May 25, 2026 by Anna Keyter Psychodynamic Psychotherapy, Therapy Approaches 0 comments

Introducing online psychodynamic psychotherapy, by Anna Keyter. Photo by CHRISTIAN PFEIFER

As an online therapist, providing depth-oriented work through telehealth opens powerful opportunities for meaningful client change. Online Psychodynamic Psychotherapy combines the rich theoretical foundation of psychodynamic thinking with the accessibility and flexibility of virtual delivery. Online Psychodynamic Psychotherapy explores how unconscious patterns, early relational experiences, and unresolved conflicts influence current emotional difficulties and relationships. Delivered via secure video platforms, it helps clients gain insight, work through transference, and achieve lasting personality-level change (Lindegaard et al., 2020; Maroti, 2025).

This article offers practical guidance for online therapists delivering online Psychodynamic Psychotherapy, including core principles, session structure, evidence base, benefits, challenges, and clinical tips specific to telehealth practice.

The Origins and Theoretical Foundations of Psychodynamic Psychotherapy

Psychodynamic psychotherapy evolved from Sigmund Freud’s psychoanalysis in the early 20th century. Over decades, it has been refined into more contemporary, time-limited, and relationally focused forms while retaining core ideas: the influence of the unconscious, the centrality of early attachment experiences, defence mechanisms, and the therapeutic relationship itself as a vehicle for change (Shedler, 2010).

Modern psychodynamic approaches emphasise insight, emotional processing, and repairing relational patterns. For online therapists, these principles remain highly relevant and adaptable to video-based work.

Core Concepts in Online Psychodynamic Psychotherapy

Key elements that guide online Psychodynamic Psychotherapy include:

Unconscious Processes: Helping clients bring hidden thoughts, feelings, and motivations into awareness.
Transference and Countertransference: Exploring how clients relate to the therapist as a reflection of past relationships — readily observable even in video sessions.
Defence Mechanisms: Identifying ways clients unconsciously protect themselves from anxiety or painful emotions.
Attachment and Object Relations: Understanding internal working models formed in early life and how they manifest in present relationships.
Free Association and Reflection: Encouraging open expression of thoughts and feelings.

In telehealth, the therapeutic frame (consistency, boundaries, and presence) remains essential, though it requires thoughtful adaptation (Maroti, 2025).

How Online Therapists Deliver Psychodynamic Psychotherapy

As an online therapist, you can structure online Psychodynamic Psychotherapy flexibly — from short-term (12–20 sessions) to longer-term work, depending on client needs and goals.

Typical Session Flow (45–50 minutes):

Opening/Check-in — Observe emotional tone, body language (even on video), and emerging themes.
Exploration — Invite free association or follow the client’s material wherever it leads.
Interpretation and Insight — Gently offer links between past and present, patterns, or transference.
Working with Transference — Comment on the here-and-now relationship as it appears on screen.
Closing — Summarise key insights and assign reflective “homework” (e.g., journaling or noticing patterns between sessions).

Delivery occurs primarily through secure video platforms. Many therapists supplement with secure messaging for reflections between sessions while maintaining clear boundaries.

Evidence Base for Online Psychodynamic Psychotherapy

Research increasingly supports online Psychodynamic Psychotherapy. A systematic review and meta-analysis by Lindegaard et al. (2020) examined internet-delivered psychodynamic therapy (IPDT) across seven RCTs (N = 1,080). Results showed small-to-moderate effects compared to controls for overall symptoms (g = 0.44), depression (g = 0.46), and quality of life (g = 0.40). Gains were maintained or increased at follow-up.

Broader evidence on telehealth psychotherapy indicates that video-based delivery is generally as effective as in-person therapy across modalities, including psychodynamic approaches (Fernandez et al., 2021; Giovanetti et al., 2022). Recent studies also support its use for depression, anxiety, somatic symptoms, and relational difficulties in virtual formats (Maroti, 2025).

While more large-scale studies are needed, current evidence positions online Psychodynamic Psychotherapy as a promising, effective option — particularly when therapists adapt techniques thoughtfully to the online environment.

