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Jonathan Shedler in Psychodynamic Therapy: A Practical Guide for Therapists

Stanley Efrem

Apr 30, 2025

Jonathan Shedler has transformed psychodynamic therapy with his evidence-based approach. His work challenges many common beliefs about how long therapy should last. A clinical professor of psychiatry at the University of California, San Francisco with over 25 years of experience, his research confirms what many practitioners already know but rarely calculate: patients need more therapy time than most controlled trials allow.

Dr. Shedler's research shows that 50% of patients experience clinically significant changes after 21 sessions - about six months of treatment. The data reveals that 75% of patients need around 40 sessions to see real improvement. His psychodynamic therapy approach stands out with solid evidence. Studies demonstrate an effect size of 0.97 for general symptom improvement, which grows to 1.51 at follow-up about 9 months after treatment ends. Unlike other therapeutic methods, Shedler's approach creates benefits that grow even after therapy ends. This suggests deep psychological change rather than just temporary relief from symptoms.

This piece shows you how to apply Shedler's psychodynamic principles in your practice. You'll learn practical techniques to build strong therapeutic alliances and work with defenses as they happen. The guide offers practical techniques you can use right away with your clients. Both newcomers to Shedler's work and experienced practitioners will find useful ways to boost their therapeutic effectiveness.

Understanding Jonathan Shedler’s Approach to Psychodynamic Therapy

Dr. Jonathan Shedler has become a key figure in modern psychodynamic therapy. He brings scientific proof to a field that many criticized for lacking evidence. His work blends traditional psychoanalytic insights with modern research methods to create a bridge between depth psychology and evidence-based practice.

Who is Dr. Jonathan Shedler?

Anyone learning about psychodynamic approaches has likely come across Shedler's influential work. He serves as a Clinical Professor of Psychiatry at the University of California, San Francisco. Before this role, he worked at the University of Colorado School of Medicine. His academic career spans more than 25 years. During this time, he has shaped how we think about psychotherapy research and practice.

Shedler's reputation grew after his groundbreaking 2010 paper, "The Efficacy of Psychodynamic Psychotherapy" in American Psychologist. This work challenged common beliefs about psychodynamic approaches. He showed through meta-analysis that these methods work. His research proved that psychodynamic therapy works just as well as—and sometimes better than—other proven treatments like cognitive-behavioral therapy.

Shedler combines clinical practice with academic work. This dual role as both therapist and researcher adds weight to his approach because it comes from real therapy sessions, not just theory. On top of that, he runs workshops and training programs worldwide to help clinicians use evidence-based psychodynamic principles.

His steadfast dedication to measuring therapy results has changed how many see psychodynamic therapy. His work shows that about 50% of patients see major clinical improvement after 21 sessions (about six months of weekly therapy). About 75% reach meaningful improvement after 40 sessions.

Core ideas behind Shedler's psychodynamic model

Shedler's approach centers on seven key features that define effective psychodynamic practice. These principles, detailed in his landmark paper, give therapists a practical framework:

Focus on affect and emotion – Patients learn to state and understand feelings, especially difficult ones
Exploration of attempts to avoid distressing thoughts and feelings – Spotting defense mechanisms and patterns of emotional avoidance
Identification of recurring themes and patterns – Finding persistent life patterns that often hide from awareness
Discussion of past experiences – Linking childhood history to current psychological state
Focus on interpersonal relationships – Learning how patients connect with others
Attention to the therapeutic relationship – Using therapy itself as a tool for information and change
Exploration of fantasy life – Taking the patient's imagination, dreams, and stories seriously

Shedler's model aims for deep psychological change by tackling underlying patterns and unconscious processes, rather than just reducing symptoms. The benefits last and even grow stronger after treatment ends. Studies show effect sizes increase to 1.51 about nine months after therapy ends.

Time matters in Shedler's approach. His research shows that while short treatments help some patients, others need more time for lasting change. This view challenges insurance companies that often limit therapy duration.

Shedler stands out because he proves his methods work without losing psychodynamic depth. He created tools like the Shedler-Westen Assessment Procedure (SWAP) that measure personality issues and therapy progress better than typical symptom checklists.

