Bearing It
We are living in a time that asks a lot of people. The news alone is enough to overwhelm most nervous systems on a daily basis. The economy is uncertain. The political ground keeps shifting. The climate is changing in ways we can feel now, not just read about. Many people carry a low-grade dread that has no single source — it comes from everywhere at once, and it doesn't let up.

And then there's the rest of life. The marriage that needs attention. The kid who's struggling. The parent who's declining. The career that doesn't feel like it fits anymore but can't be abandoned yet. The grief that hasn't been fully felt because there hasn't been time. The fury that has nowhere to go.

Most people are managing more than they let on. And most are doing it with whatever tools they picked up along the way — distraction, control, performance, withdrawal, substances, sheer force of will. These aren't failures. They're adaptations. They got you here. But at a certain point, many people find that what got them here isn't enough to get them through what's next.

This is where I think psychoanalytic work has something essential to offer — not as a luxury or an indulgence, but as a practical response to the conditions of being alive right now.

The central task of this kind of therapy, as I understand it, is growing your capacity to bear your own experience. All of it. The grief and the fury. The terror and the insecurity. The tenderness you've been afraid to feel because it might make you vulnerable. The ambition you've been afraid to own because it might make you visible. The sadness about things that can't be changed.

Bearing it doesn't mean enduring it stoically. It means being able to feel what you actually feel without collapsing, without going numb, without needing to immediately convert it into action or explanation. It means developing enough room inside yourself that difficult experience can move through you rather than getting stuck.

And here's what most people don't expect: when you can bear more, you can do more. Not in the productivity sense — in the living sense. Grief that gets felt can become depth. Anger that gets understood can become clarity. Insecurity that gets examined often turns out to be carrying information about what actually matters to you. The raw material of suffering, when it can be held and looked at honestly, has a strange tendency to become something meaningful. Not because suffering is good, but because you are more resourceful than you know, and feelings that seem unbearable in isolation become workable in the presence of someone who isn't afraid of them.

That's what the therapy provides. Not answers. Not comfort, exactly. A relationship in which you can practice bearing what's real — and discover that bearing it changes you. Not into someone tougher. Into someone more flexible, more honest, more capable of meeting the world as it actually is rather than as you wish it were.

Adapting to reality doesn't mean accepting everything passively. It means seeing clearly enough to know what you can change and what you can't, and having enough of yourself available to act on the difference. That's not a small thing. Right now, it might be the most important thing.


About the Author: Andrew Bertell is a licensed clinical social worker with over 15 years of experience in psychoanalytic psychotherapy. He practices in Ashland, Oregon and works with adults and young adults via telehealth throughout Oregon, Maryland, New York, and Idaho.

Psychedelics and Psychotherapy: What They Share
There's a growing conversation about psychedelics and mental health, and most of it focuses on the experience itself — what happens during the journey, what people see, what they feel. Less gets said about what comes before and after, which is where the real work tends to live.

Preparation and integration — the process of getting ready for a psychedelic experience and making sense of it afterward — are where psychotherapy has the most to offer. Not because a therapist needs to supervise the experience, but because what psychedelics open up is often the same territory that good therapy has always been interested in.

Here's what I mean. Psychedelics have a way of removing the lenses we normally see through. We all carry them — assumptions about who we are, what we're allowed to feel, what's real and what isn't. These lenses develop early. They're shaped by family, by culture, by the things that happened to us and the things that didn't. Most of the time we don't even know they're there. We just call what we see through them "reality."

A psychedelic experience can, for a window of time, take those lenses off. What people encounter when that happens varies enormously. Some people meet parts of themselves they didn't know existed — grief they hadn't touched, joy they hadn't allowed, ancestry and history they carry in their bodies without having language for it. Some people see the world as more vivid, more interconnected, more real than what they're accustomed to. Some discover that they themselves are more real than they've been able to know — because for once they're seeing from a point of view that is utterly personal, utterly their own, unclouded by the habitual filters that usually stand between them and their experience.

Dreams do something similar, by the way. Not as dramatically, but in the same key. A dream doesn't argue with your defenses. It just goes around them. It shows you what you already know but haven't been able to look at directly. People who dismiss their dreams and people who dismiss psychedelics often do so for the same reason — the material that surfaces doesn't fit the story they've been telling about themselves, and that's uncomfortable.

The challenge, with both dreams and psychedelics, is that the experience alone doesn't do the work. You can have a profound night and wake up the next morning and slide right back into the old lenses. The insight fades. The feeling recedes. Not because it wasn't real, but because there's no structure to hold it — no relationship in which to speak it aloud, examine it, let it settle into something more durable than a memory.

