Can Psychodynamic Therapy Help PTSD?

Written by Thomas Day, Clinical Professional Counselor in Nevada

Traumatic experiences can alter the way people experience themselves, others, and the world around them. Some continue to experience intrusive memories, heightened vigilance, emotional numbing, nightmares, avoidance, or persistent feelings of shame and fear long after the event has ended.

Trauma also affects relationships, identity, emotional regulation, and the ability to feel safe with others. These difficulties may persist even after processing what happened and attempting to move forward.

My therapy approach offers an evidence-based mode of understanding and treating PTSD by addressing not only traumatic memories but also the deeper emotional and relational patterns that trauma often leaves behind.

Understanding PTSD

Post-traumatic stress disorder (PTSD) can develop after experiencing or witnessing actual or threatened death, serious injury, or sexual violence. Symptoms commonly include:

Intrusive memories or flashbacks
Nightmares
Avoidance of reminders of the trauma
Hypervigilance
An exaggerated startle response
Persistent feelings of danger
Emotional numbness
Irritability or anger
Difficulties with trust and intimacy

Not everyone who experiences trauma develops PTSD, and not all traumatic experiences produce the same emotional consequences. Developmental history, relationships, available support, and previous experiences all influence how trauma is processed.

Trauma Is More Than a Memory

Trauma is often thought of as something that happened in the past. While this is true, its effects are frequently experienced in the present.

Many individuals describe feeling as though their nervous system continues to respond as if the danger has not fully passed. Others notice recurring patterns of withdrawal, self-criticism, emotional overwhelm, or difficulty trusting people despite wanting close relationships.

Psychodynamic psychotherapy views these reactions not simply as isolated symptoms but as understandable adaptations to overwhelming experiences.

The Lasting Impact of Trauma

Trauma can influence many areas of psychological functioning:

Emotional regulation
Self-esteem
Relationships
Sense of identity
Expectations of others
Capacity for trust
Ability to tolerate vulnerability

When trauma occurs during childhood or within important relationships, its effects may become woven into a person’s expectations about themselves and others. These expectations often continue outside of awareness, shaping adult relationships and emotional responses.

PTSD and Complex Trauma

Although PTSD is a specific clinical diagnosis, many people experience the effects of repeated or prolonged trauma extending beyond the traditional symptom profile.

Complex trauma may result from experiences such as:

Childhood abuse
Emotional neglect
Chronic family conflict
Domestic violence
Repeated interpersonal betrayal
Long-term exposure to threatening or unpredictable environments

Individuals with complex trauma often struggle not only with fear but also with shame, emotional dysregulation, identity disturbance, chronic emptiness, or unstable relationships.

Understanding Emotional Patterns

Many reactions that once served a protective purpose continue long after they are needed.

Avoiding closeness, remaining constantly alert to danger, suppressing emotions, or assuming rejection may have developed as understandable adaptations to traumatic experiences. Therapy helps identify these patterns while exploring whether they continue to serve the individual’s current life.

Exploring Attachment

Inconsistent caregiving, abuse, or emotional neglect may have us longing for closeness while fearing vulnerability. These conflicting expectations can make relationships feel confusing or emotionally exhausting.

Psychodynamic psychotherapy explores how these attachment patterns developed and how they continue to influence present relationships.

Strengthening Emotional Regulation

Trauma can make emotions feel either overwhelming or inaccessible.

Rather than teaching emotional suppression, we will expand capabilities for experiencing, understanding, and regulating our emotions without becoming overwhelmed by them.

Working Through Shame

Many trauma survivors struggle with profound shame.

They may believe they were responsible for what happened, fundamentally damaged, or unworthy of care and connection. These beliefs often persist despite evidence to the contrary.

Psychodynamic psychotherapy explores how shame develops, how it influences current functioning, and how new emotional experiences can gradually reshape these deeply held beliefs.

The Therapeutic Relationship

One of the distinguishing features of psychodynamic psychotherapy is its attention to the therapeutic relationship.

Trauma often disrupts a person’s ability to trust others or expect consistent care. Within therapy, these expectations may naturally emerge.

The therapeutic relationship provides an opportunity to understand these patterns as they unfold while developing new experiences of safety, reliability, and emotional understanding.

This process is gradual and collaborative. Trust is not assumed; it is built over time.

Is Psychodynamic Therapy Evidence-Based for PTSD?

Yes.

Research supports psychodynamic psychotherapy as an effective treatment for PTSD and trauma-related difficulties. Studies have found meaningful improvements in PTSD symptoms, depression, interpersonal functioning, and overall psychological well-being.

There are multiple evidence-based treatments for PTSD, including trauma-focused cognitive behavioral therapies, Eye Movement Desensitization and Reprocessing (EMDR), and psychodynamic psychotherapy. The most appropriate treatment depends on the individual’s history, current difficulties, treatment goals, and preferences.

Is It Necessary to Talk About Every Detail?

A common concern is whether therapy requires repeatedly describing every aspect of a traumatic experience.

The answer is no.

While discussing aspects of the trauma may become important, psychodynamic psychotherapy does not require individuals to recount painful experiences before they feel ready. Therapy proceeds collaboratively, respecting each person’s pace and capacity to engage with difficult emotions.

The goal is not simply to revisit traumatic memories but to understand how trauma continues to influence present-day life.

Who Might Benefit?

Psychodynamic psychotherapy may be particularly helpful for individuals who:

Healing Beyond Symptom Reduction

Recovering from trauma involves more than reducing intrusive memories or anxiety. For many people, healing also means rebuilding trust, developing greater emotional flexibility, strengthening relationships, and reclaiming a more coherent sense of self.

While every person’s path is different, many individuals find that understanding the deeper effects of trauma allows them not only to experience fewer symptoms but also to live with greater freedom, resilience, and connection.

References

American Psychological Association. (2017). Clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults.
Leichsenring, F., Klein, S., & Salzer, S. (2014). The efficacy of psychodynamic psychotherapy in specific mental disorders: A 2013 update of empirical evidence. Contemporary Psychoanalysis, 50(1–2), 89–130.
Steinert, C., Munder, T., Rabung, S., Hoyer, J., & Leichsenring, F. (2017). Psychodynamic therapy: As efficacious as other empirically supported treatments? American Journal of Psychiatry, 174(10), 943–953.
Abbass, A., Town, J. M., & Driessen, E. (2020). Intensive short-term dynamic psychotherapy: A systematic review and meta-analysis of outcome research. Harvard Review of Psychiatry, 28(1), 1–15.