What Is Psychoanalytic Psychotherapy? Understanding Depth-Oriented Talk Therapy
What Is Psychoanalytic Psychotherapy? Understanding Depth-Oriented Talk Therapy
Meta Description: Psychoanalytic psychotherapy explores unconscious patterns, childhood roots of current struggles, and relationship templates. DC therapist explains how this depth-oriented approach helps with depression, anxiety, shame, trauma, and identity issues—especially for LGBTQ+ clients.
Beyond Symptoms: Understanding the Depth Approach to Healing
When most people think of therapy, they imagine sitting on a couch and "just talking" about their problems. While psychoanalytic psychotherapy—also called psychodynamic therapy—certainly involves talking, it's far more than casual conversation. It's a sophisticated, evidence-based treatment approach that explores the unconscious patterns, early relational experiences, and internal conflicts that shape your current emotional struggles.
Unlike symptom-focused therapies that primarily address "what" you're experiencing, psychoanalytic psychotherapy asks deeper questions:
Why do you keep ending up in the same painful relationship patterns?
Why does your inner critic attack you so relentlessly?
Why do you feel empty, disconnected, or like something fundamental is wrong with you?
Why do successful achievements still leave you feeling inadequate?
Why does intimacy feel terrifying even when you desperately want connection?
These "why" questions lead to lasting change because they address root causes, not just surface symptoms.
At District Counseling and Psychotherapy, we specialize in psychoanalytic and psychodynamic approaches—particularly for gay, bisexual, and queer men navigating issues of identity, shame, relationships, and authenticity. This blog explores what psychoanalytic psychotherapy is, how it works, who benefits most, and why it's particularly effective for LGBTQ+ individuals working through complex identity and relational challenges.
What Is Psychoanalytic Psychotherapy?
The Foundation: Making the Unconscious Conscious
Psychoanalytic psychotherapy (often used interchangeably with "psychodynamic therapy") is based on the fundamental insight that much of what drives our emotions, behaviors, and relationship patterns operates outside conscious awareness.
The core premise:
Your current struggles have roots in past experiences—particularly early relationships
You've internalized patterns from childhood that now shape how you see yourself, others, and relationships
Defense mechanisms protect you from painful feelings but also limit your growth
Unconscious conflicts create symptoms (anxiety, depression, relationship problems)
By making unconscious patterns conscious, you gain choice and freedom to change
The goal: Not just symptom relief (though that often happens), but fundamental transformation of how you relate to yourself and others—developing a more integrated, authentic, resilient sense of self.
Historical Context and Evolution
Origins: Developed by Sigmund Freud in the late 1800s, psychoanalysis was revolutionary in suggesting that unconscious mental processes influence behavior. While classical Freudian analysis (lying on a couch, free associating 4-5 times per week) is less common today, its core insights have evolved into modern psychoanalytic/psychodynamic therapy.
Modern developments: Contemporary psychoanalytic therapy integrates:
Object Relations Theory (Melanie Klein, Ronald Fairbairn, Donald Winnicott): How early relationships become internalized and shape your inner world
Self Psychology (Heinz Kohut): How empathic attunement from caregivers (or lack thereof) shapes self-development
Attachment Theory (John Bowlby, Mary Ainsworth): How early attachment patterns influence adult relationships
Relational Psychoanalysis (Stephen Mitchell): Emphasis on the therapeutic relationship as agent of change
Intersubjectivity: How two minds meet and influence each other
How It Differs from Other Therapies
Psychoanalytic/Psychodynamic vs. Cognitive Behavioral Therapy (CBT):
Psychodynamic Therapy CBT Explores unconscious patterns and childhood origins Focuses on conscious thoughts and current behaviors Long-term depth work (typically 1-3+ years) Short-term symptom-focused (typically 12-20 sessions) Emphasis on therapeutic relationship Emphasis on skills and techniques "Why do I keep doing this?" "How can I change this behavior now?" Works with transference and past relationships Works with here-and-now cognitions Open-ended exploration Structured, goal-directed
Both are valuable—and we integrate both approaches when appropriate. CBT is excellent for symptom management and skill-building; psychodynamic work addresses deeper character patterns and relational templates.