Benefits for Online Therapists and Clients

Online Psychodynamic Psychotherapy offers distinct advantages in telehealth:

Accessibility — Reach clients in remote areas, those with mobility issues, or those with busy schedules.
Reduced Barriers — Lower no-show rates and greater comfort disclosing sensitive material from home.
Rich Observational Data — Video allows close attention to facial expressions, tone, and home environment as relational clues.
Flexibility — Easier integration of reflective work between sessions.
Depth with Convenience — Clients can engage in meaningful insight-oriented work without travel.

Many clients report strong therapeutic alliances via video, comparable to in-person work.

Potential Limitations and Clinical Considerations

Challenges specific to online Psychodynamic Psychotherapy include:

Potential attenuation of non-verbal cues or emotional intensity.
Technical disruptions affecting the therapeutic frame.
Difficulties with severe pathology, high suicide risk, or certain personality dynamics (may require hybrid or in-person referral).
Maintaining confidentiality and managing the home environment.

Skilled online therapists mitigate these through strong alliance-building, clear contracts, and proactive discussion of the medium’s impact on the work.

Practical Guide: Implementing Online Psychodynamic Psychotherapy

Best Practices for Online Therapists:

Establish a consistent virtual “frame” (same time, background, reliable technology).
Use screen sharing for occasional visual aids or joint reflection.
Pay close attention to micro-expressions and shifts in client presence.
Actively monitor and discuss transference as it appears (e.g., “I notice you seem hesitant to share today — does that connect with anything from the past?”).
Encourage clients to notice relational patterns outside sessions and bring them in.
Use validated outcome measures periodically to track progress.

Start with a thorough assessment and collaborative goal-setting. Be transparent about how the online format may influence the therapy.

Who Can Benefit and Integration with Other Approaches

Online Psychodynamic Psychotherapy is particularly helpful for clients with depression, anxiety, relationship difficulties, personality issues, trauma, and those seeking deeper self-understanding. It integrates well with other modalities (e.g., combining with mindfulness, CBT techniques for symptom relief, or attachment-informed approaches).

It serves as both a standalone depth therapy and part of a stepped-care model.

Future Directions

As telehealth evolves, online Psychodynamic Psychotherapy will likely benefit from hybrid models, enhanced training in virtual relational work, and further research on specific populations. AI-assisted reflection tools and improved platforms may further support the work.

Conclusion

Online Psychodynamic Psychotherapy allows online therapists to deliver rich, insight-oriented therapy that fosters lasting change. By working with unconscious patterns, relational dynamics, and emotional depth through secure video connections, you can help clients achieve meaningful transformation regardless of physical distance (Lindegaard et al., 2020).

Mastering this approach strengthens your telehealth practice while honouring the core values of psychodynamic work. As you adapt the frame to the online space, the therapeutic relationship remains the most powerful agent of change.

Feel free to integrate these ideas into your own style and client work. Continue prioritising ethical practice, supervision, and ongoing professional development in telehealth psychodynamic therapy.

References

Fernandez, E., Woldgabreal, Y., Day, A., Pham, T., Gleich, B., & Aboujaoude, E. (2021). Live psychotherapy by video versus in-person: A meta-analysis of efficacy and its relationship to session frequency and duration. Clinical Psychology & Psychotherapy, 28(6), 1535–1549. https://doi.org/10.1002/cpp.2594

Giovanetti, A. K., Punzo, J. F., & Muroff, J. (2022). Teletherapy versus in-person psychotherapy for depression: A meta-analysis of randomized controlled trials. Telemedicine and e-Health, 28(8), 1071–1080. https://doi.org/10.1089/tmj.2021.0294

Lindegaard, T., Berg, M., & Andersson, G. (2020). Efficacy of internet-delivered psychodynamic therapy: Systematic review and meta-analysis. Psychodynamic Psychiatry, 48(4), 437–454. https://doi.org/10.1521/pdps.2020.48.4.437

Maroti, D. (2025). Psychodynamic teletherapy: The past, the present and the future. Current Psychiatry Reports. https://link.springer.com/article/10.1007/s10879-025-09688-4

Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2), 98–109. https://doi.org/10.1037/a0018378

Online Psychodynamic Psychotherapy: A Comprehensive Guide for Online Psychotherapists