The basic idea
Some anxiety and depression make sense only once you see the pattern behind them. You may notice that you keep ending up in the same kind of relationship, that criticism from a boss lands like a blow from a parent, or that you shut down whenever you need something from someone. Insight-oriented therapy works on the "why" behind patterns like these.
It belongs to the psychodynamic tradition. Cleveland Clinic describes psychodynamic therapy as talk therapy in which you explore past thoughts, feelings and memories to see how they affect your life and personality today. The underlying theory is that present thoughts, feelings and actions are shaped by things you do not actively think about, many of them rooted in earlier experiences and relationships. Sometimes feelings or memories get pushed away because they are too hard to face, yet they keep influencing how you act. That, Cleveland Clinic notes, helps explain why people repeat certain behaviors or have unexpectedly strong emotions.
The aim is not insight for its own sake. Cleveland Clinic lists goals such as understanding yourself better, finding out what is causing stress, stopping harmful habits, improving self-esteem and strengthening relationships, with changes meant to last.
Insight work is not about blaming parents or reliving the past for its own sake. Cleveland Clinic frames the purpose as understanding yourself better so you can make healthier choices now. A useful test is whether what you learn in sessions changes something outside them: how you respond to a partner, how you speak to yourself after a mistake, or what you are willing to try.
What sessions are like
Sessions are less scripted than in some other therapies. Cleveland Clinic describes open-ended conversations in which you can say whatever comes to mind while the therapist listens closely and may guide you toward certain feelings or events. You might start by talking about a fight with your sister last weekend and find, over a few sessions, that it connects to a role you took on as a child.
You set the pace. Cleveland Clinic notes you can go as slowly as you need and do not have to share everything on the first day. Painful material is approached when you are ready, not forced.
The relationship with the therapist is part of the work. Cleveland Clinic stresses working with someone you trust, says it is fine to switch if you do not feel comfortable, and notes a risk of becoming too dependent on a therapist; a good therapist helps you build the confidence to handle things on your own.
Using it for anxiety and depression
Cleveland Clinic lists anxiety and depression among the conditions psychodynamic therapy is used for, along with trauma and coping with chronic illness, and notes it can be used together with medication. In England, the NHS includes dynamic interpersonal therapy, which helps you see how childhood experiences affect your relationships, among the talking therapies it offers for anxiety and depression.
For anxiety, insight work might ask what the worry is protecting you from, or what it learned from your history. For depression, it often looks at self-criticism, unresolved loss and relationships that leave you feeling unseen. Many people want both understanding and relief, which is why integrative therapists combine insight with practical coping skills.
What the research says
For years psychodynamic therapy had a reputation for lacking evidence. A 2010 review in American Psychologist by Jonathan Shedler argued that this did not match the data: effect sizes for psychodynamic therapy were as large as those reported for other therapies promoted as evidence-based, and patients tended to keep their gains and continue improving after treatment ended.
A 2023 umbrella review in World Psychiatry by Falk Leichsenring and colleagues looked at recent meta-analyses. It found high-quality evidence in depressive disorders and moderate-quality evidence in anxiety disorders that psychodynamic therapy works better than control conditions, and moderate-quality evidence that it is about as effective as other active therapies. The authors noted limitations, such as risk of bias, comparable to those of other evidence-based therapies.
NIMH's summary is more cautious. It names cognitive behavioral therapy and interpersonal therapy as evidence-based for depression and says psychodynamic therapy, used for a limited time, also may help some people. A fair reading is that several therapies help, no single approach fits everyone, and the fit between you, the approach and the therapist matters. Types of Therapy for Anxiety and Depression, Explained compares the main options.
Is it a good fit for you?
- You keep running into the same problem in different forms and want to understand why.
- Your mood or anxiety seems tied to family history, old losses or long-standing relationship patterns.
- You want more than symptom relief, such as a steadier sense of who you are.
- If what you want is a short, highly structured, skills-only program, ask any therapist whether a different approach would suit you better.
NIMH suggests asking any therapist about their approach, the reasoning and evidence behind it, the goals of treatment and how progress will be judged. Those questions apply here too.
Dr. Lehmann's approach
Dr. Lehmann describes her approach as insight-oriented and integrative. In practice that means looking at your history, family dynamics and current functioning, and combining that understanding with practical feedback and coping skills for daily life. She does not prescribe medication; therapy with her can sit alongside care from your physician or psychiatrist. Read more about depression therapy and anxiety therapy, or see What Therapy for Depression Looks Like With a Psychologist.