Example:
CBT approach to social anxiety: Identify catastrophic thoughts ("Everyone will think I'm stupid"), challenge them with evidence, practice exposure to social situations
Psychodynamic approach to social anxiety: Explore where the conviction "I'm fundamentally unacceptable" came from, how early experiences of criticism or rejection shaped your internal world, how you've internalized a harsh critical voice, and how this plays out in relationships now
Often the most effective treatment uses both: CBT for immediate symptom relief and skill-building, psychodynamic work for lasting transformation.
Core Concepts in Psychoanalytic Psychotherapy
1. The Unconscious Mind
The idea: Much of your mental life operates outside awareness. You're not fully conscious of:
Childhood memories and their emotional impact
Core beliefs about yourself formed in early relationships
Defense mechanisms you use to manage anxiety
Patterns you repeat in relationships
Wishes, fears, and conflicts that feel too threatening to acknowledge
In therapy: We explore dreams, slips of the tongue, what you avoid talking about, patterns in your relationships, and your feelings toward the therapist—all windows into unconscious material.
2. Defense Mechanisms
The idea: Your psyche has developed automatic ways of protecting you from overwhelming feelings or threatening thoughts. While defenses serve an important function, they can also create problems.
Common defense mechanisms:
Repression: Pushing painful memories or feelings out of awareness
Example: No memory of childhood emotional neglect, but pervasive feeling something is wrong with you
Denial: Refusing to acknowledge reality
Example: "My father's alcoholism didn't affect me at all"
Projection: Attributing your own unacceptable feelings to others
Example: "Everyone thinks I'm inadequate" (when actually you think you're inadequate)
Reaction Formation: Expressing the opposite of how you really feel
Example: Being overly nice to someone you're angry with
Intellectualization: Thinking about feelings rather than experiencing them
Example: "I understand intellectually why the breakup happened" (but not allowing yourself to grieve)
Splitting: Seeing people (or yourself) as all-good or all-bad, unable to integrate complexity
Example: Idealizing a new partner then devaluing them at first disappointment
For LGBTQ+ individuals: Common defenses include:
Compartmentalization (keeping sexual identity separate from other parts of life)
Dissociation (disconnecting from body during sex or stressful situations)
Minimization ("The homophobia I experienced wasn't that bad")
In therapy: We gently explore defenses—not to strip them away (which would be harmful) but to understand their function and develop more flexible coping.
3. Transference and Countertransference
Transference: You unconsciously relate to your therapist as if they were someone from your past (usually a parent or significant early figure). You transfer feelings, expectations, and patterns from past relationships onto the therapeutic relationship.
Examples:
Expecting your therapist to be critical (like your father was)
Feeling you need to please your therapist to keep them engaged (like you did with your mother)
Fearing your therapist will abandon you if you express anger
Assuming your therapist judges your sexuality
Why transference is valuable: It brings your unconscious relationship patterns into the room where they can be observed, discussed, and worked through in real-time.
Countertransference: The therapist's emotional response to you. Modern psychoanalysis views countertransference as valuable information—the feelings evoked in the therapist often mirror dynamics in your other relationships or reveal something about your internal experience.
The therapeutic relationship becomes a laboratory where old patterns can be identified, understood, and—through a corrective emotional experience with the therapist—transformed.
4. Object Relations: Your Internal World
Object Relations Theory explains how early relationships become internalized and shape your inner world.
Key concepts:
Internalized objects: You carry internal representations of important people from your past (particularly caregivers). These aren't accurate memories—they're subjective experiences of how you were treated and how you felt in those relationships.
Example: If your mother was critical and dismissive, you've internalized a "critical mother object" that now lives in your psyche as your harsh inner critic.
Self-object representations: You also carry internal representations of yourself based on how you were treated. If you were shamed or rejected, you've internalized a "bad self"—a belief that you're fundamentally flawed or unlovable.
Relationship templates: These internalized objects create templates for how relationships work:
How much love and acceptance you expect
Whether you feel safe depending on others
How you handle conflict or disappointment
Whether you believe you're worthy of love
Splitting: When early experiences are traumatic or confusing, you may split objects into "all-good" and "all-bad" to manage overwhelming feelings. This prevents integrating complexity and creates unstable relationships.
