Understanding what's been running you.
Written by Gerry McNamara, LMFTLast reviewed May 2026
Psychodynamic work is the depth half of how I work. The slow, careful business of seeing the patterns that have been running you — often since childhood — and what would shift if you weren't being run by them.
Request a free 15-min consultation →The patterns underneath, made visible.
A lot of what runs your adult life was built earlier than your adult life. Psychodynamic work makes those earlier patterns visible enough that they stop running the show on autopilot.
Most people come to therapy because something is happening in their adult life that they can't fix on their own. Often the same kind of thing keeps happening — a recurring relationship dynamic, a kind of work problem that follows them between jobs, a way of being hard on themselves they can't talk out of. Psychodynamic work is interested in the why underneath the what.
In sessions, this looks less like archaeology and more like noticing — out loud, together — what gets activated in you, what you're protecting, what you learned earlier in your life that's still running. Sometimes that means talking about childhood directly. More often it means talking about what's happening this week and tracing the thread back when it's useful.
The work is collaborative. You bring the data of your own life. I bring the attention and the framework to help you notice what you've been too close to see.
Insight changes things, paired with skills.
Insight without tools doesn't change daily life. Tools without insight tend not to hold. The work pairs them on purpose.
Pure insight work has a known limit. You can see the pattern clearly and still be stuck inside it. Pure skills-based work has the opposite limit — you can white-knuckle a new behavior for a while but the old pattern reasserts itself the moment life pressure rises. Working both at once is what tends to actually change things.
In a typical week, we might use cognitive behavioral or DBT skills for what your week needs traction on right now, while the psychodynamic work runs underneath: noticing why this particular pressure point is so loaded, where the loaded-ness comes from, and what would be different if it weren't loaded the same way.
Questions I get asked about psychodynamic work.
What does psychodynamic therapy actually do?
It works with the patterns that have been running you — often since childhood — that you can't see because you're inside them. The same ways of relating, the same kinds of partners or jobs, the same loops of self-criticism. Psychodynamic work makes those patterns visible, traces where they came from, and asks what would shift if you weren't being run by them anymore.Is this the same as psychoanalysis?
It comes from the same family but it's different. Classic psychoanalysis is the multiple-times-a-week, on-the-couch, decade-long version most people picture. What I do is contemporary psychodynamic therapy — weekly, face-to-face (online), focused, and integrated with practical skills work. You won't be talking about your dreams to a silent therapist.Do we just talk about my childhood?
We talk about childhood when it's relevant, which is more often than people think but less than the stereotype assumes. The point isn't archaeology. It's that some of the patterns running your adult life were built earlier than your adult life. Seeing how the pattern got built is part of what makes it changeable now.What about internal family systems (IFS)?
IFS is a related lens that's gotten popular through social media. I know it and use parts of it when it fits — the language of "parts" can be a useful way to talk about internal conflict. But I'm not primarily an IFS therapist. My deeper work is more squarely psychodynamic and attachment-based. If IFS is specifically what you want, I'd point you to a colleague who specializes in it.How long does psychodynamic work take?
Longer than skills-based work, generally. Real change at the pattern level takes time the patterns don't have on their own. That doesn't mean indefinite — it means we talk realistically about what we're working on and roughly what a good arc looks like. I'm not interested in keeping you in therapy forever.
The rest of how I work.
CBT & DBT
The practical, day-to-day half of the work. Skills you can use this week, paired with the deeper psychodynamic thread.
Read moreTrauma-informed approach
Pacing the work safely. Especially load-bearing when psychodynamic work touches material that hasn't been processed yet.
Read moreAnxiety therapy
Where psychodynamic work and practical skills most often meet. Practical, multi-modal anxiety therapy across Oregon.
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Ready to talk it through? Let's see if we're a fit.
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