His model shows that therapy techniques don't work in isolation. Specific methods work best within a strong therapeutic relationship where patients can safely explore both conscious and unconscious experiences.

Therapists who want to use this approach will find a flexible guide rather than strict rules. The focus stays on understanding each patient's unique psychological world, but with proven methods that give therapy direction and purpose.

Preparing for Sessions: Setting the Right Foundation

Success in psychodynamic therapy starts well before delving into a patient's unconscious processes. Dr. Jonathan Shedler believes the right foundation paves the way to therapeutic success.

Building a strong therapeutic alliance

The therapeutic alliance—the partnership between therapist and patient—is the life-blood of effective therapy in any discipline. Psychodynamic approaches place special emphasis on this relationship. Research shows that strong therapeutic bonds lead to better clinical outcomes, whatever the specific approach might be [1].

Shedler calls this vital connection the "working alliance" and sees it as basic to treatment success [2]. This alliance has three key elements:

Agreement on treatment goals
Agreement on the tasks required to achieve those goals
Development of a personal bond characterized by mutual trust and positive regard

Dr. Shedler supports a detailed consultation phase when treatment begins. This original period helps develop the working alliance and sets up the treatment structure. He believes therapy shouldn't move forward without this foundation that builds mutual understanding about treatment goals [3].

Shedler's unique approach emphasizes setting up the therapy "frame"—arrangements that give therapy the best shot at success. Regular appointment scheduling provides continuity to address psychological issues and creates predictability so patients can truly open up [4].

"Part of what we want to do in therapy is create a space where it becomes possible to hear from all of the different facets of the person, including and especially the ones we don't usually get to hear from in words," Shedler explains [4].

The alliance building process should focus on authenticity rather than strict rules. The frame exists to create conditions for productive work, not to impose the therapist's will. As Shedler puts it, "These are the conditions that will give us the best chance of working in a way that will be helpful to you" [4].

Creating a safe emotional space

Patients need an emotionally safe environment to explore difficult feelings and experiences. This safety becomes vital in psychodynamic work where exploring unconscious material often makes people feel vulnerable.

Trust and rapport let clients discuss sensitive topics without judgment [5]. Patients who have experienced trauma especially need this safety to avoid retraumatization [5].

Psychodynamic therapists who follow Shedler's approach know that safety allows transference to emerge naturally. Patients must feel secure enough to let their usual relationship patterns surface during therapy since examining the therapeutic relationship sits "at the heart of the work" [2].

"Transference gives patients a chance to rework old patterns," Shedler notes [2]. This work happens only when patients feel safe enough to be emotionally authentic.

Therapists create this safe space through consistent, empathetic engagement. They use active listening, reflect feelings back, and show real understanding so patients feel valued and supported [6].

Shedler suggests letting patients set their own pace instead of pushing them to share too soon. Meeting patients "where they are" shows respect and confirms their experience [6]. This approach recognizes that feelings have their own logic and need to be "accepted and worked with on their own terms" [2].

This careful foundation-building helps patients see therapy as a secure base. From there, they can explore challenging emotional territory—the key condition needed for deeper psychodynamic therapy work to begin.

Applying the 7 Principles in Real Therapy Sessions

Jonathan Shedler's psychodynamic principles become powerful therapeutic tools when put into practice. These seven principles will guide you toward meaningful psychological change after you build a strong foundation with your client.

1. Focus on emotion

Emotional experience lies at the heart of psychodynamic therapy that works. Dr. Shedler believes therapists should help patients explore their full range of emotions. This includes helping clients state their feelings that might be contradictory, troubling, or hard to accept.

Real therapy sessions need gentle prompting toward emotional experiences rather than just mental understanding. A client might intellectualize about a painful breakup, and you could ask, "What feelings come up when you recall that moment?" This change from thinking to feeling creates new paths for deeper therapeutic work.

Psychodynamic therapists know emotional insight is different from intellectual insight. A practitioner says, "Through building insight about the past, we can learn how you respond to the world in the present." This emotional understanding helps create lasting change.

