Psychodynamic psychotherapy with trainee psychiatrist

[OrangeCarrot]

I’ve been offered 9-12 months of psychodynamic therapy with a trainee psychiatrist on the NHS.

I have accepted it. I’m aware the therapist isn’t fully trained and the risks of this. I’ve always wondered about this type of therapy but knew I could never afford it so I am keen to try this.

I’m struggling with anxiety and other issues that affect my work and relationships. I’ve also suffered trauma in the past.

I met with my therapist a few weeks ago for an initial meeting to just sort out when and where we would be seeing each other and to set a start date. They warned me that this is a slow longer term therapy and that things may get difficult during it and I could feel worse at times. They explained what this type of therapy involves and told me that it would be very much led by me and that they will, for example, avoid chit chat and allow me to start speaking at the start of sessions. They said that I may develop a range of feelings towards them that may or may not reflect past relationships in my life and that this may help me understand my unconscious better and that this is part of the process. They asked that if I struggled with my feelings about anything or towards them that I try to bring it to the sessions to explore. They said they will never be judgemental but instead would like to explore the thoughts and feelings that are brought up.

I must say, it was nice to hear them acknowledge this prior to starting. I naturally already have my preconceptions and worries about them as a therapist and talking about it made me feel that I might be able to bring these things up in time.

I’m due to properly commence the therapy soon and I am apprehensive.

Has anyone had anything similar to this that could give me some wise words? How can I make the most of this experience? Where do I even begin? How will I know if it is working?

My psychiatrist integrates elements of psychodynamic therapy into his work (although I mainly only know that because he tells me). The very key thing is that there is trust in the relationship. It can take a while to develop but also can be shattered in an instant - my psychiatrist and I have both had to work hard at repairing the therapeutic relationship at times.

If you don’t mind me asking, how was the trust formed and how was it damaged?

The only thing I would be wary of is what happens when it ends. People can become very attached to the therapist with psychodynamic therapy and an ending before you are ready can be brutal. Because there is no strict structure to how it unfolds - you just bring your thoughts to the session - you and the therapist won't have a clear idea of where you will be in 9 to 12 months time.

Good for you.

I had this kind of therapy from an NHS trainee 40 years ago. It was life changing.

It's entirely normal to have those kinds of thoughts about it but as pp say, there aren't any answers at this point. Maybe learning to live with that kind of uncertainty is one of the benefits you might get from the process as it unfolds?

It may help you to bear in mind that a trainee will be even more closely supervised and supported than someone working independently so you have a bigger safety net than normal.

It sounds as if your first meeting has been more positive than you expected so you've set off on the right foot, even though you had no idea what to do or how it would go. You don't always need to see a long way ahead to make progress.

I get the impression that the therapists are meant to be some blank slate to project on. They don’t tell you about themselves… so I struggle to see how people get attached. I’m not doubting it happens but curious about how or why it does.

Wow I really appreciate your response. I hope I have a positive experience like you. I think I may update on how things go after the first proper session.

Do you mind me asking how it was life changing for you? What did you learn?

Sorry for the slow response to your question. I think trust has to be built over time; the therapeutic relationship I have now is very different to the start. Building trust required there to be the feeling that this was a safe space and that I could say whatever I wanted. A really important part of that for me was self-disclosure from my psychiatrist. Never in an inappropriate way but in a way that demonstrated this was a two-way relationship.

In terms of the trust being broken, there were a couple of incidents. The main one was when he felt I was a danger to myself and called my husband. I technically agreed to it but it wasn't really my choice and it damaged the relationship for a long time even if I acknowledge that he did the right thing.

I should add that it's been a very long term therapeutic relationship for a variety of reasons which probably makes a difference too.

They are a blank screen so they become different things to different people (it's hard to explain).
You become attached because they listen to you in a way that doesn't happen outside of therapy. They accept you for who you are and you are the centre of their attention. For many (most?) people who have psychodynamic therapy this is an unusual experience and one that you come to value hugely.
The therapist should prepare you for the ending and the adult side will understand that but you will also have a child side which may want to cling onto the therapist. This may not make much sense until you experience it.

@OrangeCarrot I don't mind you asking but it's a hard question to answer until you've experienced this sort of therapy. I suppose the short answer is that I experienced a fundamental shift in the way I saw myself, the world and my place in it. Some of this came about in lightbulb moments and some of it grew gradually, though on reflection it's probably true to say that the lightbulb moments were actually the recognition of things that had been growing slowly outside my conscious awareness.

In my experience, when a therapist says that the work is led by the client, they don't mean in the sense of 'the client has to know where they're going and if they don't, we won't be going anywhere'. It's more like 'I'll be on the lookout for tentative suggestions about where the client might want to go and I'll give them the opportunity to explore further, but I won't impose my ideas on them'. So it doesn't matter at all that you don't have a clear idea of where to start.

Hi @OrangeCarrot , and everyone else that kindly contributed to this thread.

I wondered if people would be willing to share insights they've gleaned whilst going through or after ending psychodynamic therapy?

I have been made a very similar offer by the NHS as the one you received @OrangeCarrot - 40 weeks of one to one sessions with a trainee therapist. The therapist is a qualified psychiatrist, I believe 5 years pqe, but is now undertaking further studies to qualify as a psychotherapist.

We had our initial meeting today, it was a type of contracting meeting, no therapy took place, we just talked through the logistics of the course of sessions. The meeting went very well, much better than I expected. I am however a little unnerved at how young the therapist looks, and the fact that they're still only at the half-way point of their studies/ training.

I realise now that I didn't explore in today's session what the expectations are for this therapy.

Could people share, what would be a reasonable expectation to harbour, how should I expect/ anticipate my life being different whilst I receive this ongoing therapy, and how different could my life look at the end of this 'treatment'. What should look different for me after receiving a 1 hour therapy session per week, for 40 weeks.?

@OrangeCarrot how did things go for you? I wondered if you ever felt that being seen by a trainee altered how effective the therapy was? Do you think your mental health is in a better place now than it was back in 2024? On reflection, could you share, what did the therapy offer you that wasn't available from elsewhere?

Gosh I've a million and one questions....

The questions I've posed to the OP, if anyone else has either in the recent past / or is currently going through similar psychodynamic/ person centred therapy, either through the NHS or privately, I'd love to hear about your experience.