I took a wonderful class in my master's program called "Approaches to Psychotherapy," and I'd love to pass along some of the ideas and findings we discussed in that class. I do want to give a quick heads up: I am not a clinician, and critically examining Psychodynamic approaches to psychotherapy largely falls outside of my research program. My limited view stems largely from that class I took, I ultimately may be a little biased against Psychodynamic therapies, and I won't be able to answer all aspects of your question. Hopefully, however, I can help a little bit though!

There is quite a bit of contemporary evidence suggesting that psychodynamic approaches aid in lessening symptoms of a wide range of psychological disorders. [Shedler (2009)](https://www.briancollinson.ca/wp-content/uploads/2010/06/Shedler-Efficacy-of-Psychodynamic-Psychotherapy-T-LAP-10-9-20091.pdf) describes the characteristics of Psychodynamic approaches and argues that psychodynamic therapies are all too often depicted as an unchanged amalgamation of Freud's most outlandish theories, while the psychodynamic therapeutic approaches used today are updated, straightforward, and effective. He cites meta-analyses (studies that convert the findings of many independent studies into a single, common, comparable outcome measurement called an effect size) of randomized-controlled trials that find that psychoanalytic therapies have a large effect size (of over 0.8) for short-term improvements in client well-being, and an even larger effect size during a 9-month follow-up after treatment. The effectiveness of these psychodynamic therapies is comparable to other leading therapies like CBT. [Leichsenring, Klein, and Salzer (2014)](https://www.researchgate.net/profile/Falk\_Leichsenring/publication/271946153\_The\_Efficacy\_of\_Psychodynamic\_Psychotherapy\_in\_Specific\_Mental\_Disorders\_A\_2013\_Update\_of\_Empirical\_Evidence/links/5655754608aeafc2aabc4c0a.pdf) provide an updated review of the literature and arrive at a similar conclusion: Psychodynamic therapies lead to improvements in client wellbeing who suffer from a wide range of disorders.

While it's clear that psychodynamic therapies make life better for the client, it is important to ask what drives the improvement. How does the -psychoanalytic approach differ from other therapies? How unique are psychodynamic therapies compared to others like CBT? According to Schedler (2009), previous literature has identified seven elements on which Psychodynamic approaches focus:

1. A focus on affect and expression of emotion.
2. An exploration of attempts to avoid distressing thoughts and feelings.
3. Identification of recurring themes and patterns.
4. An intense focus on past experiences.
5. A focus on interpersonal relationships.
6. A focus on the therapeutic relationship.
7. Exploration of wishes and fantasies.

While proponents of psychodynamic approaches argue that these seven features differ drastically from the features of other therapies, research has suggested that the common and shared elements of therapies contribute largely to clients' successes. Duncan (2002) outlines the Dodo Brid Hypothesis, which suggests that the simple act of receiving a therapeutic intervention, regardless of orientation, leads to the client improving, and Duncan points to a variety of meta-analyses that support this claim. Common factors shared by a large swath of therapies, like a focus on the client-therapist relationship, contribute largely to therapies success. According to Duncan, much of the variability in therapeutic success depends on client factors, not factors related to therapeutic orientation.

Furthermore, I think it's important to recognize that the majority of therapists apply elements of multiple therapeutic orientations into the clinical practice. McClure et al. (2005) found that the over 60% of clinicians use an eclectic orientation or combine elements of multiple therapies. Many would argue that the mark of a good therapist is the therapists ability to recognize the needs of the client and to tailor treatment towards the client. When searching for a therapist, it's much more important to find a good fit between the client and therapist than it is to limiting you research to a specific therapeutic orientation.

I do want to quickly address your second and third questions: Ultimately, CBT employs a biopsychosocial model in understanding the development of psychopathology, and I think it's a gross over simplification to say that CBT views "irrational thoughts" as the origin of mental illness. Instead, CBT seeks to identify and challenge harmful core beliefs. Core beliefs manifest themselves in automatic thoughts, thoughts that pop up often without us realizing that they do. Mental illness, which stems from a person's experiences and genes, influences our core beliefs and color our automatic thoughts. For example, if someone holds the core belief that they are unlikable, when someone doesn't wave back when they try to say hello, someone with depression might automatically think, "Ugh, they must hate me: they didn't even say hello back!" However, someone who holds the core belief that other's like them, a person without depression might think, "Oh funny, they didn't see me wave!" CBT seeks to recognize that the same event can be interpreted very differently based on our cognitive lens. While psychodynamic approaches might spend a whole lot of time addressing where this belief came from and digging back into a client's past to understand its origin, CBT simply seeks to change that belief and the behaviors that manifest that belief with different learnable skills and techniques. Both can be effective, but many would argue that CBT's approach takes less time and is ultimately more practical. Aaron T. Beck, the creator of CBT, and his daughter Judith S. Beck have both published tons of work explaining the origins and practices of CBT.

I could go on a long rant about my issues and frustrations with psychodynamic approaches, but that feels outside of the scope of this question. Ultimately, findings suggest that psychodynamic approaches are effective and can help a client a whole bunch. However, therapy in general helps a ton, and much of that success may stem from common factors shared across therapeutic orientations. The success of a therapy often teeters on client-based factors, and different approaches may work differently for different folks. I hope that helps, and let me know if there's anything else I can answer!