2. Study avoidance

People create ways to avoid distressing thoughts and feelings. These patterns show up in therapy:

Overt avoidance: Missing sessions, arriving late, or changing topics
Subtle avoidance: Focusing on small details instead of emotional content
Defense mechanisms: Using rationalization, intellectualization, or humor to stay away from painful emotions

Studying avoidance means paying attention to what clients don't say or do. A therapist might say, "I've noticed whenever we talk about your father, you change to discussing work issues." This observation lets clients explore why certain topics feel threatening.

Research shows chronic avoidance reduces wellbeing and increases emotional pain. Clients who explore avoided emotions with their therapist tend to have better outcomes.

3. Identify recurring themes

Psychodynamic therapists look for patterns in their client's thoughts, feelings, relationships, and life experiences. These recurring themes often work below the surface yet shape behavior deeply.

"People of varying worldviews and religious beliefs struggle with the deepest of philosophical questions surrounding meaning, purpose, and fulfillment," a therapist points out. Universal themes like self-comparison, wanting different circumstances, or dealing with shame often come up in therapy.

Careful listening over multiple sessions reveals these patterns. Your client might keep choosing unavailable romantic partners or undermining their achievements. By pointing out these patterns gently, you help clients see how they recreate familiar but problematic situations.

4. Focus on development and growth

Early experiences connect to how we function today. Past relationships, especially with attachment figures, shape our current relationships in ways we might not see.

Someone who struggles with authority figures might find links to their experiences with controlling parents. The past matters because it lights up current difficulties.

Shedler says that "the goal of psychodynamic therapy is to loosen the bonds of past experience to create new life possibilities." This developmental view helps clients see when old emotional solutions no longer help them.

5. Explore relationships

Relationship patterns play a vital role in Shedler's approach. Our personality develops through attachment relationships, making this exploration revealing.

Therapists watch how clients interact with others—their hopes, fears, desires, and letdowns. You might notice clients who always put others first while ignoring their own needs. Then you can help them see how this started when their needs went unmet early in life.

Clients start to see how their past relationships affect their current ones. This awareness creates room for more authentic connections.

6. Work with the therapy relationship itself

The therapeutic relationship becomes a tool for change in psychodynamic therapy. Shedler explains, "It is specifically because old patterns, scripts, expectations, desires, schemas become active and 'alive' in the therapy sessions that we are able to help patients examine, understand, and rework them."

Relationship patterns emerge during therapy sessions. A client afraid of abandonment might worry about session endings. The therapist could say, "I wonder if these feelings about our session ending remind you of other goodbyes in your life."

This approach is a chance to explore relationship dynamics as they happen. Shedler calls it "a relationship laboratory" where clients can recognize and change their patterns.

Recognizing and Working with Defenses in the Room

Defense mechanisms work quietly in therapy rooms. They shape what clients say and carefully avoid. Dr. Jonathan Shedler defines these mechanisms as "anything a person does that serves to distract their attention from something unsettling or dissonant" [7]. Therapists who recognize these patterns can create opportunities that lead to deep therapeutic change.

Common defense mechanisms to watch for

Several defense mechanisms appear often in clinical work, according to Shedler's psychodynamic approach. Clients use these unconscious strategies to avoid psychological discomfort, which can limit their growth. Therapists should look out for:

Intellectualization and isolation of affect - Clients discuss emotionally charged topics with detached rationality and separate feelings from ideas [8]. They might theorize excessively about problems without emotional connection.
Denial and avoidance - Clients might refuse to acknowledge painful realities unconsciously [9]. Beyond skipped sessions, they move subtly away from difficult topics or focus on external circumstances instead of internal experiences [10].
Projection - People attribute their unacceptable thoughts or feelings to others [8]. To name just one example, clients might accuse others of hostility while remaining unaware of their own anger.
Splitting - People see others as completely good or bad without middle ground [8]. This defense shows up often in borderline personality dynamics but can emerge in anyone under stress.
Rationalization - People create plausible but incorrect explanations for behaviors to avoid uncomfortable truths [8]. Shedler points out that therapists must become sensitive to these justifications.

