August 2025

Many people first seek psychotherapy because of a troublesome mental health symptom or symptoms that do not go away and repeat. It might be anxiety, depression, sleeplessness, relationship issues that reoccur, or a difficult habit (repeating behaviours, spiralling thoughts) that it is hard to let go of, doesn’t matter how much you try. Mental health symptoms can feel disruptive and sometimes, it seems like they take over your life. They interfere with what you really want to do, get in the way of work and relationships, and can leave you feeling as though something is wrong with you. Something that needs to be fixed and get rid of.

It is only natural to want troublesome symptom to go away. Yet in psychoanalytic psychotherapy, symptoms are not simply treated as problems to be eliminated after a set number of sessions. Mental health symptoms are also signals, a way the mind communicates something that cannot yet be expressed directly in words. Psychoanalysis says that symptoms have some sort of function that is why they do not disappear so easily. Even if symptom did disappear without the working through process taking place, it can re-appear in different form. This is what makes a psychoanalytic approach different from models that focus only on symptom management.

What kinds of symptoms bring people to psychotherapy?

Symptoms can take many forms. Some of the most common reasons people contact me for therapy include:

Persistent anxiety or panic attacks
Ongoing low mood or depression
Repeating relationship difficulties
Work stress and burnout
Problems with sleep
Feelings of emptiness or lack of meaning
Addictions or compulsive behaviours
Questions around identity or self-esteem

Often, someone begins therapy with one of these difficulties in mind, but over time discovers that the symptom is part of a wider pattern in their life. Everything connects somehow, which is why ready-made answers and solutions towards “the source” of a symptom rarely hold up for long.

How psychoanalysis understands symptoms

In psychoanalysis, a symptom is not just a problem to get rid of. It is often a sign of something unspoken or unresolved, connected to the unconscious in a specific way for the particular person, this is why it is difficult to find a truly working one-size-fits-all approach to treating symptoms. A symptom may be the mind’s way of expressing a conflict or wish that cannot yet be acknowledged directly.

For example:

Anxiety may point to something feared but not yet recognised.
A depressive symptom may hold unspoken anger, guilt, or a sense of loss.
An addiction may be a way of escaping feelings that otherwise feel overwhelming.

This does not mean a symptom is ‘good’ or something to accept passively. But it does mean that a symptom may hold clues about what is going on beneath the surface. If therapy only aims to remove it and the symptoms that inevitably follow, it can miss the chance to get to the root.

Why do symptoms feel so disruptive

Symptoms often disrupt daily life, but what makes them particularly difficult is their hidden quality. A panic attack might appear suddenly, without warning. An intrusive thought might feel alien, as though it does not belong to you. A compulsion might feel both irresistible and pointless at the same time.

There can also be resistance to change itself. Getting closer to what lies behind the symptom often feels unfamiliar or unsettling. This is why psychoanalytic psychotherapy is gradual and unfolds at your pace, allowing space to discover, assimilate, and reflect. Over time, it supports a different way of thinking about yourself and others.

The source or meaning of a symptom is not always obvious or linear. It can feel confusing, messy, even irrational, to talk about what arises in sessions. This can add another layer of distress, leaving someone not only struggling with the symptom but also fearing it says something “bad” about who they are. Part of the work is to move away from such binary categories of good and bad, beautiful and ugly, and to begin to find more complexity and even a different sense of aesthetics in one’s inner and outer life.

The problem with simply removing symptoms

When a symptom is removed without being unpacked, another often takes its place. The symptom changes its form, but the underlying conflict remains.

Take the example of someone who struggles with drinking and, after many months as a member of AA, manages to stop. On the surface, the problem looks resolved. Yet rather than easing, their frustration shifts into anger and harsh judgement of others who drink. The difficulty has not disappeared; it has simply found a new outlet.

From a psychoanalytic perspective, this can occur because the symptom was serving a previously hidden function. Once the drinking is taken away, the feelings it was masking need to go somewhere, and they may reappear in another form.

This is why a psychoanalytic approach does not aim only at symptom removal. Instead, it creates space to explore what the symptom may be pointing to, so that a deeper and more lasting change becomes possible.

What psychoanalytic psychotherapy offers

Psychoanalytic psychotherapy provides a place to begin speaking freely, and to get used to speaking freely, often without the self-censorship or self-judgement that initially makes people wonder whether what they say is “useful.” In this space, the symptom can gradually loosen its grip on both mind and body.

This does not happen through quick techniques or surface strategies, but through careful listening. Over time, connections emerge. A symptom that once seemed arbitrary begins to make sense in the wider context of a person’s history and relationships. Rather than being simply a burden, the symptom becomes a point of entry into understanding oneself more fully.

The possibility of lasting change

By attending to symptoms in this way, psychoanalysis does not promise an immediate fix. But it does offer the possibility of lasting change. The work is not about endlessly analysing or finding hidden meanings in every gesture. Instead, it is about allowing space for something new to emerge, so that life is no longer organised mainly around the symptom.