That's where psychoanalytic psychotherapy comes in. Not as a gatekeeper, but as a place where what was opened can be understood. Psychoanalytic work has always been interested in the parts of the self that don't get airtime — the underdeveloped, the undertraveled, the disowned. It's interested in what the body carries, what history deposited in you before you had any say in the matter, what keeps repeating because it hasn't yet been felt all the way through. These are the same territories psychedelics tend to reveal.

A good preparation process helps someone approach that territory with enough self-knowledge to meet what comes. A good integration process helps them bring it back — not as a peak experience that fades, but as something that changes how they understand themselves and how they live.

I don't guide psychedelic experiences. What I offer is the before and after — a therapeutic relationship with enough depth and continuity to help someone prepare for what they might encounter, and to make real use of what they find. The psychedelic may open the door. The therapy helps you understand what's on the other side, and figure out how to live there.

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About the Author: Andrew Bertell is a licensed clinical social worker with over 15 years of experience in psychoanalytic psychotherapy. He practices in Ashland, Oregon and works with adults and young adults via telehealth throughout Oregon, Maryland, New York, and Idaho.

How Often Should You Go to Therapy?
This is one of the first questions people ask, and it's a reasonable one. Therapy costs money and time, and most of us have limited quantities of both. So: how often should you go?

The honest answer is that it depends — but not in the vague, unhelpful way that phrase usually gets used. It depends on what you're trying to do. If you're coming to therapy to manage a specific problem — a rough patch at work, a decision you can't make, a relationship that's driving you crazy — once a week may be plenty. You come in, we think together, you leave with something useful. That's real and it matters.

But some people discover, after a while, that the most interesting things happen not in any single session but in the space between them. You start noticing things during the week — a reaction that surprised you, a dream that stuck around, a moment where your body did something your mind hadn't caught up to yet. You bring it in. We look at it together. And over time, a kind of continuity builds. The work starts to have its own momentum.

That's when coming more often can matter. Not because there's a rule about it, but because the thread holds better when you pick it up more frequently. It's like any practice — music, exercise, writing. Once a week keeps you in the game. Twice or three times a week and something shifts. You're not starting over each time. You're deepening.

I bring this up not to sell anyone on more sessions, but because the question of frequency is really a question about what therapy can be. And most people don't know the full range of what's available to them.

Here's what I mean. In a single session, we can do good work with what you bring in verbally — the thing that's been on your mind, the story you need to tell, the problem you want to think through. But therapy has more channels than conversation. There's what your body is doing while you talk — the tension in your shoulders, the way your breathing changes when certain topics come up, the restlessness or the stillness. There's what happens in silence, which is its own kind of communication and often a more honest one than speech. There's what shows up in dreams, which most people dismiss but which often carry exactly the thing that waking life is trying not to look at.

None of these require special effort. They're already happening. The question is whether there's enough room and enough continuity for them to become part of the work.

A client might mention, offhandedly, a dream about a locked room. We might sit with that for a minute. It might not mean anything yet. But the next session, they're talking about their mother, and something clicks — not because I drew a line between the two, but because they felt it. The dream was already knowing something. It just needed a little time and a little quiet to land.

Or someone is telling me about an argument with their partner, and mid-sentence they stop. Something shifted in their chest. They don't know what it is. In a faster-paced therapy, that moment might get talked over — filed away, moved past in favor of the next thought. In the kind of work I do, that's often where the session actually begins.

These are the moments where contact happens — not the polite, social kind, but the real thing. Contact with yourself, with what you're actually feeling rather than what you think you should be feeling. Contact with me, in the sense that something true passes between us and we both know it. That kind of contact is what makes therapy work. Everything else is just talking.

So when someone asks me how often they should come, what I'm really hearing is: how much room do you want to make for this? There's no wrong answer. Some people come once a week for years and the work is rich and real. Some people come more often for a stretch and then settle into a rhythm. Some start slow and increase when they're ready.

The only thing I'd say is: don't let logistics be the only thing that decides. Think about what you want from this. Think about what it might be like to have a place where you don't have to rush — where the quiet parts count as much as the talking, where a dream is worth mentioning, where your body gets a vote. That's what's on offer. How often you come is just a question of how much of it you want.

​About the Author: Andrew Bertell is a licensed clinical social worker with over 15 years of experience in psychoanalytic psychotherapy. He practices in Ashland, Oregon and works with adults and young adults via telehealth throughout Oregon, Maryland, New York, and Idaho.

