How It Works
What to Expect in Psychoanalytic Psychotherapy
Psychoanalytic psychotherapy is a way of coming to know the psychological processes that shape our feelings, thoughts, behavior, and relationships—particularly those that take place outside of conscious awareness.
People often begin therapy with some sense of what they're struggling with but less understanding of why these difficulties persist, where they come from, or why they feel so stuck with them. Sometimes we clearly recognize the specific patterns that we struggle with—in relationships, in our emotions, in our sense of self—but feel unable to change them; other times, we may have only a vague or very general sense of them—or even be entirely unaware of them altogether.
Psychoanalytic treatment aims to address these questions by looking closely at not only our conscious thoughts and feelings but also the unconscious parts of ourselves that deeply organize our psychological lives—feelings, wishes, anxieties, conflicts, fears, traumas, desires—as well as the unconscious, habitual ways we keep ourselves from becoming aware of and knowing those parts of our mind.
What happens during sessions?
You begin sessions with whatever happens to be on your mind in the moment. You might talk about something that happened during the week, a difficult relationship, a painful memory, an uncomfortable feeling, or something that doesn't seem especially important or meaningful.
There is no particular subject you're expected to discuss, and you don't need to prepare an agenda or organize your thoughts beforehand. Nor should you feel the need to focus only talking about what distresses or upsets you—your troubles, struggles, or symptoms.
Instead, I encourage patients to speak as freely as they can—allowing thoughts to arise naturally and spontaneously rather than intentionally choosing what's relevant or worth mentioning.
Speaking in this way includes talking about thoughts that seem unrelated to the conversation, feelings that feel difficult or frightening to put into words, memories or fantasies that unexpectedly come to mind, and things you might ordinarily hold back in a regular conversation—things that could feel inappropriate, silly, offensive, confusing, vulnerable, rude, embarrassing, insulting, or strange.
The purpose of speaking freely is to make it possible for thoughts, feelings, ideas, memories, and fantasies to come to mind in ways that they usually don’t when we're organizing, filtering, or controlling what we say.
What does the therapist do?
My role is to listen carefully and help us investigate what emerges together.
I pay close attention to what you say and do in our sessions and to what it tells us about you, your mind, and the difficulties that brought you to therapy—and I help you pay close attention to your own mind in the same way.
Sometimes this process involves asking questions, clarifying something you've said, or reflecting my understanding to you. Other times, I might comment on a contradiction, point out a recurring pattern, note an unexpected association, or identify a subtle shift in how you seem to be thinking or feeling.
I am especially paying attention to the ways that what I see and hear in your speech, your body, your voice, your face, or your behavior could suggest that you are keeping yourself from becoming aware of something in your mind.
These observations are made without any intention of judgment, criticism, or scorn. I share with you what I notice and observe because it provides opportunities for us to examine psychological habits and impulses that could be entirely unconscious—that you are perhaps not consciously aware of at all—and that might play an important role in causing or keeping up the difficulties that brought you to therapy.
I might also offer interpretations about the possible unconscious meanings of what you talk about or what you do in our sessions, including how what I notice could relate to your early relationships and experiences. These suggestions are ideas for us to consider and investigate together, not explanations you're expected to accept.
What are we trying to understand?
A central idea in psychoanalysis is that our minds defend against experiences that threaten to cause psychological distress.
We may have wishes or feelings that conflict with other wishes, with our values, with how we understand ourselves, or with what we believe others expect of us. Or we may have fears or anxieties about other people or about ourselves that get in the way of success at work, closeness in relationships, or satisfaction in pursuing goals. These conflicts can give rise to depression, anxiety, panic, compulsive behaviors, guilt, shame, and other painful experiences.
Often, we manage these conflicts by keeping certain aspects of our psychological lives outside of awareness.
The ways we protect ourselves can be useful and necessary, but they can also contribute to persistent symptoms, difficulties in relationships, and patterns of feeling and behavior that we struggle to understand or change.
An important part of our work is therefore to understand not only what has been warded off but also how and why your mind has kept you from becoming aware of it.
Why do we sometimes talk about the therapy itself?
The same psychological patterns that shape our experiences outside of therapy can also emerge in the treatment.
For this reason, we may sometimes examine together what happens between us in our sessions: how you experience me, what you expect from me, how you feel toward or about me, how you respond to something I've said, or how we find ourselves relating to one another.
When we talk about external situations in your life from the present or the past and try to find important psychological processes, habits, tendencies, and patterns that they might reveal, we are doing so retrospectively from memory. Talking about what takes place between us in the treatment provides opportunities to observe and investigate psychological processes as they're happening—right now, in real time.
And it's also important for me to understand how you're experiencing the treatment itself. I encourage you tell me if something related to our process feels uncomfortable, confusing, unhelpful, or difficult to discuss, because before and above anything else, I aim to do what I can to help you feel safe, trusting, and secure in our work together. You do not need to agree with my understanding of an experience, and there is no requirement to explore something before you feel ready.
How does change occur?
Psychoanalytic treatment is not structured around a fixed sequence of exercises, skills, or prescribed steps. The process develops gradually through a patient, unhurried, and careful investigation of what emerges in the course of our sessions.
Sometimes important insights arise quite unexpectedly. More often, understanding deepens through returning again and again to familiar experiences and slowly recognizing more and more about them that had you had previously had little or no awareness of.
As our work unfolds over time, we come to know both the parts of yourself underlying persistent psychological difficulties as well as the protective or defensive patterns that have kept those parts of you unconscious and maintained those difficulties.
The aim is not simply to feel better temporarily but to become more integrated and whole through making contact with all parts of yourself, even those that felt like they could never be allowed into the light. Our work helps you become less ruled by unconscious fears, conflicts, impulses, and patterns, resulting in greater freedom in how you experience yourself and relate to the world.