Beyond Techniques: What Creates Lasting Change in Therapy

Wilfred Bion once wrote, “the world is littered with cures,” a line that feels increasingly relevant today. There are countless therapy approaches, tools, and techniques available, each offering a way to reduce distress or manage symptoms. Many people arrive at therapy having already tried several of them.

During my graduate training at UC Berkeley, the emphasis was largely on evidence-based treatments — approaches that could be empirically measured and standardized. I trained in modalities such as Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT), which offer practical tools for identifying emotions, challenging thought patterns, and regulating behavior. For many people, these approaches provide real and meaningful relief. Learning to notice a feeling, label it, or interrupt a familiar thought loop can feel stabilizing, especially during periods of acute distress.

Yet research shows that symptom relief from these approaches is often short-lived once the techniques are no longer actively practiced. Studies have found higher relapse rates following CBT for depression when therapy focuses primarily on symptom management rather than underlying psychological processes (Cuijpers et al., 2013; Hollon et al., 2005). In other words, people may feel better while doing the work — but find themselves struggling again when life inevitably becomes stressful.

During graduate school, I took a single course in psychodynamic psychotherapy. I never forgot it. After graduating, I continued to seek out training in this approach because it addressed something I felt was missing: an understanding of the unconscious — the blind spots, emotional conflicts, and internal narratives that shape how we relate to ourselves and others without our awareness.

Unlike skills-based therapies, psychoanalytic and psychodynamic approaches focus on meaning rather than technique alone. Through careful attention to patterns, emotions, relationships, and what emerges between therapist and patient, interpretations are made that bring ideas and feelings together. When an interpretation is grounded in emotional truth, it often lands in a way that is deeply felt. These are the moments people remember years later — the insights they repeat to friends or carry quietly with them. They reorganize how a person understands themselves in a way that lasts.

In recent years, neuroscience has begun to corroborate what early psychoanalytic thinkers such as Freud, Klein, Winnicott, and Bion intuited long ago. Neuropsychoanalyst Mark Solms has demonstrated that emotional experience — not cognition alone — is central to the functioning of the mind and the formation of the self. His work shows that affect is foundational to consciousness and decision-making, lending scientific support to the psychoanalytic emphasis on emotional meaning and unconscious processes (Solms, 2018).

Alongside this, a growing body of research has demonstrated the effectiveness of psychodynamic psychotherapy. Meta-analyses have shown that psychodynamic treatment leads not only to symptom reduction, but to continued improvement after therapy ends — a phenomenon known as the “sleeper effect” (Shedler, 2010; Steinert et al., 2017). This suggests that when people develop a deeper understanding of themselves, change continues to unfold over time rather than fading once treatment stops.

Despite this growing evidence, psychoanalytic ideas often carry a cultural stigma or are dismissed as outdated. Many of the original texts are also dense and difficult to access for people outside the field. I happen to be an absolute nerd about this material — I spend a great deal of time reading original papers, attending seminars, and discussing these ideas with colleagues.

I share this writing because many people don’t know what a treatment modality actually is, or why one approach might be more helpful than another. Therapy is not only about feeling better in the moment; it is about understanding how we came to be who we are, why certain patterns repeat, and what becomes possible when those patterns are brought into awareness.

There is no single “right” or “wrong” form of therapy. Decades of research consistently show that one of the strongest predictors of change is not the specific modality, but the quality of the relationship between therapist and patient — whether the work feels meaningful, collaborative, and emotionally attuned (Horvath et al., 2011; Wampold & Imel, 2015). For this reason, my clinical work remains eclectic and responsive, drawing from a range of approaches including harm reduction, DBT-informed skills, Acceptance and Commitment Therapy, and other experiential techniques when they are useful.

My hope is that these essays offer a clearer sense of what psychoanalytic and psychodynamic psychotherapy can provide — not as a superior treatment, but as a particular way of understanding emotional life, suffering, and change. They reflect how I think about my work, and offer one framework among many for making sense of patterns that feel difficult to shift, and for creating change that can endure.

Ultimately, what matters most is finding a therapist and an approach that fits — someone who helps you explore, reflect, and grow in a safe, attuned space. When therapy resonates and you engage deeply with your feelings and experiences, change continues long after sessions end, and life feels more meaningful, connected, and self-aware.

REFERENCES

Cuijpers, P., et al. (2013). Relapse rates following cognitive behavioral therapy for depression.
Hollon, S. D., et al. (2005). Prevention of relapse following cognitive therapy vs medications.
Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist.
Steinert, C., et al. (2017). Psychodynamic therapy: As efficacious as other empirically supported treatments.
Solms, M. (2018). The conscious id. Neuropsychoanalytic perspective.
Horvath, A. O., Del Re, A. C., Flückiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. Psychotherapy, 48(1), 9–16.
Wampold, B. E., & Imel, Z. E. (2015). The Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work. Routledge.