For LGBTQ+ individuals:
If you were rejected for your authentic self, you may have split into a "false self" (acceptable but inauthentic) and "true self" (authentic but shameful)
Internalized homophobia represents absorbing society's "bad object" and directing it toward yourself
Early lack of mirroring for your LGBTQ+ identity creates gaps in self-development
In therapy: We explore these internalized relationships, how they shape current struggles, and work toward developing more integrated, compassionate internal objects.
5. Self Psychology: Empathy and Self-Development
Self Psychology (Heinz Kohut) focuses on how the self develops through empathic attunement from caregivers.
Key concepts:
Selfobject needs: As children, we need caregivers to provide:
Mirroring: Reflecting back that we're valuable, delightful, worthy of attention
Idealization: Providing a strong, capable figure we can admire and feel protected by
Twinship: Experiencing others as fundamentally like us, providing belonging
Empathic failures: When caregivers fail to meet these needs (through abuse, neglect, or simply not attuning to the child's actual feelings), the self doesn't develop cohesively. Instead:
You develop a fragile, fragmented sense of self
You're vulnerable to "narcissistic injuries" (experiences that threaten your sense of worth)
You may develop a "false self" to gain acceptance
You struggle with self-esteem regulation
For gay and bisexual men:
Parents couldn't mirror your authentic identity because they didn't recognize or rejected it
You lacked idealized figures who were like you (gay role models)
No twinship experience (feeling fundamentally different from others)
This creates profound self-fragmentation and shame
In therapy: The therapist provides belated selfobject experiences—empathic attunement to your actual feelings, validation of your authentic self—allowing the self to develop more cohesively.
What Happens in Psychoanalytic Psychotherapy?
The Structure and Process
Frequency: Typically once or twice weekly (more intensive than many therapies but less than classical psychoanalysis)
Duration: Long-term work—typically 1-3+ years, sometimes longer. This isn't a limitation but a feature: deep character change takes time.
Format: Traditional face-to-face talk therapy (not lying on a couch, despite the stereotype). At District Counseling and Psychotherapy, we provide secure virtual sessions.
What happens in sessions:
1. Free association: You're encouraged to say whatever comes to mind—thoughts, feelings, memories, dreams, fantasies—without censoring. This allows unconscious material to surface.
2. Exploration, not advice: The therapist doesn't give you solutions or tell you what to do. Instead, they help you explore your inner world, notice patterns, and develop insight.
3. Attention to feeling: Not just discussing events, but experiencing the emotions connected to them.
4. Pattern recognition: Noticing repetitive themes in relationships, reactions, and internal experiences.
5. Exploration of the past: Understanding how childhood experiences shaped current patterns—not to blame parents but to make sense of your development.
6. Working with resistance: When you avoid certain topics, miss sessions, or deflect—these "resistances" are explored as meaningful, revealing what feels too threatening to face.
7. Analysis of transference: Exploring your feelings about the therapist and the therapy itself as windows into relationship patterns.
The Therapeutic Relationship as Agent of Change
In psychoanalytic therapy, the relationship between therapist and patient is central to healing—not just a vehicle for delivering techniques.
How the relationship heals:
1. Corrective emotional experience: The therapist responds differently than early caregivers did—providing empathy instead of criticism, acceptance instead of rejection, attunement instead of misattunement.
2. Safe space for exploration: Consistent, non-judgmental presence allows you to explore feelings and experiences you've never felt safe sharing.
3. New internalization: Over time, you internalize the therapist's accepting, curious, empathic stance—developing more self-compassion and less harsh self-attack.
4. Working through transference: When old relationship patterns emerge in therapy, they can be identified, discussed, and experienced differently.
5. Affective attunement: The therapist's emotional resonance with your experience validates and organizes feelings that may have felt overwhelming or confusing.
For LGBTQ+ clients: The therapist provides perhaps the first consistently affirming, empathic response to your authentic self—a crucial developmental experience you may have missed.
What Issues Does Psychoanalytic Therapy Treat?
While psychodynamic therapy can address many concerns, it's particularly effective for certain issues:
1. Depression (Especially Chronic or Recurrent)
Why psychodynamic therapy helps:
Explores underlying causes (loss, anger turned inward, internalized critical objects)
Addresses character patterns that maintain depression
Works with the "why" not just the "what"
Particularly effective for depression rooted in early relational trauma
Research: Meta-analyses show psychodynamic therapy is as effective as CBT for depression and may have longer-lasting effects because it addresses root causes.
