Psychodynamic Therapy
What Actually Changes When Therapy Goes Beyond Symptom Management
Los Angeles psychologists providing psychodynamic therapy online to physicians, executives, entrepreneurs, attorneys, and high achievers anywhere in California, Texas, and 40+ PSYPACT states.
If you’re looking for a psychodynamic therapist, one of two things is probably true.
Either you’ve tried therapy before and hit a ceiling with it. Or you’ve never been in therapy, but you already know you don’t want the version where someone hands you a worksheet every week and asks you to rate your mood on a scale of 1 to 10.
If it’s the first: maybe therapy helped for a while. You learned some skills, picked up useful language for what you were going through, and maybe felt a little better. But at some point, you noticed the same patterns kept showing up again.
The anxiety came back. The burnout crept back in. The relationship dynamics you thought you’d worked through start playing out again with a different person in a different context. Nothing was wrong with the therapy, per se. But it just didn’t go deep enough.
If it’s the second: trust that instinct. You’re right that therapy can do more than just manage symptoms on the surface. You don’t need someone to teach you how to think differently about your stress. You need someone who can help you understand why your stress keeps persisting, despite everything you’ve already tried.
Either way, you’re probably here because you want a therapist who can work with all of your complexities and nuances. Not someone who just addresses what’s on the surface of things, but instead, someone who helps you with what’s driving things underneath.
That’s what psychodynamic therapy is. And it’s the foundation of how we work at Helm Psychology.
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What Is Psychodynamic Therapy?
Psychodynamic therapy (also called psychodynamic psychotherapy) is a form of talk therapy that’s rooted in the idea that much of what drives your behavior, your relationships, your emotional life, and how you move through the world operates below your conscious awareness (and this goes for all of us, it’s just the nature of human existence).
In plainer terms: the way you react under pressure, the way you relate to authority, how you handle conflict or closeness or vulnerability, the things that keep you up at 2am even when everything in your life looks fine on paper.
These patterns didn’t come from nowhere. They were shaped by your early relationships, your family dynamics, the experiences you grew up with, and the beliefs that you absorbed about yourself and the world long before you had the language to name them, much less question them.
Psychodynamic therapy works by helping you see and understand these patterns, but understanding alone isn’t what changes these things. What changes things is the experience of actually feeling what’s likely been there all along.
A lot of people who come to us can already articulate their patterns perfectly. They know they have trouble asking for help. They know they tend to overwork in order to avoid sitting still. They can often describe the dynamics with their mother in precise clinical detail.
But knowing alone hasn’t been enough to change things. And that’s because knowing something in your head is different from feeling it in your mind and body. Psychodynamic therapy creates a space where you can:
Start to feel what you’ve been keeping at arm’s length
Put the urges to fix and explain things away on the proverbial shelf
Stay with things long enough for them to start softening and moving over time
In psychodynamic therapy at Helm Psychology, we don’t follow a set agenda or work from a manual. We follow what’s alive for you: what you’re noticing, what you’re feeling, what came up this week or what keeps coming up across years.
Sometimes that means talking through a situation at work. Sometimes it means sitting with a feeling that showed up in the room and doesn’t have words yet.
Over time, we start to see the threads that connect your present-day struggles to deeper material. And as those connections become visible, things start to shift.
More specifically, we practice relational psychodynamic therapy. This means that we also pay close attention to how patterns play out within the therapeutic relationship itself. How you show up with your therapist can often mirror how you show up in other parts of life. And working through those things, rather than seeing those dynamics and experiences as side quests, is one of the powerful things psychodynamic therapy can offer.
Why Psychodynamic Therapy for High Achievers?
We’ll be direct: most of the people we work with don’t need more coping strategies.
Most of the people we work with are physicians, executives, entrepreneurs, attorneys, and other kinds of high achievers more broadly. They are extraordinarily good at executing, problem-solving, and pushing through hard things.
But here’s the reality: if there was a quick fix for what they’re dealing with, they would have found it already, and it probably would have worked.
What psychodynamic therapy offers is something different. It gives you a space to look at the deeper patterns that your professional success may be sitting on top of, and to examine honestly whether those patterns are still serving you, or whether they’ve started running the show of your life in ways that no longer serve you.