Humor, sublimation, and suppression represent more adaptive defenses [11]. These healthier mechanisms protect from anxiety but don't substantially distort reality or harm functioning.

How to gently confront defenses

Addressing defenses needs a tactful approach after identifying them. Shedler suggests avoiding confrontational statements like "You're in denial" [12]. He demonstrates several techniques that work:

Therapists should notice patterns without judgment. Simple observations like "I've noticed this is the third time we've moved away from discussing your marriage" acknowledge the defense naturally [4].

The defense should connect to the therapeutic relationship. Questions like "I wonder if you're communicating something through actions rather than words" create room for exploration [4].

Understanding the defense's protective function helps: "There are good reasons why you might feel reluctant to discuss this" [4]. This confirms the client's experience while encouraging further exploration.

Collaborative curiosity matters: "I think we might find more than meets the eye here, and that's part of our work together" [4]. This approach positions defense work as shared discovery rather than criticism.

Clients don't need to eliminate defenses completely. The goal is to bring them into awareness where they become "more controllable, less automatic" [13]. Clients gain flexibility in handling emotional challenges as they learn to recognize their habitual protective patterns.

Using Emotional Insight to Drive Change

Emotional insight drives change in psychodynamic therapy and works differently from just understanding things intellectually. Jonathan Shedler's work emphasizes this difference. He shows that simply knowing something in your head rarely changes people deeply.

Helping patients move from intellectual to emotional understanding

Most clients start therapy by analyzing their problems instead of feeling them. They use this intellectual approach as a shield to keep painful feelings away. This defense mechanism keeps emotions at a distance but blocks real progress in therapy.

"What our group suggested is that perhaps these factors are not as primary as they may initially appear," states one study that applied Shedler's principles. The research proved that patients who moved beyond just talking about their problems experienced significant pain reduction (55%) at follow-up [14].

These strategies can help clients bridge this gap:

Notice when words don't match feelings: "I notice you're discussing your mother's death very calmly. What happens if we slow down and check what's happening in your body right now?"
Show understanding of their protection: "It makes sense that analyzing keeps you safe from overwhelming feelings."
Use silence with purpose: Give space after emotional statements rather than filling it with more analysis.

Techniques to deepen emotional exploration

As clients start feeling their emotions, several techniques that line up with Shedler's approach can take this exploration deeper:

Focus on bodily sensations – Redirect attention to physical experience when intellectual clients can't identify feelings: "Where do you feel that in your body?" This method bypasses mental filters and taps into raw emotional experience.

Explore mixed feelings – Shedler stresses the value of exploring contradictory emotions. A case study showed a breakthrough when a therapist helped explore mixed feelings about painful traumas. This led to "several minutes of painful sobbing, ultimately resulting in a newfound sense of compassion" [14].

Create corrective emotional experiences – Alexander and French (1946) first identified these experiences that change old patterns through new emotional encounters in therapy. Clients need to feel differently—not just think differently—to change deeply.

Work with transference in real-time – Emotions about the therapist create unique chances to spot recurring patterns. Clients develop better emotional control outside therapy as they gain emotional insights within its safe space.

Common Challenges and How to Handle Them

Expert application of psychodynamic techniques faces major hurdles. The therapeutic trip has roadblocks that challenge both client and therapist.

Managing resistance and setbacks

Resistance plays a natural role in therapy, not a sign of failure or client stubbornness. Dr. Jonathan Shedler sees resistance as "the way in which clients present themselves to the world in general and to the therapist in particular." Effective therapists welcome resistance as valuable information instead of fighting it.

Therapy setbacks—when progress stalls or reverses—happen normally. A practitioner points out, "Having deep emotional expressions are actually helpful, as the feelings can help you move forward and take you deeper into your process of resolution."

Client backsliding calls for these approaches:

Normalize the experience – Psychological growth isn't linear, and setbacks are expected
Study the avoidance – Learn what feelings surface when progress stops
Reframe resistance – See it as protection against vulnerability

Note that setbacks often lead to breakthroughs. Therapists trained in Shedler's approach know that resistance signals approaching emotional material.

