What Is Psychoanalytic Psychotherapy, and Is It Right for You?

Psychoanalytic psychotherapy is a depth approach to understanding the self. Unlike therapies focused on symptom management, reducing anxiety through breathing exercises, changing thought patterns through cognitive restructuring, psychoanalytic work is interested in what those symptoms mean, and where they come from.

The underlying belief is that much of what drives our behavior, our relationship patterns, and our emotional life operates outside of conscious awareness. Not because we're hiding something from ourselves on purpose, but because certain experiences, feelings, and ways of relating were organized before we had words for them, and have continued to shape us ever since.

Why does psychoanalytic therapy focus on the unconscious?

Most of us have had the experience of knowing something intellectually, understanding exactly why we respond a certain way, and still being unable to change it. We can see the pattern clearly. We sometimes can even trace it back to its origins. And then we find ourselves in the same dynamic again, with different people, in different circumstances.

This gap between insight and change is what psychoanalytic therapy is designed to address. The patterns that shape us most deeply aren't primarily cognitive, they're relational and emotional, laid down in early experience before thinking could fully organize them.

Psychoanalytic therapy works by creating conditions in which these deeper patterns can emerge, be experienced, and be understood in a different way, often through what happens in the relationship between therapist and patient.

What does psychoanalytic therapy actually look like?

Sessions are typically weekly, and often twice weekly as the work deepens. Unlike more structured therapeutic approaches, there isn't a fixed agenda or curriculum. The patient is invited to speak freely, to follow what's alive, what recurs, what surprises them, what they've never quite put into words.

Dreams can be important material. So can the ways the therapeutic relationship itself develops — the feelings that arise in the room, the moments of connection or difficulty, the patterns that emerge between patient and therapist.

At times, the work moves into early relational experiences that organize a person's emotional life. We visit those moments not to place blame or dwell in the past, but because recognizing how the past lives on in the present is what allows something to shift.

How is psychoanalytic therapy different from CBT?

Cognitive Behavioral Therapy (CBT) is a structured approach focused on changing specific thought patterns and behaviors. It works well for many people, particularly for discrete and targeted concerns. A typical course of CBT may be 12–20 sessions.

Psychoanalytic psychotherapy is less structured, longer-term, and oriented towards understanding and awareness rather than symptom reduction as a primary goal. It's less interested in changing a specific thought pattern and more interested in why that pattern exists, what it means, and what it protects against.

Neither is universally better. They address different questions and suit different people. Many patients have tried CBT and found some relief in symptom management but sense that something more fundamental remains unaddressed.

What kinds of concerns does psychoanalytic therapy address?

Psychoanalytic therapy is particularly well-suited for:

Symptoms that persist or return. Anxiety and depression can endure despite other treatments, or return cyclically without clear external cause. The question psychoanalytic work asks isn't only "how do we reduce this?" but "what is this about? Where does it come from? What might it be trying to express that we haven't been able to say more directly?" Symptoms such as procrastination, avoidance, isolation, impulsivity, lack of motivation, and overthinking can be a solution, or a compromise, to an unconscious wish, belief, or conflict.

Relationship patterns that repeat. If you find yourself in the same dynamics, with partners, colleagues, friends, family, despite wanting things to be different, the source is often something that predates those relationships. Understanding the earlier relational experiences that organized these patterns opens the door to change.

Self-criticism and self-doubt that feel deeply embedded, less like a habit and more like a core sense of who you are. Psychoanalytic work explores where this inner critic came from and what function it serves, which is usually the first step toward something actually shifting.

A sense that something important hasn't yet been understood. Many people come to psychoanalytic therapy not with a specific presenting problem, but with a felt sense that something in their inner life is asking to be known, that there's more to understand about why they are the way they are.

How long does psychoanalytic therapy take?

Psychoanalytic therapy is a longer-term process. Unlike brief, focused approaches, it isn't structured around a fixed number of sessions. The work tends to deepen over time, and the most significant changes often emerge gradually, in the way a person relates to themselves, to others, and to the emotional life they've been carrying.

Most patients work weekly. Many move to twice-weekly sessions as the work develops. The appropriate length is something that emerges from the work itself, some patients work for a year or two, others for much longer.

This kind of commitment requires a genuine willingness to engage with the process, to stay with discomfort, to bring curiosity to what emerges, and to invest real time and attention in understanding what's driving the difficulties that brought you to therapy in the first place.

Is psychoanalytic therapy available via telehealth?

Yes. While there is something irreplaceable about the in-person setting, the shared physical space, the subtleties of presence, psychoanalytic work can be conducted meaningfully via video. Many patients find that the intimacy and focus of the telehealth session supports the work effectively.

I offer in-person sessions in Merrick, NY, and telehealth throughout New York, Rhode Island, and Florida.

How do you know if psychoanalytic therapy is right for you?

The patients I work best with tend to share a few qualities. They're curious about their inner life and interested in what drives them. They've sometimes already tried other approaches and found that something important remained unaddressed. They sense that the patterns causing difficulty have earlier roots, even if they can't quite articulate where.

They're also willing to commit to the process. Not because they know exactly what that will look like, but because they sense that the kind of change they're looking for requires time and trust for deeper work to unfold.

Human beings are full of contradictory feelings and creative adaptations to life. D. W. Winnicott, a British pediatrician and psychoanalyst, famously wrote in the 1960s:

If any of this resonates, if something in you wishes to be more fully known, and you're ready to do that work, I'd welcome a conversation.