On the Couch
Most people, when they picture psychoanalysis, picture the couch. The patient lying down, staring at the ceiling, the analyst seated somewhere behind them, out of view. It looks, from the outside, like a strange arrangement — almost theatrical, maybe a little cold. People joke about it. It has become shorthand for a certain image of therapy that feels dated, formal, faintly absurd.
I want to say something in its defense.

The couch isn't about hierarchy or mystification. It isn't a power move, though it has sometimes been used as one. It's a tool — a surprisingly practical one — and understanding what it actually does helps explain why it has persisted for over a century despite every effort to modernize it away.

When you lie down and the therapist moves out of your direct line of sight, something shifts. The social pressure of face-to-face conversation relaxes. You're no longer reading expressions, managing impressions, calibrating your words against another person's visible reactions. The self-monitoring that governs most conversation — am I boring them, did that land right, what do they think of me — loosens its grip. And in that loosening, something else tends to emerge.

Thought becomes more associative. Speech becomes less curated. People find themselves saying things they didn't plan to say, following threads they'd have redirected in ordinary conversation. The body settles differently horizontal than it does upright — more like the state between waking and sleep, when the mind is more permeable and less defended. This isn't accidental. Freud noticed it early and understood it as creating conditions where unconscious material could surface more readily.

There's also something about not being watched. Many people carry a chronic self-consciousness — a sense of being observed, evaluated, found wanting — that shapes how they present themselves even in therapy. The couch interrupts this. You're speaking into the room rather than to a face, and the quality of that speech is often different: less performed, more genuine, more willing to follow the strange or uncomfortable thought rather than steering toward something more presentable.

None of this means the couch is right for everyone or every treatment. It isn't. Some patients find the shift in position disorienting. Some need the relational anchor of eye contact, particularly early in treatment or when working through trauma. The couch tends to be most useful once a working relationship is established — once there's enough trust that the reduced visual contact feels like freedom rather than isolation.

But for patients who are ready for it, using the couch often marks a transition in the depth and character of the work. The sessions feel different. The material that comes up is different. People are frequently surprised by what they say when they're not looking at anyone.

Silence, too, is different on the couch. Horizontal, not meeting anyone's gaze, with the analyst's presence felt rather than seen — silence becomes less socially fraught and more genuinely interior. The two tools, couch and silence, work together in ways that are hard to fully articulate until you've experienced them.
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The couch is not a relic. It's an unusually elegant piece of clinical technology — one that creates, simply by changing the body's position in space, conditions that are very difficult to replicate any other way.

About the Author: Andrew Bertell is a licensed clinical social worker with over 15 years of experience in psychoanalytic psychotherapy. He practices in Ashland, Oregon and works with adults and young adults via telehealth throughout Oregon, Maryland, New York, and Idaho.

On Silence
There's a moment that happens in therapy, usually early on, when the conversation pauses and both people sit with it. For most new patients, this is uncomfortable. The silence feels like a problem to be solved, a gap to be filled, evidence that something has gone wrong. People apologize for it. They rush to fill it with whatever comes next, even if what comes next isn't quite what they meant to say.

I've come to think of silence as one of the most valuable things that can happen in a session.

This runs against most people's experience of conversation, where silence signals awkwardness or disconnection. In ordinary social life, we're trained to keep things moving, to rescue each other from the quiet. Therapy asks something different. It asks you to stay with what just happened — to let it land, to feel its weight, to notice what arises in the space before the next thought.

What arises is often surprising. Sometimes it's an emotion that was just below the surface of the words. Sometimes it's a memory, or an image, or a bodily sensation that wouldn't have had room to surface if the talking had continued. Sometimes it's simply the recognition of how much has just been said, and how much it cost to say it. The silence after something true has been spoken has a particular quality — dense, clarifying, almost palpable. It deserves to be honored rather than hurried past.

Winnicott wrote about the capacity to be alone in the presence of another — the developmental achievement of being able to exist quietly alongside someone without needing to perform or produce. For many people, therapy is one of the few places where this becomes possible. Not because the therapist is absent, but because they're present in a particular way: not waiting to respond, not filling the space with reassurance, just accompanying. Bearing witness, without demand.

This kind of silence is anything but empty. It's a medium, like speech. Things move in it. Understanding forms. The body sometimes knows something in a silence that the mind hasn't caught up to yet.