Dealing with intense transference reactions

Transference occurs when clients project past relationship patterns onto therapists. It can demonstrate as idealization, devaluation, or ambivalence. These reactions create critical therapeutic opportunities despite their challenges.

Dr. Shedler highlights that a patient's dysfunctional patterns affecting their view of others naturally extend to their view of you as the therapist. You can spot their likely behavior toward important people in their lives through these reactions.

Effective management needs careful balance: acknowledging transference without reacting complementarily. To cite an instance, see when a client becomes hostile - avoid counter-aggression while staying authentically involved.

Strong transference requires:

Keeping empathic curiosity about the situation
Confirming the feelings without endorsing distortions
Connecting current reactions to broader relationship patterns

"Focusing on transference allows the patient and therapist to realize the difference between reality and fantasy in a therapy session directly," a researcher notes. This exploration creates chances for meaningful change beyond cognitive discussion alone.

Conclusion

Dr. Jonathan Shedler's psychodynamic approach combines deep psychological work with empirical validation. In this piece, you have found that his seven core principles turn abstract concepts into practical therapeutic tools. Research confirms what clinicians know intuitively - meaningful psychological change takes time. About 40 sessions are needed for 75% of patients to see major improvement.

Shedler's framework excels beyond technique application. The therapist's ability to create spaces allows authentic emotional experiences to emerge naturally. Patients see better results when the focus stays on building strong therapeutic alliances and exploring defenses that surface during sessions. This method helps people move from intellectual understanding to genuine emotional insight that catalyzes lasting change.

Of course, obstacles will surface - resistance, setbacks, and intense transference reactions are part of the therapeutic experience. All the same, these challenges often point to approaching breakthroughs rather than failed treatment. Research shows the lasting value of psychodynamic therapy, with benefits that continue after treatment ends.

Modern healthcare systems favor shorter interventions. Yet Shedler's evidence supports longer-term participation for substantial psychological transformation. His effect size of 0.97 during treatment grows to 1.51 at follow-up. These numbers highlight psychodynamic therapy's ability to create lasting change instead of temporary relief.

The psychodynamic process follows its own timeline that respects human experience's complexity. Note that patience and attunement lead to deeper results than technique alone. This process provides a relationship laboratory where natural healing occurs.

FAQs

What are the key principles of Jonathan Shedler's psychodynamic therapy approach?

Dr. Shedler's approach is based on seven core principles: focusing on emotion, exploring avoidance, identifying recurring themes, examining past experiences, exploring relationships, working with the therapeutic relationship, and exploring fantasy life. These principles aim to create lasting psychological change rather than just temporary symptom relief.

How long does psychodynamic therapy typically take to be effective?

According to Dr. Shedler's research, about 50% of patients experience significant clinical improvement after approximately 21 sessions (roughly six months of weekly therapy). For 75% of patients to reach meaningful improvement, it takes about 40 sessions. The benefits of this approach often continue to develop even after therapy concludes.

What is the importance of the therapeutic alliance in psychodynamic therapy?

The therapeutic alliance, or working alliance, is fundamental to treatment success in psychodynamic therapy. It involves agreement on treatment goals, tasks to achieve those goals, and development of a personal bond characterized by mutual trust. A strong therapeutic alliance is a reliable predictor of positive clinical outcomes.

How does psychodynamic therapy deal with defense mechanisms?

Psychodynamic therapists recognize defense mechanisms as unconscious strategies clients use to avoid psychological discomfort. Rather than confronting these defenses directly, therapists gently explore them with curiosity, linking them to patterns in the therapeutic relationship and emphasizing collaborative discovery.

What sets Shedler's approach apart from other therapeutic modalities?

Shedler's approach uniquely combines classical psychoanalytic insights with contemporary research methodologies. It emphasizes empirical validation without sacrificing psychodynamic depth, challenges assumptions about therapeutic timeframes, and focuses on creating lasting psychological change rather than just symptom reduction.