Psychotherapy

What is psychotherapy?

Psychotherapy is a broad term for talking therapies that explore deeper patterns in how you think, feel, and relate to others. While counselling tends to focus on specific present-day concerns, psychotherapy often works at a deeper level - looking at how early experiences, unconscious processes, and relational patterns shape your current difficulties.

Psychotherapy is typically longer-term than counselling, often lasting months or years. It can address a wide range of issues, including anxiety, depression, trauma, relationship difficulties, identity, and self-understanding.

There are many different types of psychotherapy. This page covers the main depth-oriented and relational approaches. Other approaches - including CBT, DBT, ACT, and EMDR - are covered on their own pages.

Psychodynamic psychotherapy

Psychodynamic psychotherapy is one of the most established forms of talking therapy. It is rooted in the idea that much of our emotional life is shaped by processes outside our conscious awareness - and that bringing these processes into awareness can reduce distress and improve how we relate to ourselves and others.

How it works

Psychodynamic therapy typically involves regular sessions (usually weekly) with a trained therapist. The therapist listens carefully, asks open-ended questions, and helps you notice patterns - particularly patterns that repeat across relationships, situations, and over time.

Key concepts include:

• Unconscious processes - the idea that thoughts, feelings, and memories outside your awareness still influence your behaviour and emotional responses
• Defence mechanisms - unconscious strategies you use to protect yourself from painful feelings, such as avoidance, denial, or intellectualisation
• Transference - the way feelings from past relationships (particularly with caregivers) can be unconsciously redirected onto the therapist, offering a window into relational patterns
• Insight - the process of developing a deeper understanding of why you feel and act the way you do

What to expect

Sessions are usually 50 minutes, once a week. The therapist may be less directive than in CBT - rather than setting tasks or goals, they follow where the conversation leads and help you make connections between past and present.

Short-term psychodynamic therapy typically lasts 12 to 40 sessions. Long-term psychodynamic therapy can continue for a year or more, and research suggests that its benefits often continue to grow after therapy ends.¹

Psychodynamic therapy and neurodivergence

Psychodynamic therapy can offer something that more structured approaches sometimes miss - space to explore identity, grief, self-criticism, and the emotional impact of growing up neurodivergent in a neurotypical world.

For people diagnosed late in life, psychodynamic work can help make sense of long-standing patterns: why certain relationships felt difficult, why particular defences developed, and how years of masking may have shaped your sense of self.

However, there are challenges. Psychodynamic therapy relies heavily on identifying and talking about emotions - something that can be difficult for people who experience alexithymia (difficulty recognising or describing emotions), which affects an estimated 50% of autistic people and around 42% of adults with ADHD.² The open-ended, non-directive style may also feel confusing for people who prefer structure and clarity.

Psychoanalytic psychotherapy

Psychoanalytic psychotherapy is closely related to psychodynamic therapy but tends to be more intensive and work at greater depth. It is rooted in the tradition of psychoanalysis, originally developed by Sigmund Freud and since developed by many others.

How it differs from psychodynamic therapy

The main differences are practical rather than theoretical:

• Frequency - psychoanalytic psychotherapy typically involves two or more sessions per week, compared to one session per week for most psychodynamic therapy
• Duration - treatment is usually longer, often lasting several years
• Depth - the higher frequency allows deeper exploration of unconscious material, relational patterns, and the therapeutic relationship itself
• Setting - in classical psychoanalysis, the patient lies on a couch with the analyst seated behind them. In psychoanalytic psychotherapy, patient and therapist usually sit face-to-face

Schools of thought

Psychoanalytic thinking has evolved considerably since Freud. Major schools include:

• Object relations - focuses on how early relationships (particularly with caregivers) create internal “templates” for how we relate to others throughout life. Key figures include Melanie Klein, Donald Winnicott, and Ronald Fairbairn
• Attachment-informed approaches - draws on John Bowlby’s attachment theory to understand how early bonding experiences shape emotional regulation and relationships
• Self psychology - developed by Heinz Kohut, focuses on the development of a cohesive sense of self and the role of empathic attunement in healthy development
• Contemporary relational psychoanalysis - emphasises the mutual, two-person nature of the therapeutic relationship and moves away from the classical “blank screen” model of the analyst

Psychoanalytic therapy and neurodivergence

Psychoanalytic approaches have historically had a difficult relationship with neurodivergence. Early psychoanalytic theories attributed autism to “refrigerator mothers” - a theory now thoroughly discredited but which caused enormous harm.

Modern psychoanalytic practice has moved considerably from these origins. Contemporary practitioners are more likely to draw on neuroscience, attachment theory, and relational models that can be adapted for neurodivergent clients.

That said, psychoanalytic therapy remains an intensive commitment (both in time and cost), and the evidence base for its use with neurodivergent people specifically is limited. If you are considering this approach, it is worth asking whether the therapist has experience working with neurodivergent clients and how they would adapt their practice.