Not all silences in therapy are productive. Some are defended — a patient going quiet because something feels too dangerous to approach, or because the relationship doesn't yet feel safe enough to go further. A good therapist can usually sense the difference, and knows when to wait and when to gently open a door. The work isn't to sit in silence for its own sake, but to be willing to let it be there when it's doing something.
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What I try to offer is a room where silence isn't a problem. Where you don't have to fill every moment with words. Where what goes unsaid is as welcome as what gets said — because sometimes the most important thing is the one that hasn't found its way to language yet, and it needs a little quiet to get there.

About the Author: Andrew Bertell is a licensed clinical social worker with over 15 years of experience in psychoanalytic psychotherapy. He practices in Ashland, Oregon and works with adults and young adults via telehealth throughout Oregon, Maryland, New York, and Idaho.

How I Work
People come to therapy for all kinds of reasons. Anxiety that won't let up. A relationship that keeps hitting the same wall. Depression that doesn't quite explain itself. A sense that something is off, even when nothing is obviously wrong. Sometimes people arrive with a clear presenting problem and discover, over time, that it was really a doorway to something else — something older, more private, more interesting.

My job, as I understand it, is to be genuinely curious about that something else.

I've been doing this work since 2009. My training has been deliberately eclectic — grounded in modern psychoanalysis and classical psychodynamic theory, and expanded over the years to include somatic psychotherapy, relational and intersubjective approaches, ISTDP, mindfulness, DBT, family systems, and CBT. I keep training because the work keeps asking more of me, and because no single framework is adequate to the full range of what people bring into the room.

In practice, what this means is that I don't apply a method to you. I try to understand you — how you're put together, what you're carrying, what has and hasn't worked before, and what kind of support will actually be useful. Some people need something structured and skills-focused alongside the deeper work. Some need room to talk and follow the thread wherever it leads. Most need both, in different proportions at different times.

What happens in sessions
We talk. That's the medium. But it's a particular kind of talking — one that pays attention not just to the content of what you're saying, but to the emotional texture underneath it. The way something lands in the body. The thing you almost said. The pattern you've noticed yourself repeating without quite being able to stop.

I'm an engaged, active presence in sessions. You won't get someone nodding neutrally and waiting for you to arrive at the answer. I ask questions. I share observations. I'll sometimes say something that surprises you, or that you'll need to sit with before you know if it fits. The therapeutic relationship itself is part of the work — what happens between us, the feelings that arise, the moments of being understood and the moments of misunderstanding — all of it carries information about how you move through relationships more broadly.

At the same time, I'm not in a hurry. There's no agenda I'm pushing. The pace of good therapy follows the person, not a protocol, and I've learned to trust that the work finds its own rhythm.

What I specialize in
I work with adults and young adults across a wide range of presentations: anxiety and depression, relationship difficulties, identity and purpose, addiction, trauma, grief, life transitions, and the more diffuse suffering that arrives without a clear name. I also work with clinicians — early and mid-career therapists who want case consultation, a sharper clinical lens, or a place to think through the work that keeps them up at night.

I have particular interest in people who've tried therapy before and found it useful but incomplete — who are ready to go further, or who are looking for something more exploratory than symptom-focused. And I'm drawn to people who are curious about themselves, even when that curiosity is uncomfortable.

A few things worth knowing
I practice via telehealth across Oregon, Maryland, New York, and Idaho, with an office in Ashland, Oregon for in-person sessions. I'm an out-of-network provider — I don't bill insurance directly, but I can provide documentation for reimbursement. Sessions are typically 50 minutes, and I work with people at a range of frequencies depending on what the work calls for.

I offer a free 15-minute consultation before we begin, which gives us each a chance to get a sense of fit. Therapy is a significant investment of time, money, and vulnerability, and it matters that it's with the right person.

On the approach, briefly
The psychoanalytic tradition I work in isn't the one that most people have a caricature of — the silent analyst, the relentless excavation of childhood. The past is always with us but how we carry it and regard it in the here and now is just as important, if not more. It takes seriously the idea that much of what drives us operates outside conscious awareness, and that making those patterns more visible — gradually, carefully, at a pace that's bearable — creates real room for change.

About the Author: Andrew Bertell is a licensed clinical social worker with over 15 years of experience in psychoanalytic psychotherapy. He practices in Ashland, Oregon and works with adults and young adults via telehealth throughout Oregon, Maryland, New York, and Idaho.

