Therapy has become more identity-aware in the last twenty years, and that's mostly been a good thing. The field had a long history of treating its own assumptions as universal — white, male, secular, middle-class, heterosexual — and pretending the consulting room was a culturally neutral space. It wasn't. The work of clinicians like Kimberlyn Leary, Dorothy Holmes, Anton Hart, and many others named what had been pretended away, and the field is better for it. The room isn't neutral. The therapist's identity is in it. The patient's experience of being differently positioned in the world matters. None of that is in dispute for me.

What's harder to talk about is the step after that — the move from identity-aware to identity-organized. Increasingly, both patients and therapists arrive at the work with elaborated identity frameworks already in place. Identity becomes the explanatory architecture: what something means, what's missing, what's broken, what's affirmed. That has real uses. It also has costs that don't always get named.

The cost I watch for is over-narration. When a patient has a story about themselves that's well-worked, well-defended, and well-supplied with categories, the story can do something that looks like understanding but functions like distance. The patient knows about themselves but doesn't know themselves. The categories become a way of organizing experience that keeps the experience from being had freshly. I've sat with patients who could name every facet of their identity with precision and could not say what had happened to them last Tuesday.

This isn't an indictment of identity work. It's an observation about how any framework — psychoanalytic ones included — can be used defensively when it becomes the organizing layer rather than one layer among several. The patient who's over-narrated through psychoanalysis has the same problem, just in a different vocabulary.

My stance is something like this: I don't pathologize anyone's identity. I take seriously what it means to be positioned the way you're positioned in the world you live in. We're all better off when we're able to help others know who we are instead of the other way around. And I'm also alert to what gets lost when identity becomes the only frame — when the work shrinks to identity confirmation rather than including identity as one part of a larger picture of who you are.

In practice this means I work with everyone. I don't position myself as a specialist in any one identity category. Not because the clinicians who do are wrong — they're often doing essential work for patients who need exactly that — but because that's not where my expertise is. My expertise is in being curious about the person underneath the names. Identity is part of that picture. So is what was unsaid in your house growing up. So is what your body knows. So is what shows up between us in the room.

I'm more of a verb person than a noun person. There is action under a defined category; let's not let the category end the conversation. That's not a political position. It's a clinical one, rooted in the psychoanalytic traditions I've trained in. The work is to get underneath the organized self-narrative to what hasn't been articulated yet. Identity claims, like other claims, can be doorways or doors closed against the room behind them. The work is figuring out which is which.

If you want a therapist whose practice is organized around your particular identity, there are people who do that beautifully, and I'd encourage you to find them. If you want someone who'll meet you as a person whose identity is welcome material but not the frame, I might be your person.

Identity is welcome here. So is what's underneath it.

The cultural stereotype of psychoanalysis is so persistent that I should probably address it before anything else. Picture: a bearded man, a couch, four sessions a week, twenty years of treatment, vague references to your mother. That's the version that gets parodied in New Yorker cartoons. It's not what I do. It's not what most contemporary psychoanalytic practitioners do. And it hasn't been the dominant form of the work for a long time.

So what is it?

Psychoanalytic therapy is a form of talk therapy rooted in the idea that a lot of what drives our behavior, moods, and relationship patterns runs outside conscious awareness. It takes that proposition seriously and builds a method around it. The method, simplified: we pay attention together to what's happening in you, what's happening between us, what shows up and what doesn't, and over time you come to know yourself differently.

The most common question I get is some version of what's the difference between psychoanalysis and regular therapy? The honest answer is the line is blurrier than most people think. It's not defined by how often you come. It's not defined by whether you lie on a couch — most of my patients sit in a chair across from me. It's defined by what we pay attention to. In psychoanalytic work, we take seriously what's happening in the room as much as what you're reporting about your life outside of it. The relationship between us isn't a frame around the work. It's part of the work.

The second most common question is how psychoanalytic therapy compares to CBT. They're not opposed. CBT focuses on identifying and changing specific thought patterns and behaviors, often with structured exercises. It tends to be shorter-term and symptom-focused, and for a lot of people it's exactly what they need. Psychoanalytic work is more exploratory. It pays attention to the emotional life underneath the symptoms, and to the patterns that created the difficulty in the first place. Many of the people who come to me have done CBT and found it helpful but incomplete — the tools worked, the symptoms eased, but the underlying thing kept generating new versions of itself. That underlying thing is what psychoanalytic work is interested in.

How long does it take? It depends on what you're looking for. Some people come for several months to work through a specific transition. Some stay for years because the work opens something up they want to keep exploring. I don't impose a timeline. The pace follows you, not a protocol.

How do you know if it's working? Sometimes it's obvious — less anxiety, better relationships, a stuck decision that finally moves. Sometimes it's subtler. You notice you're less reactive. You notice you're curious about something you used to flinch from. You notice you're able to sit with uncertainty without spiraling. One useful sign: you find yourself bringing more to sessions over time, not less. The work is opening things rather than closing them.

