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.