2. Anxiety Disorders
Why psychodynamic therapy helps:
Explores what anxiety defends against (often deeper fears about self or relationships)
Addresses perfectionism and self-criticism fueling anxiety
Works with attachment wounds creating anxious relationship patterns
Integrates traumatic experiences contributing to hypervigilance
Particularly effective for:
Generalized anxiety with perfectionistic features
Social anxiety rooted in shame
Anxiety in relationships (fear of abandonment or engulfment)
3. Shame and Internalized Homophobia/Biphobia
Why psychodynamic therapy is ideal:
Shame operates unconsciously and requires depth work to access
Explores where shame was internalized (family, religion, society)
Works with split between "false self" (acceptable) and "true self" (authentic but shameful)
Provides corrective experience of being fully seen and accepted
Addresses internalized "bad objects" that maintain self-attack
This is arguably psychodynamic therapy's greatest strength for LGBTQ+ clients: Surface work on shame rarely produces lasting change because the internalized homophobia operates at unconscious levels.
4. Relationship Patterns and Difficulties
Why psychodynamic therapy helps:
Identifies repetitive relationship patterns (always choosing unavailable partners, sabotaging intimacy, etc.)
Explores internalized relationship templates from childhood
Works with attachment wounds
Uses transference to bring patterns into the therapy for direct work
Effective for:
Choosing the same type of problematic partner repeatedly
Difficulty with intimacy or vulnerability
Intense, unstable relationships
Fear of abandonment or engulfment
Inability to trust or depend on others
5. Identity and Authenticity Issues
Why psychodynamic therapy is ideal:
Explores the development of "false self" vs. "true self"
Works with fragmentation and lack of cohesive identity
Addresses developmental failures that prevented authentic self-expression
Provides mirroring and validation of authentic self
Particularly relevant for LGBTQ+ individuals:
Never being seen for who you truly are
Developing elaborate masks to hide identity
Feeling like you don't know yourself
Chronic sense of emptiness or disconnection from self
6. Complex Trauma and PTSD
Why psychodynamic therapy helps:
Explores how trauma shaped your sense of self and relationships
Works with dissociation and fragmentation
Addresses developmental trauma (ongoing childhood abuse/neglect) as well as single-incident trauma
Integrates traumatic experiences into coherent narrative
Often combined with: Somatic Experiencing or other body-oriented approaches for trauma processing.
7. Personality Patterns and Character Issues
Why psychodynamic therapy is essential:
Character patterns (ways of being in the world) require long-term depth work
Surface approaches rarely produce lasting change in personality organization
Explores how early experiences created current personality structure
Effective for:
Narcissistic vulnerability (fragile self-esteem, need for admiration)
Borderline patterns (intense relationships, fear of abandonment, identity instability)
Avoidant patterns (difficulty with intimacy, social isolation)
Obsessive-compulsive personality patterns (perfectionism, rigidity)
8. Eating Disorders and Body Image Issues
Why psychodynamic therapy helps:
Explores what eating disorder symptoms defend against or express
Addresses underlying issues of control, self-worth, identity
Works with internalized critical objects
Particularly relevant for gay men struggling with body image pressures
9. Substance Use and Addictive Behaviors
Why psychodynamic therapy helps:
Explores what substances or behaviors are managing (shame, emptiness, anxiety)
Addresses underlying relational wounds
Works with internalized bad objects that maintain self-destructive patterns
Note: Active substance dependence typically requires addiction-specific treatment first; psychodynamic work is ideal after stabilization.
10. General Dissatisfaction and "Existential" Concerns
Why psychodynamic therapy helps:
Addresses questions of meaning, purpose, authenticity
Works with feeling like something is fundamentally wrong even when life looks good externally
Explores chronic sense of emptiness or disconnection
Effective for:
"I should be happy but I'm not"
Feeling like you're going through the motions
Chronic dissatisfaction despite external success
Sense that you're not living your authentic life
Who Benefits Most from Psychoanalytic Psychotherapy?