Here’s what we mean. A lot of high achievers were the responsible one long before they ever had a title:
The kid who held it all together when things at home were uncertain
The one who figured out early that performance earned love, or at least earned some predictability
The one who learned to read the room with surgical precision, manage other people’s feelings (and chaos) effectively, and never be the problem
Those patterns work brilliantly in building a successful career. They get you into medical school, get you promoted, get you funded. But they can also make it incredibly hard to:
Rest without guilt
Ask for help
Tolerate imperfection
Be genuinely vulnerable with the people closest to you
Know what you actually want when nobody’s watching
Helm Psychology’s founder, Dr. Annia Raja, worked in management consulting at BCG and investment banking at Morgan Stanley before becoming a psychologist. Her spouse is a physician. And every clinician at Helm Psychology shares this kind of deep knowledge and expertise with high-stakes professional worlds. That firsthand understanding shapes how we work with every client at Helm.
We know from the inside what these high-pressure environments demand of people. And we’ve seen what happens when someone who’s been holding everything together for decades finally gets a space where they don’t have to.
Psychodynamic therapy is built for this kind of depth and complexity within you.
We’re not going to spend our time together reviewing your to-do list or practicing deep breathing (we’ve watched too many high achievers turn a breathing exercise into yet another optimization metric).
We’re going to go underneath the “doing,” and instead, work on moving towards “being” over time. We’ll get curious about the parts of you that your professional life has required you to set aside (or even altogether neglect). And we’ll look at why certain things keep feeling so hard, even when you’re objectively killing it by every external measure.
How Psychodynamic Therapy Is Different from CBT and Coaching
People ask us about this a lot, so we’ll be straightforward.
CBT and structured approaches typically work session by session with a set agenda. Worksheets, homework, skill-building exercises. The goal is symptom reduction as defined by diagnostic manuals within a defined timeframe. For some people and some problems, that works well.
But for many of the high-achieving professionals we work with, CBT ends up feeling like yet another task to optimize.
Sure, you do the homework. You learn the cognitive reframe. You can probably explain the cognitive distortion to someone else better than anyone. And yet the underlying dynamics haven’t really shifted.
That’s because the things under the surface aren’t necessarily a thinking error. It’s a way of being in the world that has been built over decades, living in your body, your relationships, and what happens inside you when you try to slow down.
Coaching is a different conversation altogether. Good coaching can help you perform better, think more strategically, lead more effectively. But coaching doesn’t meaningfully go where therapy can go. It doesn’t touch the unconscious. It doesn’t work with your history, your defenses, or the relational patterns that shape how you experience everything the way that therapy can.
Put simply:
CBT is about what’s wrong.
Coaching is about what’s next.
Psychodynamic therapy is about what’s underneath.
At Helm Psychology, we take a longer view. We’re not trying to fix a discrete symptom as fast as possible. Instead, we’re here to help you work towards changes that are longer lasting, rather than bandage on temporary patches that inevitably wear off over time and under pressure.
What Psychodynamic Therapy Actually Looks and Feels Like
People sometimes imagine psychodynamic therapy means lying on a couch in silence while someone takes notes behind you. But that’s a caricature. (Though we will probably talk about your parents at some point, because that stuff matters more than most people want to admit.)
What therapy sessions actually look like: you show up and we talk.
Not small talk. Not a recap of your week’s calendar. We talk about what’s on your mind, what happened that stirred something up, or sometimes what’s been sitting with you for months that you haven’t said out loud to anyone.
Your therapist listens closely, notices patterns, and names what they’re seeing. They’ll push back when they think you’re circling around something important. And they’ll also stay with you when things get hard or painful.
Over time, the work deepens. You start noticing connections that you may not have seen before:
The way you react to a certain colleague starts to remind you of something with a parent
The reason you can’t delegate starts to connect to something much older about how you learned to hold everything yourself
The burnout stops looking like a workload problem and starts revealing itself to be another type of pattern entirely that’s been running for a very long time
Some sessions may feel like we’ve cracked into something together. Some may feel like “nothing much happened” (even though it very much still has). And sometimes the most important moment comes at minute 45, or in the car on the way home. But over time, the work in psychodynamic therapy compounds to create real, lasting change and transformation that just can’t be arrived at if we came at things with a “problem solving” hammer.