Many people find that as this process unfolds, symptoms lose their grip. More importantly, they begin to feel freer in how they live, relate, and make choices. The symptom that once dominated their life may recede, not because it was forcibly removed, but because it is no longer needed in the same way.

Taking the first step

If you are struggling with symptoms such as anxiety, low mood, or difficulties that keep repeating, psychotherapy can provide a way forward. Psychoanalytic therapy does not aim to silence symptoms but to help you understand what they might be saying and in that process, open the possibility of change.

I offer sessions in East London (Stratford, Stratford East Village, Hackney). If you would like to find out more, you can contact me to arrange an initial consultation.

We often think of change as linear, move forward, don’t look back. But when it comes to relationships, especially the ones that stay with us long after they end, the past has a way of repeating itself. This blog explores how psychoanalysis understands repetition not as failure or inertia, but as something alive and meaningful. What do we repeat, and why? And could the very pattern we feel trapped in be holding the key to something we haven’t yet been able to say?

Early in My Brilliant Friend, Elena Ferrante sketches a friendship that’s anything but simple. Elena and Lila’s bond is immediate, electric, and often unbearable. There’s a hunger in it: intellectual, emotional, almost physical. But just as strongly, there’s tension. Rivalry. A relentless push and pull. Elena is drawn in, inspired, and repeatedly diminished by Lila’s brilliance. The relationship ignites her, wounds her, and never quite lets her go.

As the girls grow, drift apart, reconnect, and compete, the dynamic repeats itself. A rhythm of idealisation and resentment, closeness and distance, loops back again and again.

It’s a pattern that many will recognise – not necessarily in the form Ferrante describes, but in the emotional choreography. The feeling of returning to an oddly familiar relationship dynamic, even when the people and context are new. The friendship ends, or fades, or shatters, but the questions remain. Why did this happen again? What was I drawn to? What was I trying to resolve?

We tend to think of repetition as a path to improvement. “Practice makes perfect,” we say, as if repeating something is always a way of getting better. But relational repetition doesn’t feel like progress. It feels like being caught in a loop.

Psychoanalysis listens closely to these returns. Not to stop them or fix them, but to ask: What is this repetition doing? What memory might it be holding in place, something remembered without words? What hidden script is being played out again, not quite consciously, but with unmistakable emotional force?

We may enter a friendship or relationship believing it’s new, spontaneous, and a clean slate. But something familiar draws us in. A dynamic that echoes earlier bonds. Perhaps a hope that this time, things will be different. This time, we’ll be seen, understood, and chosen. And when that doesn’t happen, the hurt feels not just current, but historical, saturated with past disappointment.

Still, repetition isn’t just a sign of failure. There’s something alive in it. We repeat because we are trying – again and again – to come closer to what couldn’t be grasped the first time. It may be clumsy, painful, or even self-sabotaging. But it’s rarely meaningless. In fact, it might be the most meaningful thing about us.

To repeat is not necessarily to remain unchanged. Each repetition is a little different. Something slips. Something shifts. There’s always the possibility, however small, for the pattern to break, for something new to emerge. Not through willpower, but because repetition itself starts to unravel.

We repeat to learn. Children rehearse words, dancers drill steps, and musicians practise scales. Repetition gives us fluency, familiarity, and a sense of control. But not all repetitions are conscious or chosen. Some return like echoes. We find ourselves having the same argument, choosing the same kind of partner, reacting in ways that feel scripted. We ask ourselves, Why do I keep doing this?

Freud called this repetition compulsion: the drive to return to unresolved scenes or dynamics. Not for pleasure, but in an attempt—often unconscious—to master what once overwhelmed us. We circle back, not to re-live, but to finally make sense of what was too much to bear the first time. And yet, in repeating, we may also be defending against something even more disruptive: the unknown, the truly new.

Here lies the paradox. Repetition can be a way of avoiding change, of staying in familiar discomfort rather than facing what we can’t yet name. But within the cracks of repetition, something else might insist on being heard. Psychoanalysis listens for that. Not to correct, but to understand: What’s being protected? What’s being remembered? What’s waiting to emerge?

You notice you’ve ended up in a similar relationship again. Or caught in a reaction that doesn’t feel entirely your own. What’s repetition doing here—and why does it feel both frustrating and strangely known?

Perhaps repetition isn’t a sign that nothing is happening. Perhaps it’s the sign that something is happening, but not yet visible. What looks like stuckness might be holding something in place. A necessary pause, buying time for something new to form.

Rather than asking, Why haven’t I changed?, psychoanalysis invites a subtler question:

What is my repetition trying to tell me about what I lost, what I’m avoiding, and what I’m trying to repeat until it finally speaks?

This kind of change rarely happens all at once. The retranslation of repetition, turning something compulsive into something that can be thought about, often takes time. It unfolds gradually, in the space between recognising the pattern and being able to do something different with it.