Ideal Candidates
Psychoanalytic therapy works best for individuals who:
✅ Want to understand "why," not just "what": You're curious about patterns and interested in self-exploration
✅ Are willing to commit long-term: You understand deep change takes time
✅ Are psychologically-minded: You're able to reflect on your internal experiences and notice patterns
✅ Want lasting character change: You're seeking fundamental transformation, not just symptom management
✅ Struggle with repetitive patterns: You keep ending up in the same situations despite consciously wanting different outcomes
✅ Have relationship difficulties: Problems in relationships are core concerns
✅ Experience shame or identity issues: Particularly relevant for LGBTQ+ individuals
✅ Have childhood trauma or relational wounds: Early experiences significantly impact current functioning
✅ Feel something is fundamentally wrong: Despite external success, chronic sense of emptiness or inadequacy
✅ Want to work at a deeper level: Previous short-term therapies provided temporary relief but not lasting change
Special Considerations for LGBTQ+ Individuals
Psychoanalytic therapy is particularly valuable for gay, bisexual, and queer men because:
1. Shame operates unconsciously: Surface-level work rarely touches the deep internalized homophobia and shame that operates outside awareness
2. Identity fragmentation: LGBTQ+ individuals often develop split between "false self" (acceptable to others) and "true self" (authentic but shameful)—requiring depth work to integrate
3. Developmental trauma: Missing crucial developmental experiences (mirroring, twinship, idealization of someone like you) creates gaps requiring long-term reparative work
4. Complex relationship patterns: Internalized relationship templates from families who couldn't accept your authentic self create specific relationship difficulties
5. Need for authentic therapeutic relationship: Perhaps first experience of being fully seen, accepted, and valued for your authentic self
When Other Approaches Might Be Better
Psychoanalytic therapy may not be the best fit if:
❌ You're in acute crisis requiring immediate stabilization ❌ You need concrete skills for symptom management urgently ❌ You prefer short-term, structured approaches ❌ You're unable to commit to weekly sessions long-term ❌ You have active substance dependence (need addiction treatment first) ❌ You have severe, untreated psychiatric illness requiring medication management first ❌ You're not interested in exploring the past or unconscious patterns ❌ You want the therapist to tell you what to do
Often the solution is integrative: Using multiple approaches in sequence or combination.
What to Expect: The Journey of Psychoanalytic Therapy
Beginning Phase (Months 1-6)
What's happening:
Building safety and trust in the therapeutic relationship
Initial exploration of current struggles and life history
Beginning to notice patterns
Establishing the "frame" (consistent time, fee, frequency)
Often experiencing relief from being heard and understood
What it feels like:
Hopeful and engaged
Sometimes anxious about vulnerability
Relief at being able to talk freely
Curiosity about the process
Middle Phase (Variable—Often 1-2+ Years)
What's happening:
Deeper exploration of unconscious patterns
Working with resistance and defense mechanisms
Experiencing and working through transference
Connecting current patterns to past experiences
Grief about what you missed or endured in childhood
Gradual internalization of therapist's accepting stance
Shifts in how you relate to yourself and others
What it feels like:
Sometimes frustrating ("Why isn't this faster?")
Periods of feeling worse before feeling better (as defenses soften, painful feelings surface)
Increasing self-awareness and insight
Gradual changes in relationships and self-experience
Moments of profound connection and being understood
This is the core work—and it requires patience and commitment.
Ending Phase (Months to a Year)
What's happening:
Processing the ending of therapy (often activates past loss)
Consolidating gains
Grieving the loss of the therapeutic relationship
Internalizing the work so you become your own therapist
Preparing to maintain growth independently
What it feels like:
Bittersweet
Grief and gratitude
Confidence in your growth
Anxiety about managing without therapy
Note: Some people return periodically for "tune-ups" or during difficult life transitions—this is normal and healthy.
Evidence Base: Does Psychoanalytic Therapy Work?