What Does Psychodynamic Therapy Actually Feel Like?
If you've been researching therapy, you've probably come across the terms psychodynamic and psychoanalytic — sometimes used interchangeably, sometimes not. It's worth taking a moment to untangle them, because understanding the difference can help you know what you're actually looking for.
Psychodynamic therapy is the broader term. It refers to any approach rooted in the idea that much of what drives our behavior, our moods, our relationship patterns, operates beneath the surface of conscious awareness. The word "dynamic" points to the idea that these forces are active — they push and pull, create conflict, shape how we experience ourselves and others. Abby's overview of psychodynamic therapy offers a clear and accessible introduction to its core concepts.
Psychoanalysis is the original form — Freud's invention — and psychoanalytic therapy is its contemporary descendant. Over the past several decades, the field has evolved considerably. The image of a silent analyst offering nothing but interpretations from behind a couch has given way to something warmer, more mutual, more honest about the fact that two people are in the room, not one. Contemporary psychoanalytic practice — shaped by object relations theory, relational and intersubjective thinking, modern psychoanalysis, and a growing dialogue with neuroscience and attachment research — understands the therapeutic relationship itself as the primary vehicle for change. Technique matters, but the relationship is the thing.
So what does this actually feel like from the inside?
It feels, first, like being listened to in an unusually complete way. Not just your words, but the feeling underneath them, the thing you almost said, the way your voice shifted when you mentioned your father or your last relationship or the job you left. A therapist oriented this way is tracking all of it — not to catch you in something, but because they're genuinely curious about you as a whole person. That quality of attention can be disarming at first. People aren't often listened to this carefully.
Over time, it feels like something beginning to move. Patterns you hadn't quite named start to become visible — the way anxiety shows up reliably before certain conversations, the way you pull back when something good is happening, the way you've been telling yourself a particular story about who you are for a very long time. None of this is confrontational. It emerges gradually, often sideways, through a dream you mention offhandedly or a joke that turns out to contain something real.
Sessions don't always feel productive in the moment. Some of the most important ones are quiet, or strange, or leave you sitting with something you can't quite articulate. That's not a sign that the work isn't happening. It often means it is.
What builds over months and years is harder to describe but unmistakable when it's happening: a greater ease with yourself, more room to think before reacting, relationships that feel less like something happening to you and more like something you're participating in. A growing sense — not dramatic, but solid — that you understand your own life better than you did.
This kind of therapy isn't for everyone, and it isn't always the fastest route to symptom relief. But for people who want to understand something deeper about why they are the way they are, it tends to be the work that actually holds.

About the Author: Andrew Bertell is a licensed clinical social worker with over 15 years of experience in psychoanalytic psychotherapy. He practices in Ashland, Oregon and works with adults and young adults via telehealth throughout Oregon, Maryland, New York, and Idaho.

What to Expect from Psychoanalytic Therapy: A Brief Orientation
If you're considering therapy — or have recently begun — you may find yourself wondering what actually happens in the room, and how talking to someone is supposed to help. These are good questions, and they deserve a thoughtful answer.
The Psychoanalytic Research Consortium has put together a clear and accessible overview of how psychotherapy works that I recommend to anyone curious about the process. What follows is meant to accompany it.
One thing the article makes clear is that change in therapy tends to unfold in phases. Early on, many people feel some relief simply from the act of seeking help — a restoration of hope, a sense of being heard. This is real, and worth acknowledging. But it's usually not the whole story. Deeper shifts in how we relate to ourselves and others, the kind that actually hold over time, tend to require something more sustained.
That's what psychoanalytic therapy is designed for. Rather than focusing narrowly on symptoms, it takes the whole person seriously — your history, your patterns, your inner life, the way you move through relationships. The goal isn't just to feel better in the short term, but to understand something about why you've been feeling the way you have, and to loosen the grip of whatever has been getting in the way.
The relationship between therapist and patient is central to this. Not as a technique, but as the actual medium of the work. What happens between two people in a room — the feelings that arise, the moments of understanding and misunderstanding, the gradual development of trust — turns out to be one of the most powerful vehicles for change we know of.
This kind of work asks something of you. It isn't passive. But most people find that over time, the process becomes genuinely interesting — that learning about yourself, even the uncomfortable parts, opens something up rather than closing it down.
The article linked above goes into considerably more depth, including how therapists listen, how patterns get identified, and what the research actually shows about outcomes. It's written for a general audience and worth reading in full.

About the Author: Andrew Bertell is a licensed clinical social worker with over 15 years of experience in psychoanalytic psychotherapy. He practices in Ashland, Oregon and works with adults and young adults via telehealth throughout Oregon, Maryland, New York, and Idaho.