Our therapists are warm and direct. They’ll remember what you said three sessions ago—and 80 sessions ago. We’ll laugh together when something is genuinely funny. Yes, we take the work seriously, but play and humor are essential parts of how real connection happens, not breaks from it.
Who We Work With
We specialize in psychodynamic therapy for high achieving professionals navigating burnout, anxiety, perfectionism, relationship strain, the particular kind of stuckness that comes from being great at everything except slowing down, and so much more.
Physicians: The emotional toll of medicine, compassion fatigue, moral injuries, and the impossible standard of being the one who holds it together for everyone.
Executives: Performance pressure, isolation at the top, decision fatigue, the gaps between looking successful and actually feeling like yourself.
Entrepreneurs and founders: The fuzzy line between who you are and what you’re building, loneliness, the inability to turn it off, and the pressures to care for other people’s livelihoods through the business.
Lawyers and attorneys: Billable-hour pressure, adversarial thinking that follows you home, perfectionism baked into the profession, overly generalized analytical tendencies.
We also work with professionals in entertainment, tech, finance, and other high-pressure fields.
If you’re someone who’s used to being the one everyone else depends on, we get you, and we’re here to help.
Getting Started with Psychodynamic Therapy
Step 1: Free 15-minute phone consultation.
A brief call to talk through what’s going on, what you’re looking for, and whether our approach feels right → Book a free 15-minute phone consultation.
Step 2: Initial session.
We meet and talk about how we work, and we both get a sense of whether things feel like a good fit.
Step 3: Ongoing weekly sessions.
Consistency matters in psychodynamic work. Weekly sessions let us:
Build on what has come up before
Track patterns as they emerge
Maintain the kind of trust that allows you to say the harder things and actually stay with them
We do require weekly frequency in order to work together in ongoing therapy. There are many reasons for this, which we’re happy to discuss further with you, but briefly: if too much time passes between sessions, we end up spending more time when we do meet playing catch up and staying in “update mode” than actually being able to go deep together.
Need a different therapy container?
We also offer therapy intensives for people who need extended sessions (two to four hours) less frequently. These are especially useful for professionals with demanding or unpredictable schedules, or for anyone who keeps bumping up against something important right as the session is ending.
All sessions are conducted online. Based in Los Angeles, we see clients throughout California, Texas, and 40+ PSYPACT states.
FAQs about Psychodynamic Therapy
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Most structured therapies (CBT, DBT, and similar approaches) focus on symptom reduction through specific skills and techniques. Psychodynamic therapy focuses on understanding the deeper emotional patterns and early experiences that keep generating those symptoms, as well as experiences in your life and mind that don’t have to be categorized as symptoms at all.
But we also go beyond mere understanding. This kind of therapy helps to create the conditions for you to actually feel and work through the emotions tied to those patterns, which is what makes change stick over time.
If you’ve tried therapy before and it helped for a while, but the same patterns came back, then this may be why. You may have been addressing the symptoms, but not yet have gotten into what’s underneath the symptoms.
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Because we’re working at a different, deeper, and arguably more meaningful level.
Changing a thought pattern or learning a coping skill can happen in weeks. But changing the way you fundamentally relate to yourself, to other people, and to your own emotional needs takes longer because, well, those patterns didn’t develop overnight, so they’re certainly not going to shift quickly either.
The upside: the changes tend to be longer lasting and more meaningful. Therapy clients who engage in psychodynamic therapy tend to not cycle back through the same struggles the way they often can with shorter-term approaches.
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You’ll probably feel it before you can name it. You might notice:
·You’re reacting differently in situations that used to throw you off
Conversations that would have sent you into a spiral don’t land the same way
You’re less on edge, or able to sit with discomfort instead of immediately needing to fix it
Feelings that used to overwhelm you start to feel more manageable, more like information you can actually use
The constant internal pressure to perform loosens its grip
These shifts happen gradually, but they’re real.
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You don’t have to do anything you don’t want to do.
But we’ll be honest: your history usually turns out to be relevant. Not because we’re going to spend years relitigating every detail of your upbringing, but because the patterns you’re dealing with now almost always have roots in how you learned to navigate relationships, emotions, expectations, needs, and so much more early on.
