Psychoanalytic therapy
Understanding feelings and patterns that are difficult to explain, even to yourself.
By Richard Mann · 15 October 2026
← Integrative therapy and the different approaches
You may know that a reaction seems larger than the situation, yet still feel unable to change it. Perhaps you repeatedly expect rejection, become uncomfortable when someone cares for you, or lose interest whenever something starts to go well. Understanding the pattern intellectually may not change how it feels.
Psychoanalytic therapy explores the possibility that parts of our emotional lives are outside our immediate awareness. Earlier relationships, wishes, fears and ways of protecting ourselves can continue to shape the present. The work involves becoming curious about those influences, rather than treating a repeated difficulty as a personal failing.
Why look beneath the immediate problem?
Sometimes a way of coping once served an important purpose. Keeping feelings private might have helped you in a family where vulnerability was unwelcome. Later, the same protection might leave you lonely with someone who wants to know you. Making sense of that history can help explain why change feels both desirable and frightening.
The aim is not to blame your family or find one event that explains everything. It is to develop a fuller understanding of your experience and the conflicts within it. Feeling two things at once—for example wanting closeness and fearing it—can become something to explore.
What can sessions involve?
You are encouraged to speak about what comes to mind, including thoughts that seem unimportant, memories, dreams and feelings about the therapy itself. The therapist listens for connections, contradictions and recurring themes, and offers ideas for you to consider. These should be explored together, rather than treated as unquestionable truths.
The relationship with the therapist can bring familiar expectations into the room. You might worry that they are bored or disappointed before you know whether they are. Talking about that experience can help you recognise how you anticipate and respond to other people. It needs care, time and a relationship in which disagreement is possible.
Psychoanalysis and psychoanalytic psychotherapy
Formal psychoanalysis is an intensive arrangement, commonly involving several sessions each week over a substantial period. Psychoanalytic psychotherapy draws on related ideas and may involve fewer sessions. Frequency, use of a couch and the overall arrangement vary and should be discussed with the practitioner.
These are specialist forms of work. This article explains the approach; it is not a statement that I offer formal psychoanalysis. Drawing on psychoanalytic ideas in integrative counselling is a different arrangement. It is sensible to ask any practitioner about their training, the commitment involved and how you will review the work.
Wanting closeness, then pulling away
As an illustration, someone might feel excited about a new relationship and then become preoccupied with the other person’s faults. Exploring when that shift happens could reveal anxiety about depending on someone or being hurt. The useful change is not simply deciding to ignore doubts. It may be becoming able to recognise fear, talk about it and make a more considered choice about the relationship.
What might change?
Recognising a familiar pattern
You may notice earlier when an old expectation is shaping a new situation.
More room for mixed feelings
Affection, disappointment and dependence can become easier to acknowledge.
Different choices in relationships
Understanding a protective response may help you decide when it is still needed.
These are possible signs of progress, not promises. What matters is whether the work is making a useful difference to your life. You and your therapist can review that together.
How this fits with integrative therapy
Integrative counselling can make room for less obvious feelings and the influence of earlier relationships, while also considering what would help in your life now. You do not need to undertake formal analysis to be curious about the patterns you find yourself repeating.
Read about integrative therapy and explore the other approaches →Sources and further reading
- British Psychoanalytical Society: About psychoanalysis
- British Psychoanalytical Society: Things to think about
- NHS: Treatments for depression, including psychodynamic psychotherapy
This article explains an approach in general terms. The right support depends on your needs, preferences and the practitioner’s training.
We can begin with a conversation.
You do not need to work out which approach you need before getting in touch. I offer a free 15-minute consultation to talk about what is troubling you and whether working together feels right.
Sessions are available in North London and online across the UK.
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