The Research
For decades, psychoanalytic therapy was criticized for lacking empirical support. Recent research has conclusively demonstrated its effectiveness:
Meta-analyses show:
Psychodynamic therapy is as effective as CBT for depression and anxiety
Effects are long-lasting and often increase after therapy ends (unlike symptom-focused approaches where gains may diminish)
Particularly effective for complex presentations, personality issues, and chronic conditions
Works well for treatment-resistant cases
Key studies:
Shedler (2010): Major review in American Psychologist showing effect sizes for psychodynamic therapy equal to or exceeding other therapies
Leichsenring & Rabung (2008): Long-term psychodynamic therapy highly effective for complex disorders
Town et al. (2017): Meta-analysis showing psychodynamic therapy effective for wide range of conditions
Why effects last: By addressing root causes and character patterns, psychodynamic therapy creates lasting structural change rather than just symptom suppression.
Psychoanalytic Therapy at District Counseling and Psychotherapy
At District Counseling and Psychotherapy, we specialize in psychoanalytic and psychodynamic approaches—particularly for gay, bisexual, and queer men navigating identity, shame, relationships, and authenticity.
Our Approach
We integrate:
Psychoanalytic and psychodynamic theory:
Exploration of unconscious patterns
Attention to transference and therapeutic relationship
Understanding how past shapes present
Self Psychology:
Providing empathic attunement you may have missed
Working with fragmentation and self-development
Addressing narcissistic vulnerabilities
Object Relations Theory:
Exploring internalized relationships
Working with split between true and false self
Transforming internalized critical voices
Shame resilience (Brené Brown):
Identifying shame triggers
Developing shame resilience skills
Building authentic connection
Self-compassion (Kristin Neff):
Learning to treat yourself with kindness
Recognizing common humanity
Mindful awareness of suffering
Trauma-informed care:
Understanding how trauma shaped development
Addressing dissociation and fragmentation
Somatic Experiencing when appropriate
LGBTQ+-affirming practice:
Deep understanding of minority stress
Experience working with internalized homophobia/biphobia
Affirmation of authentic LGBTQ+ identity
Understanding unique developmental challenges for LGBTQ+ individuals
What We Treat
We specialize in psychodynamic therapy for:
Internalized homophobia and shame: Deep work on unconscious self-rejection
Identity and authenticity issues: Integrating split between false self and true self
Depression (especially chronic): Exploring roots in loss, anger, internalized critical objects
Anxiety and perfectionism: Understanding what anxiety defends against
Relationship patterns: Why you keep choosing unavailable partners or sabotaging intimacy
Childhood trauma: Complex developmental trauma requiring long-term depth work
Attachment wounds: Difficulty trusting, depending on others, or allowing intimacy
Chronic emptiness or dissatisfaction: "Something is fundamentally wrong" despite external success
Substance use in recovery: After stabilization, addressing underlying relational wounds
What to Expect
Initial consultation (free 15 minutes):
Discuss your concerns and goals
Determine if psychodynamic therapy is a good fit
Answer questions about the process
First sessions:
Comprehensive assessment
Exploration of current struggles and life history
Beginning to establish therapeutic relationship
Discussing expectations and structure
Ongoing work:
Weekly sessions (50 minutes)
Open-ended exploration following your associations
Attention to patterns, feelings, and relationship dynamics
Working with transference as it emerges
Gradual deepening of self-understanding
Long-term commitment (typically 1-3+ years)
Virtual Therapy in the DC/DMV Area
We provide secure, convenient virtual therapy sessions to clients throughout Washington DC, Northern Virginia, and Maryland. The depth and intimacy of psychoanalytic work translates beautifully to virtual sessions—many clients find the comfort of their own space facilitates deeper exploration.
Is Psychoanalytic Therapy Right for You?
Consider psychoanalytic therapy if:
✅ You keep ending up in the same painful situations despite wanting change ✅ You struggle with shame about your identity or who you are ✅ You feel like you don't truly know yourself ✅ You've developed elaborate masks to hide your authentic self ✅ Relationships are consistently difficult or unsatisfying ✅ You feel empty, disconnected, or like something is fundamentally wrong ✅ Childhood experiences significantly impact your current functioning ✅ Previous short-term therapies provided temporary relief but not lasting change ✅ You're interested in understanding the "why" behind your patterns ✅ You're willing to commit to long-term, depth-oriented work ✅ You want fundamental transformation, not just symptom management
For LGBTQ+ individuals: If you struggle with internalized homophobia, identity fragmentation, chronic shame, or relationship patterns rooted in developmental wounds, psychoanalytic therapy offers the depth and duration needed for lasting healing.