When those connections become visible, things start to make more sense, and becoming conscious of those connections over time is what creates the possibility for things to change.
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Yes. There’s a substantial body of research supporting psychodynamic therapy for depression, anxiety, personality patterns, relational difficulties, and much more.
One of the most notable findings is what researchers call the “sleeper effect” (Shedler, 2010): gains from psychodynamic therapy tend to continue growing even after treatment ends, while gains from shorter-term therapies sometimes plateau or fade.
This makes sense when you think about what each approach is doing. Skill-based therapy teaches you a skill. Psychodynamic therapy helps you change how you understand and relate to yourself and others.
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This is one of the most common reasons people find us. But the way we work with burnout is probably different from what you’d expect.
We don’t focus primarily on workload management or work-life balance tips (though of course, those conversations come up when they need to). Instead, we focus on things like:
Understanding why it’s so hard for you to stop
What happens internally when you try to rest
What feelings and experiences surface for you when there’s nothing left to do or fix
What beliefs about your self-worth are tangled up in your output
For a lot of high achievers, burnout isn’t really just about the workload alone. It’s often about deeper patterns that were set in motion long before the current job. (More on burnout and high achievers)
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Most of our clients are indeed functioning just fine. In fact, many of them are functioning exceptionally well by most external measures. But that’s kind of the point.
You don’t need to be falling apart to benefit from psychodynamic therapy. Some of the most meaningful therapeutic work happens with people who look great on paper, but know something underneath isn’t right.
Feeling stuck, flat, disconnected from your life, going through the motions despite having everything you worked for. Those are exactly the kinds of experiences that psychodynamic therapy is built for.
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Yes. The depth and quality of the therapeutic relationship is what drives change in psychodynamic therapy, and that doesn’t require being in the same physical space.
Our clients are physicians, executives, founders, and attorneys whose schedules and travel make online sessions the most realistic and consistent format. We’ve also found that online therapy often makes it easier for people to show up from a private, comfortable setting, which can actually support more openness.
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CBT works from the premise that changing how you think changes how you feel. You identify distorted thought patterns, test them against evidence, and practice different responses. It's structured, usually time-limited, and it has strong research support across a range of presentations.
Psychodynamic therapy starts somewhere else. It assumes that how you think and feel now was shaped by your history and by relationship patterns operating outside your awareness, and that change comes from becoming conscious of those patterns and actually feeling what sits underneath them.
The practical differences:
Structure: CBT follows a session agenda, often with homework in between. Psychodynamic therapy follows what you bring, without a manual.
Timeframe: CBT protocols typically run a set number of sessions. Psychodynamic therapy is open-ended.
Target: CBT works on symptoms. Psychodynamic therapy works with you as a whole person and on what keeps producing the symptoms.
The therapeutic relationship: In CBT, the therapeutic relationship supports the work. In relational psychodynamic therapy, the therapeutic relationship is part of the work.
Neither approach is better in the abstract. CBT is a strong fit for a discrete, well-defined problem. Psychodynamic therapy is a better fit when the same difficulties keep returning in new forms, or when you can already explain your patterns in detail, but understanding alone hasn't changed anything.
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Psychodynamic therapy grew out of psychoanalysis and kept its central premises about unconscious processes and the lasting influence of early experiences. The differences are mostly about frequency, format, and how the therapist participates.
Psychoanalysis usually means meeting four to five times a week, often for years, and may involve lying on a couch with the analyst seated out of view. Analysts complete formal training at a psychoanalytic institute, including their own analysis.
Psychodynamic therapy meets weekly at minimum, and sometimes more frequently. Your therapist will ask questions, respond to what you say, share with you what they're noticing, and push back when needed. In relational psychodynamic work specifically, your therapist will also name what's happening between the two of you when it's relevant, because how you relate to them tends to reflect how you relate to people outside the room.
At Helm Psychology, we work psychodynamically in weekly online sessions. You get the depth of the psychoanalytic tradition without the frequency and format demands that can make psychoanalysis impractical for a lot of working professionals.
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Reach out for a free 15-minute phone consultation. We’ll talk about what’s going on, what you’re hoping for, and whether this approach sounds like a fit.
