Symptoms in psychodynamic therapy

Symptoms are often seen as problems to get rid of: anxiety to calm down, depression to lift, physical complaints to fix. Psychodynamic therapy takes a different view, understanding symptoms as meaningful signals.

From this perspective, symptoms are not random. Symptoms are ways the mind communicates when feelings, wishes, or fears feel too difficult or unsafe to recognise directly. Anxiety, depression, or physical symptoms often appear when there is an inner conflict, such as wanting closeness but fearing dependence, or feeling anger that seems unacceptable.

To show how this works, we can look at popular films. Movies are especially helpful because they make inner experiences visible. They show emotions through images, relationships, bodies, and repeated patterns. What can take months to understand in therapy can sometimes be captured in a single powerful scene.

Anxiety: Black Swan

Anxiety is often described as fear without a clear cause. Psychodynamically, anxiety is a signal that something important is happening inside the person.

In Black Swan, Nina Sayers is a ballet dancer who experiences intense anxiety: panic before performances, harsh self-criticism, physical tension, and moments of losing touch with reality. On the surface, her anxiety seems to be regarding perfection. Yet underneath the surface, Nina is caught in painful inner conflicts: between restraint and liberty, innocence and sexuality, obedience and anger.

She has grown up with a controlling mother and in a ballet world that rewards being “perfect” and compliant. Feelings of desire, independence, and aggression feel dangerous to her. When these feelings start to surface, anxiety appears. Her anxiety helps keep these emotions out of awareness and protects her “good girl” identity, even though it causes great suffering.

Depression: Joker

Depression is often understood as sadness or lack of motivation. From a psychodynamic perspective, it is seen as a state formed by loss, shame, and emotional deprivation.

In Joker, Arthur Fleck is lonely, withdrawn, and filled with self-hatred long before he becomes violent. His history includes severe neglect and abuse. He never experienced reliable care, so he never developed a stable sense of being valued.

Arthur’s depression shows up as shame, self-blame, and emotional emptiness. His uncontrollable laughter can be understood as a physical release of feelings he cannot hold inside. From a psychodynamic perspective, depression frequently entails anger turned inward. Arthur accepts humiliation and sees himself as defective. When that anger eventually turns outward, the depression shifts, but not into health, but into rage and grandiosity.

A key theme of the film is Arthur’s desperate search for empathy. He wants to be perceived and comprehended. His depression is closely tied to feeling invisible, unreal to others, and therefore unreal to himself.

Psychosomatic Symptoms: The Piano

Psychosomatic symptoms are real physical experiences, such as pain, fatigue, or bodily tension, that cannot be fully explained by medical tests. They are not imagined. They are feelings expressed through the body.

In The Piano, Ada McGrath does not speak, despite having no medical reason for her muteness. From a psychodynamic perspective, her silence is a bodily expression of emotions that are not permitted to be spoken.

Ada lives in an environment in which her anger, desire, and independence are not welcome. Speaking would threaten her safety and relationships. Her body carries what her spoken words cannot. Music becomes her way of expressing love, rage, longing, and grief. When she enters a relationship where her feelings are recognised rather than controlled, her symptom begins to change. This illustrates a core psychodynamic idea: symptoms shift when emotions become safe to feel and share.

Psychodynamic therapy does not aim to remove symptoms quickly. Instead, it helps people understand what their symptoms mean and why they developed. As feelings become more understandable and less frightening, symptoms often ease naturally. Because when a symptom no longer needs to speak for the unconscious, it may soften or disappear, not because it was forced away, but because it has been heard.