Monthly Spotlight

Integrative Treatment of Anxiety Through a Psychodynamic Lens

Anxiety is one of the most common mental health challenges, affecting millions of people worldwide. From a psychodynamic perspective, anxiety is not just a symptom to be eliminated but a message from the unconscious, pointing to unresolved conflicts, deep-seated fears, and ingrained defence mechanisms. While classical psychodynamic therapy focuses on uncovering these unconscious patterns, an integrative approach blends this insight with structured interventions from cognitive-behavioural therapy (CBT), exposure therapy, mindfulness, and transactional analysis (example below).

By combining these approaches, therapy can be both deeply transformative and practically useful; I have found a pluralistic way of working is helpful for most clients.... This is always dependent on the presenting issues which may, of course, require the use a more targeted and specfic modality - such as psychodynamic. Ways of working can be set at the beginning of therapy and can change as required/agreed with client.

The Therapeutic Relationship: The Heart of Healing

One of the most important aspects of psychodynamic therapy is the relationship between therapist and client. Many people who struggle with anxiety have attachment wounds— which means the early relational experiences that shape how they manage distress, regulate emotions, and interact with others. The therapeutic relationship offers a safe, consistent space in which clients can explore their fears and vulnerabilities without judgement.

Transference: How the Past Plays Out in the Present

In therapy, clients often unconsciously project past relationship patterns onto their therapist, a process known as transference. If someone grew up with a highly critical parent, for example, they may assume the therapist is judging them, even when this is not the case. Recognising these patterns can help the client see how early relationships continue to influence their anxiety.

The Corrective Emotional Experience

One of the most powerful aspects of psychodynamic therapy is the opportunity for a corrective emotional experience. If someone has always feared rejection when expressing vulnerability, experiencing patience and acceptance from the therapist can begin to reshape their internal world. Over time, this helps them develop a more secure attachment style, reducing their anxiety and allowing them to engage with others from a place of confidence rather than fear.

Integrating Psychodynamic Therapy with Other Approaches Psychodynamic Therapy and

Cognitive-Behavioural Therapy (CBT)

While psychodynamic therapy provides insight into the origins of anxiety, CBT offers structured techniques for managing symptoms in the present. A client with generalised anxiety disorder (GAD), for example, may constantly anticipate worst-case scenarios. CBT would help them challenge these thoughts, while psychodynamic therapy would explore how early life experiences—perhaps a chaotic or unpredictable home environment—led to their hypervigilance. This combination allows for both deep self-awareness and practical coping strategies.

Exposure Therapy with Psychodynamic Understanding

For clients with phobias or social anxiety, exposure therapy is highly effective. However, when combined with psychodynamic therapy, exposure becomes more meaningful. If someone fears public speaking, for example, behavioural exposure would help them gradually confront this fear,

while psychodynamic therapy would explore what public speaking symbolises to them—perhaps a fear of humiliation rooted in childhood experiences of being mocked or dismissed. Understanding this connection can make exposure work more powerful and emotionally significant.

Mindfulness and Emotional Regulation

Mindfulness practices align well with psychodynamic therapy, as both encourage self-awareness and emotional tolerance. Many people with anxiety rely on avoidance or intellectualisation to escape distressing feelings. Psychodynamic therapy helps them explore why they do this, while mindfulness offers practical tools to sit with discomfort without being overwhelmed by it. This is particularly useful for individuals with health anxiety, social anxiety, or obsessive-compulsive tendencies.

An example of Integrating Transactional Analysis in Anxiety Treatment - Anna’s Story: Relationship Anxiety

Anna, a 32-year-old woman, came to therapy because of intense anxiety in her romantic relationships. She constantly feared her partner would leave her, leading to excessive reassurance-seeking, emotional outbursts, and a sense of losing control whenever she felt uncertain. Although she knew her fears were irrational, she struggled to manage them.

Through psychodynamic exploration, Anna discovered that her anxiety was rooted in her childhood relationship with her mother, who was emotionally inconsistent—sometimes warm and affectionate, at other times distant and critical. As a child, Anna learned to monitor her mother’s moods closely, seeking constant reassurance to feel safe. As an adult, this pattern carried over into her romantic relationships.

Transactional Analysis: Understanding Anna’s Relational Patterns

Transactional analysis (TA), developed by Eric Berne, offers a useful framework for understanding interpersonal dynamics. It identifies three ego states that shape how people interact - also known as PAC:

1. Parent (Critical or Nurturing) – Internalised messages from authority figures.
2. Adult – Rational, present-focused decision-making.
3. Child (Adapted or Free) – Emotional responses learned in childhood.

When Anna felt anxious in her relationship, she often shifted into her Adapted Child ego state—feeling helpless, panicked, and desperate for validation. She unconsciously placed her partner in the Nurturing Parent role, expecting him to provide the constant reassurance she never received consistently as a child. However, when he was unavailable or emotionally distant, she perceived this as abandonment, leading to emotional distress.

Integrating Multiple Approaches in Anna’s Treatment:

• Psychodynamic Therapy: Anna explored how her early experiences with her mother shaped her need for reassurance.

• Transactional Analysis: She identified when she was acting from her Child ego state and learned how to shift into her Adult state, where she could communicate her needs more effectively.

• CBT: She challenged catastrophic/irrational thinking patterns, such as “If he doesn’t reply immediately, he doesn’t love me.”

• Mindfulness: She practised tolerating uncertainty without reacting impulsively.

As therapy progressed, Anna became more aware of her unconscious relational patterns, developed the ability to self-soothe, and ultimately engaged in relationships from a place of security rather than fear.

An integrative approach to anxiety treatment through a psychodynamic lens provides both depth and practicality. The therapeutic relationship serves as a safe container where clients can explore unconscious fears and relational wounds. By recognising transference patterns and engaging in a corrective emotional experience, they develop new ways of relating to themselves and others.

By incorporating CBT, exposure therapy, mindfulness, and transactional analysis, therapy becomes both insight-driven and actionable. Clients not only gain self-awareness but also learn concrete strategies to regulate anxiety and build healthier relationships. This holistic approach fosters long-term emotional resilience, enabling individuals to navigate life’s uncertainties with greater confidence and security.

Healing is a journey, and you don’t have to take it alone, use the get in touch form below or text/WhatsApp/call me…..