The Little Things Become The Big Things (Part II)
A Look at How Psychodynamic Therapy Works
Last week I wrote a personal example of how a seemingly small, internal shift made a huge difference in my felt experience when I was invited by my friend to stop using my GPS for places I already knew how to get to. This week I want to take this idea further to look at a parallel process that can occur in psychotherapy.
There are many types of psychotherapy used for a whole host of reasons.1 The kind of therapy I want to explore here is psychodynamic psychotherapy, sometimes referred to as “depth work.” This kind of therapy seeks to look to the deeper, unconscious psychological processes that are at play in people’s lives. Author, Professor and Psychologist Jonathan Shedler says it this way, “Transformative psychotherapy aims to change something fundamental about who we are. This means relinquishing familiar, well-worn life and relational patterns to find and experience something new.”2
When you’re able to do the deeper work of moving beyond behavior modification and symptom reduction, you can get to the unconscious internal structures that invisibly shape our view of the world, guide how we interact with others and impact our felt experiences. This kind of psychotherapy can be a slow and disruptive process, and is often non-linear. It involves returning again and again to awareness, connections and creating new experiences. Below is an oversimplified look at how one can work through psychodynamic psychotherapy, moving from seemingly small insights to big changes in one’s felt experience.
I. Beginning with Awareness
The first part of good psychodynamic psychotherapy begins with awareness or “insight.” This is a coming-to-know or a shift in consciousness, something that was once not thought of, is now front of mind. Oftentimes people think that insight is the goal of psychotherapeutic work; the belief is that insight is what leads to change. It may sound something like: “If I just knew xyz, then I could stop doing it.” However ,it is not that simple, Insight is only a part of the work, and it is typically just the beginning.
Take my example from last week: I wasn’t consciously aware that I was using my GPS unnecessarily until it was brought to my attention by my friend. It was something I just did without thinking. And when it was brought into my awareness, I did not realize the fullness of what was happening for me internally in the moment. I only knew that I was uncomfortable at the thought of not using it but did not really know why. I chalked it up to habit, which indeed it had become, and this insight was like a seed that was planted.
This is what happens in psychotherapy. Through the therapeutic relationship, simple yet deep truths are arrived at by mutual discovery.3 Freud believed that free association, where patients could simply express their thoughts, feelings, and desires in a stream-of-consciousness, uninhibited/uncensored way, allowed for the deeper unconscious thoughts and feelings to surface. In this way, the patient consciously and unconsciously brings the content of their minds into the psychotherapy session. By working together with the therapist, one can gain insight and awareness to the previously unconscious thoughts, feelings and desires that are silently working within the patient’s internal world.
Since many times these insights and awareness come up against our well-worn patterns and defense mechanisms, repetition is often necessary and should be expected. Again, the work is not linear. We return again and again to insight and awareness until we can begin to make connections.
Defense Mechanisms are “the unconscious and automatic ways in which the mind responds to internal and external stress and emotional conflict. They are coping mechanisms that limit a person’s awareness of painful affects like anxiety, depression, or envy, and resolve internal emotional conflicts.”4
II. Connecting Patterns and Processes
When something unconscious is brought into our conscious awareness, it opens the door for beginning to notice patterns and making connections to both past and present relationships and experiences. Dr. J. Derek McNeil, president of The Seattle School of Theology and Psychology , often repeated the refrain “learning is linking” and I think this aptly speaks to the therapeutic process.
Back to my previous example—insight and awareness alone did not do much for my attachment to my GPS. In fact, I was not quick to give it up. What my new awareness did for me was open up a space to be curious about what was happening for me. To begin wondering what was I feeling and thinking in the moment; What felt familiar or unfamiliar about the experience; What past experiences or relationships seemed connected to all that was coming up in the weeks and months that followed? In a way, I was asking myself the kinds of questions a therapist would ask a patient after gaining new insight as a way to begin the process of linking and connecting to previous patterns. I started to recall other times when I successfully navigated to and from places without a GPS, thus challenging the belief that I was directionally challenged and easily disoriented. And while I did not come to know how or when I began this false belief (yet!), I had started to make links to the past through this ongoing internal reflection.