Relational psychotherapy

Relational psychotherapy places the therapeutic relationship itself at the centre of the work. Rather than focusing primarily on techniques or interpretations, relational therapists believe that healing happens through the experience of being in a genuine, attuned relationship.

How it works

Relational therapy draws on attachment theory, developmental psychology, and contemporary psychoanalytic thinking. The therapist pays close attention to what happens between you - how you communicate, where misunderstandings arise, and what patterns emerge in the relationship.

The idea is that many emotional difficulties have their roots in relationships - and that a different kind of relationship (one that is safe, consistent, and non-judgemental) can create the conditions for change.

Relational therapy and neurodivergence

Relational approaches can be particularly valuable for neurodivergent people, for several reasons.

Attachment and neurodivergence. Research shows that autism itself does not cause insecure attachment. Rather, the experiences that often accompany growing up neurodivergent - social rejection, misattunement from caregivers, pressure to mask, and repeated experiences of being misunderstood - can shape how attachment develops.³ Relational therapy can help explore these patterns without pathologising neurodivergence itself.

Masking and relational trauma. Many neurodivergent people have spent years masking - hiding their natural communication style, suppressing stims, and performing neurotypicality to fit in. This often develops in response to relational experiences: being told you are “too much” or “not enough”, being punished for being yourself, or learning that acceptance is conditional on appearing “normal.” Relational therapy can provide a space to explore these patterns and begin to build more authentic ways of connecting.⁴

The therapeutic relationship as practice. For people who find relationships confusing or anxiety-provoking, the therapeutic relationship can function as a kind of practice ground - a consistent, boundaried relationship where ruptures can be repaired and patterns can be examined in real time.

Integrative psychotherapy

Many therapists in the UK describe themselves as “integrative.” This means they draw on ideas and techniques from multiple therapeutic traditions, rather than working within a single model.

How it works

An integrative therapist might combine psychodynamic understanding with cognitive-behavioural techniques, or draw on attachment theory alongside mindfulness-based approaches. The goal is to tailor the therapy to what you need, rather than fitting you into a single framework.

There are different ways therapists integrate approaches:

• Common factors - focusing on the elements shared by all effective therapies (such as the therapeutic relationship, hope, and emotional processing)
• Technical eclecticism - selecting specific techniques from different models based on what works for a particular problem
• Theoretical integration - creating a unified framework that combines concepts from different traditions
• Assimilative integration - working primarily within one approach while drawing selectively on others

Integrative therapy and neurodivergence

The flexibility of integrative therapy can be a significant advantage for neurodivergent clients. A therapist who works integratively can:

• Use structured, goal-oriented techniques when you need practical strategies
• Shift to more exploratory, relational work when deeper patterns need attention
• Adapt their style based on how you process information - whether you prefer visual aids, concrete examples, or abstract discussion
• Combine emotional insight work with skills-based approaches (such as emotion regulation or executive functioning strategies)

For people with both ADHD and autism, or with co-occurring mental health conditions, an integrative approach may be particularly helpful because it can address multiple layers of experience without being limited to a single model.

Choosing between approaches

There is no single “best” type of psychotherapy for neurodivergent people. The right approach depends on what you are looking for, how you process information, and what feels comfortable.

Some questions that may help:

• Do you want structure or space? If you prefer clear goals and practical techniques, CBT or a structured integrative approach may suit you. If you want open exploration of feelings and patterns, psychodynamic or relational therapy may be a better fit.
• Are you dealing with specific symptoms or deeper patterns? For specific issues (such as anxiety management or phobia), shorter-term approaches may be appropriate. For identity, relationships, and long-standing emotional patterns, longer-term depth work may be more helpful.
• How do you process emotions? If you find it difficult to identify or describe your feelings, look for a therapist who is comfortable working with alexithymia and who can adapt their approach accordingly.
• What is your budget and availability? Psychoanalytic therapy (two or more sessions per week) is a significant commitment. Weekly psychodynamic or integrative therapy may be more practical.

Finding a psychotherapist

In the UK, look for therapists registered with a recognised professional body:

• UKCP (UK Council for Psychotherapy) - the main registration body for psychotherapists
• BACP (British Association for Counselling and Psychotherapy) - covers both counsellors and psychotherapists
• BPC (British Psychoanalytic Council) - specifically for psychoanalytic and psychodynamic practitioners
• BPS (British Psychological Society) - for psychologists who also offer psychotherapy

When contacting a therapist, consider asking:

• What is your experience of working with neurodivergent clients?
• How would you adapt your approach for someone with ADHD or autism?
• Are you familiar with the concept of neurodiversity-affirming practice?
• What model or models do you work with?

Further reading on neurobetter

• Counselling and therapy - overview
• Counselling
• CBT
• DBT
• Late diagnosis
• Masking
• Emotional dysregulation

neurobetter services

• Local services directory - find therapists near you
• Ask a Counsellor - get a confidential response from a registered counsellor