Common Questions About Psychoanalytic Therapy
"How long does it take?"
Honest answer: Longer than you'd like, but as long as it needs to. Typically 1-3+ years, sometimes longer. Deep character change and healing from developmental trauma takes time—there are no shortcuts.
Why so long? You're not just learning skills or changing thoughts—you're transforming fundamental patterns that have been decades in the making. The therapeutic relationship itself is what heals, and relationships develop over time.
"Will I have to lie on a couch?"
No. Classical psychoanalysis (4-5 times per week with the analyst sitting behind you) uses a couch. Modern psychoanalytic therapy is face-to-face, typically once or twice weekly, and much more interactive.
"Will we just talk about my childhood?"
Not just childhood, but yes, we'll explore it. Understanding how early experiences shaped current patterns is crucial. However, we're always connecting past to present—exploring how childhood templates play out in current relationships and self-experience.
"Is it just talk? Won't I need skills?"
Psychoanalytic therapy isn't "just talk"—it's deep emotional work. The therapeutic relationship provides corrective emotional experiences that literally change your internal working models.
That said, we integrate approaches. If you need specific coping skills, we can incorporate CBT techniques. But often, once underlying conflicts are resolved, symptoms naturally improve without needing to directly target them.
"Will you tell me what to do?"
No—and that's the point. The goal isn't dependence on the therapist for answers but developing your own capacity for insight, self-reflection, and authentic decision-making. We help you understand yourself so you can make choices aligned with your authentic self.
"What if I can't commit long-term?"
Then psychodynamic therapy may not be the best fit right now. Consider shorter-term approaches like CBT or solution-focused therapy. You can always transition to depth work later if you find short-term approaches insufficient.
"Is it evidence-based?"
Yes. Research demonstrates psychodynamic therapy's effectiveness for depression, anxiety, personality issues, and complex presentations. Effects are long-lasting and often increase after therapy ends.
"Will you be affirming of my LGBTQ+ identity?"
Absolutely. Our practice specializes in LGBTQ+-affirming therapy. We understand minority stress, internalized homophobia, and the unique developmental challenges LGBTQ+ individuals face. Your authentic identity is not just accepted but celebrated.
Ready to Explore Depth-Oriented Therapy?
At District Counseling and Psychotherapy, we provide psychoanalytic and psychodynamic therapy for individuals seeking lasting transformation—particularly gay, bisexual, and queer men navigating identity, shame, relationships, and authenticity.
We offer:
Deep, long-term psychoanalytic and psychodynamic therapy
Integration of Self Psychology, Object Relations, and contemporary relational approaches
Shame resilience and self-compassion work
LGBTQ+-affirming, sex-positive practice
Trauma-informed care
Secure virtual sessions throughout Washington DC, Northern Virginia, and Maryland
Flexible scheduling including evenings and weekends
If you're tired of surface solutions and ready for fundamental transformation, psychoanalytic therapy offers the depth and duration needed for lasting change.
Schedule a free 15-minute consultation: Call 202-641-5335 or complete our contact form
Let's explore whether depth-oriented therapy is right for you.
Additional Resources
Related Blog Posts:
Recommended Reading:
The Drama of the Gifted Child by Alice Miller
Daring Greatly by Brené Brown
Self-Compassion by Kristin Neff
Attachment in Psychotherapy by David Wallin
The Velvet Rage by Alan Downs (LGBTQ+-specific)
Professional Organizations:
American Psychoanalytic Association (APsaA)
Division 39 (Psychoanalysis) of the American Psychological Association
International Psychoanalytic Association (IPA)
Keywords: psychoanalytic therapy DC, psychodynamic therapy, depth psychology, gay men therapy, LGBTQ+ psychotherapy, shame therapy, internalized homophobia treatment, object relations therapy, self psychology, childhood trauma therapy, virtual therapy DMV, District Counseling and Psychotherapy
Written by the clinicians at District Counseling and Psychotherapy, specialists in psychoanalytic and psychodynamic therapy, LGBTQ+-affirming care, shame resilience, and trauma-informed treatment. Providing secure virtual sessions to clients throughout Washington DC, Northern Virginia, and Maryland.