The same process happens with the deep work of psychotherapy: one grows this reflective muscle with their therapist, linking and connecting past and present. And over-time, one learns to do this effectively on their own.
III. Creating New Experiences
At some point, people don’t need more information, they need a different experience.5 And this was certainly true in my example from last week. After months of marinating in the awareness of my unnecessary dependency on my GPS, and noticing patterns and connections to previous life experiences, I was willing, ready and able to try creating a new experience. I took the small brave act of driving without my GPS and found I gained new inner confidence as I continued to build resilience and grow my capacity to tolerate my own discomfort. While it seemed like such a little thing, internally it felt huge.
Gaining insight and making connections is what sets us up for being able to create new experiences that can lead to lasting change. This is one of the ways psychotherapy works. “Change happens not only because people learn new things about themselves, but also because they feel safe enough to try out new ways of thinking and behaving in the context of this new [therapeutic] relationship.”6
And this is part of the magic of psychotherapy: it acts as a laboratory for gaining new relational experiences as we play out our ways of relating in the “here and now” with the therapist. Shedler suggests that it is the relationship that heals by helping patients understand the patterns they are caught up in in real time.7 The therapeutic relationship is central to providing a “safe enough”8 environment for people to explore and learn more about themselves, connect past and present, and form new experiences.
The healing work of psychotherapy is a slow and sometimes disruptive process of gaining awareness and insight, connecting to past patterns and uncovering unconscious processes, and creating new experiences. What starts out as a small insight or observation builds towards even greater internal shifts, affecting how we view ourselves, others and the world. Small internal shifts feel like a big deal because they are significant. They create the ground work for new relational experiences that offer healing and result in deep, lasting change.
The little things become the big things.
Next week, in the third and final essay in this series, I will be exploring how the little things become the big things in our relationships.
I have written elsewhere using the iceberg metaphor to explain how there are different kinds of therapy for different purposes. [See “Exploring the depths: Psychotherapy beyond symptom reduction” Ampersand Counseling Collective, January 6, 2026. https://ampersandcollective.net/exploring-the-depths/ ] Of course there are times and situations where crisis management, symptom reduction and behavior modification require concrete solutions, clear action steps, and structured treatment plans. These kinds of therapies can be absolutely necessary and lifesaving and I am grateful there are modalities like this available for folks. I in no way want to suggest they are not useful/practical/helpful, or are less effective.
Shedler, Jonathan. “You Have to Get Lost Before You Can Be Found,” Jonathan Shedler Substack. November 17, 2025. www.jonathanshedler.substack.com/p/you-have-to-get-lost-before-you-can
Symington, Neville. The Analytic Experience. Free Association Books, London, 1986. Pg. 20.
Cabaniss, Deborah L, et al. Psychodynmic Psychotherapy: A Clinical Manual. Second Edition. John Wiley & Sons Ltd. West Sussex, UK, 2017. Pg. 31.
This concept is attributed to Sue Johnson, the creator of Emotionally Focused Therapy, in the context of relationships. She emphasized that having more information about a relationship does not create change itself but rather, people need a new emotional experience within the therapeutic environment in order to rewire their relational patterns. I am applying it here more broadly than just relationships.
Cabaniss et al. Psychodynamic Psychotherapy, 2017. Pg. xx.
He writes, “The relationship heals, but only if the therapist knows how to use it.”
Shedler, Jonathan. “Therapists Say the Relationship Heals. Few Know What It Means.” Jonathan Shedler Substack. September 30, 2025. www.jonathanshedler.substack.com/p/the-relationship-is-the-treatment
The term “safe enough” is a reflection that there is no perfect safety in any relationship but rather the hope in the psychotherapeutic relationship is that it is a safe enough place to have relational rupture and experience repair, which is in many ways is a large part of the new relational experiences that bring healing.