China Psychological Society clinical and counseling registration system (CPS, launched February 2007) offers registered assistant psychologist, psychologist, and supervisor credentials. The Chinese Mental Health Association psychoanalytic committee and its study groups (e.g., Zeng Qifeng as deputy head of the study group and central-China head) are key academic bodies. The Mental Health Law (2012, effective 2013) stipulates that counselors must not engage in psychotherapy or diagnosis/treatment of mental disorders, thereby separating counseling and psychotherapy and reinforcing the legal status of the psychological therapist (NHC health professional qualification).

8. Local Evidence and Research

China's randomized controlled research on psychodynamic therapy is still early. A landmark is the team of Qiu Jianyin at the Shanghai Mental Health Center, which conducted China's first multicenter randomized controlled trial of dynamic interpersonal therapy (DIT) for depression — protocol published in 2020 (Trials/PubMed 32703316), results in Psychological Medicine (2023), providing local RCT evidence. Psychodynamic therapy in China has long relied on cases, experience, and training outcomes, with fewer high-quality RCTs than CBT.

9. Further China Resources

Local works: Zhong Youbin's Chinese Psychoanalysis; translations by Zeng Qifeng, Zhang Peichao, Li Mengchao, Xu Jun; international journal columns/special issues on Chinese psychoanalysis. Organizations: CPS registration system; Chinese Mental Health Association psychoanalytic committee; IPA China study group (preparatory), hosted by Wuhan Mental Health Center (its site also calls itself the "British IPA Wuhan Representative Office," ipawh.cn); CAPA (capachina.org); Deutsche Gesellschaft fuer Psychotherapie (DCAP); university centers. Databases: PubMed, CNKI.

10. Development Timeline Overview

11. Choosing and Experiencing Psychodynamic Therapy in China

• Where to find a qualified therapist: look for a psychological therapist (NHC health qualification, in medical institutions) or a registered psychologist/supervisor under the CPS registration system, ideally someone with substantial personal analysis and ongoing supervision. Hospital outpatient clinics, university counseling centers, and community mental-health service stations are more regulated entry points; private practitioners vary, so ask about their training and supervision.
• Cost and time: dynamic work is typically open-ended, so it is usually a larger commitment of time and money than a limited course. A credible dynamic therapist should be able to explain the frame (frequency, duration, fee, confidentiality), how they handle breaks, and how they use supervision.
• What to expect: expect to talk about your life, feelings, and relationships, and sometimes to experience discomfort or silence. Progress is often felt gradually and relationally rather than as a quick symptom drop. If a "dynamic" session is only advice-giving or generic support with no frame or reflection, question whether it is truly a psychodynamic approach.
• Data note: program cohorts, editions, and fees change — verify with the current organizer (data as of 2025).

In one sentence: psychodynamic therapy has a century-long Western lineage from psychoanalysis through object relations, self psychology, attachment, and mentalization; in China it passed through Republican-era translation, the 1949–1978 interruption, localization via Zhong Youbin's cognitive insight therapy, and clinical systematization through Sino-German/Norwegian/British/American classes and CAPA — now with a CPS registration system, a psychoanalytic committee, the Mental Health Law, and Qiu Jianyin's first multicentered dynamic-depression RCT, though evidence and workforce scale still need strengthening.

Disclaimer: This overview is educational and does not replace professional training or individualized clinical judgment.