Anna M. A. Sergent

Many people first seek psychotherapy because of a troublesome symptom. It might be anxiety, depression, sleeplessness, a pattern of relationships that keep breaking down, or a habit (repeating behaviours, spiralling thoughts) that has become difficult to control. Symptoms often feel disruptive and hard to shift. They interfere with daily life, get in the way of work and relationships, and can leave a person feeling as though something is wrong with them that needs to be fixed.

It is natural to want a 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. 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 to “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. 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.