Contemporary psychoanalytic practice is warmer, more relational, and more conversational than the stereotype suggests. It's collaborative. It pays close attention. And it works on a layer that other approaches don't always reach — not because they're worse, but because they're built to do something different.

​If you've done therapy before and gotten somewhere but not far enough, this is one direction further to go.

The first thing a lot of people say in a first session is some version of "I think there's something wrong with me." They've usually been carrying this idea for a long time. Sometimes since childhood. Sometimes it's gotten louder lately, after a relationship ended or a job fell apart or a body started doing something it didn't used to do. Sometimes they've come to therapy specifically to get the broken part fixed.

I've stopped finding this framing useful, and I've started saying so earlier in the work.

You're not broken. You're someone who developed, over a long time and under specific conditions, a particular set of ways to cope with what was once overwhelming. Those ways made sense once. They were doing real work — keeping you safe, keeping you connected, keeping you functional in a situation that might not have been workable any other way. Calling them broken misses what they are. They're survivals. They got you here.

The trouble is that survivals don't always know when their job is over. The thing that protected you at eight is still running at thirty-eight, and now it's keeping you from the very life it once made possible. The vigilance that kept you safe at home becomes the anxiety that keeps you from rest. The withdrawal that protected you from a parent's mood becomes the distance you can't close with your partner. The performance that earned love early becomes the exhaustion you can't admit to. The pattern isn't pathology. It's a strategy that outlived its situation.

This matters because what you do with a broken thing is different from what you do with a survival. A broken thing you replace, fix, or discard. A survival you understand. You ask what it was for, when it started, what it was protecting, what it still thinks it's protecting. You let it tell you about the world it came from. And then, slowly, you find out whether it's still needed in the world you actually live in now.

That's most of the work. Not fixing. Understanding.

The goal of therapy, as I think about it, isn't to make you happier — though that often happens. It isn't to fix you, because you're not the thing that needs fixing. The goal is to help you become more interested in yourself. More able to bear your own experience without flinching from it. More capable of the relationships and work and creativity that make a life feel lived rather than just endured.

Becoming more interested in yourself is harder than it sounds. Most people relate to themselves with some mixture of impatience, shame, and management. They want themselves to be different. They want the difficult feelings to go away. They want the parts they don't like to behave better. Therapy gradually makes room for a different stance — one closer to curiosity. What is this? Where did it come from? What is it doing for me? What would I lose if I let it go?

That curiosity is the thing that actually changes you, in the long run. Not insight, exactly. Not technique. The slow accumulation of being interested in your own life rather than at war with it.

People sometimes worry that if they stop calling themselves broken, they'll stop trying to change. The opposite is usually true. People who think they're broken spend most of their energy hating the broken part. People who think they're carrying survivals worth understanding spend their energy understanding them — which, it turns out, is what actually allows them to shift.

​You're not broken. You're a person with a history, and the history is still talking. Therapy is one place to listen.

There's a thing therapists don't usually say out loud, which is that the work isn't symmetrical. You bring one set of things to a session and I bring another, and the difference between them is part of what makes the work work.
What you bring: willingness to speak. Willingness to keep speaking even when you don't know where the sentence is going. Willingness to notice what you almost said. Willingness, sometimes, to say the thing you'd rather not have said.
What I bring is sustained attention — to what you said, to what you didn't quite say, to what your body might have known before you had words for it, to what's happening between us in the room. I bring training, time, a frame, a chair. I don't bring my own material. That's the asymmetry, and it's the point.
People sometimes worry that the asymmetry means they're being analyzed at, judged, kept at arm's length. It doesn't. The asymmetry is what makes it possible to say things you couldn't say in a friendship or a marriage — because the other person isn't going to need anything from you about it later. There's nothing you can say that I have to react to, defend against, take personally, or repair. That's the freedom the structure gives you.
But the structure also asks something. It asks for tolerance of not-knowing. Most of what we work on isn't going to resolve in the session it comes up in, or the week after, or sometimes the year after. Things take the time they take. Insight arrives when it arrives. You can't schedule it, and trying to speeds nothing up.
It asks for the capacity to stay with difficult feeling rather than rush to resolve it. The fastest way to learn nothing in therapy is to come in with a problem and demand the solution by Thursday. Real change usually requires a stretch of time where you sit with something painful and don't yet know what to do with it. That sitting is the work. The not-knowing is the work.
It asks for some kind of commitment — not to a length of treatment, not to a number of sessions a week, but to the process itself. To staying with it when it's uncomfortable, which it will be. To not bolting when something hard surfaces, which it will. To trusting that the relationship can hold what you bring, even the parts you're embarrassed about.
What it doesn't ask: that you know what's wrong. That you have the words for it yet. That you arrive ready, polished, or sure. Most of my patients start by talking around the thing for weeks before they say it directly. That's the work, too — the talking around. Speech doesn't have a recommended pace.
If you've been in therapy before and it didn't go deep enough, this is some of what depth looks like. Not exotic technique, not clever interpretation. Just the slow business of two people in a room paying attention long enough for something underneath the surface to come up and be looked at.
Bring what's hardest. We'll find out what it's made of.

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.
​
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.