Psychodynamic Psychotherapy Video No. 2: The Early Weeks

This is the second installment in my video series about what to expect in psychodynamic psychotherapy, focusing on what happens during the early weeks. In addition to developing a deeper understanding of the client’s past and current emotional issues, these sessions involve a fair amount of education about the process itself: how it’s the job of the psychotherapist to make the unconscious conscious; encouraging clients to begin thinking of themselves as a collection of parts, more or less like distinct individuals cohabiting and relating to one another; and explaining what kind of change is possible and how it occurs.

Following the advice given in one of the comments to my last video, I bought myself a clip-on mike, so the sound is much better now. There’s still an occasional glint of reflected light in my glasses … I’ll get all the kinks worked out eventually. I’m enjoying this new mode of “just talking” a lot more, and surprisingly, getting something that I like in only two takes (I had to abort the first one in the middle because a gnat kept flying into my eyes). Next video will be about the early phases of the transference.

By Joseph Burgo

Joe is the author and the owner of, one of the leading online mental health resources on the internet. Be sure to connect with him on Google+ and Linkedin.


  1. Very Interesting; I learned a thing or two I didn’t know before; after eight years of therapy, that’s a little surprising, but then different therapists have different approaches.

    Well done!

  2. Nice video post. I liked very much how you focused on the technical aspects of the psychotherapy, where your expertise really comes into play. This always seemed way more important to me than the “paid friend” aspect of what’s going on in the room.

    At some point in the future, perhaps you’ll want to post on what it’s like in the first or early sessions with a patient who is an experienced insight therapy-goer. That is, a patient for whom you are not their first rodeo with psychodynamic psychotherapy. I imagine it is a very different kind of beginning.

    1. Let me give that some thought. It IS different … and yet, I’m always surprised that certain issues that seem important to me right away were never discussed in the prior therapy. If someone has been in therapy, I’ll often start off by asking a lot of questions about what came up in the prior treatment, the primary issues, why it came to an end, etc.

  3. As an MFT Intern (actually awaiting receipt of my intern number), I deeply appreciate your writings and videos, Dr. Burgo. Thank you!

  4. The videos are really coming along. This was excellent.

    I’m a little confused about your take on the goal of making the unconscious conscious. I’ve always heard that the goal of this, among other things, was to relieve debilitating symptoms like major depression or panic attacks…or as Freud put it, exchanging neurotic misery for ordinary human unhappiness. Do you find that this is not generally the case?

    1. Freud’s formulation was based on his view that society requirements all sorts of instinctual renunciation that can make people neurotic; but even when they become aware of their unconscious impulses, they still can’t act on them, at least most of the time. So they’re unhappy but no longer neurotic. I think that making the unconscious conscious is usually the beginning of the work. If unconscious anger plays a part in depression, for instance, once the person becomes more conscious of that feeling, he or she has to learn how to cope with it. How to acknowledge the feeling but not “run with it” so that they end up doing something destructive to themselves or others.

  5. I was so pleased when you came out with your video on bipolar. Then there was a space. Now you have started your new video series. This adds even more to you persona. You are such a gentle person and knowledgeable. I learn from you in your written posts, and in your videos I feel even more of a connection. Definitely looking forward to your video on Transference, one of my pet peeves. Getting down to the basics in this one was good listening. Someone made mention of how you would respond to a person who is a long-term therapy client with a history of multiple therapists. I think you’re right that each new therapist brings something new and often more intense than the last therapist. I hope you continue this video series on a regular basis as you do your blog posts. Love seeing “After Pyschotherapy” in my email. Thank so much. Jen

    1. You’re welcome (I did a little minor editing to fix some of those slips you mentioned … I hope you don’t mind!)

  6. Very interesting! I loved the clarity of “making the subconscious become conscious.” Do you think in many ways some symptoms we associate with many mental illnesses are desperate and disorganized attempts of the subconscious to make itself conscious? And without guidance, there can be an almost epic battle within between the subconscious crying out to be heard and the conscious fighting to repress it, too afraid to listen and understand?

    1. I’m not sure that I understand what you mean, but I certainly think that the symptoms of mental illness have an unconscious meaning that needs to be understood. It’s a big part of the work of therapy.

    2. Sundra,

      I have heard this idea before, too – namely that there is unconscious material striving to become conscious while we continue to keep it “stuffed down” inside via repression or maybe distraction (this might include addictions). This causes a conflict, and the conflict manifests as various kinds of symptoms. I have no idea if this is actually what can happen, but I’ve often read that this is one hypothesis for the presence of symptoms.

      Also, I’m not sure what the distinction is between ‘subconscious’ and ‘unconscious’ but I don’t believe they are the same.

      1. The word subconscious really doesn’t have much of a meaning in psychodynamic terms. The unconscious (noun) or unconscious emotions (adj) are the correct terms to use.

  7. I mean this: I used to be in pathological denial about my mother, who was abusive in every way as well as being a narcissist. Whenever I moved close to her, I would experience panic attacks. In retrospect, I believe that was my subconscious trying to connect with my conscious mind with the truth. She was frightening and abusive, not the “ideal, perfect mother”! I used to suffer from sleep paralysis. I think that was my subconscious screaming out to my conscious to remember a severe trauma that led to me being kept unconscious at home for three days, with my parents willing to see me die rather than risk doctors finding out I’d been incestuously raped. All my chronic nightmares and apparently irrational phobias were related to the traumas, as if my subconscious was trying to force me to face the trauma and some very hard truths. The sleep paralysis stopped when I did. When depression finally hit me, I had non-stop thinking, memories, going over and over the past. That symptom was as if my subconscious was forcing me to relieve my life, this time, listening, with open eyes, without denial and to feel the pain and fear, etc. The more I tried to fight and stop the symptoms, the more intense they got. The more I listened to “what they were saying” and combined that with whatever I could learn and read about the effects of trauma and abuse, since I couldn’t afford therapy other than a little short-term counselling, the more I worked through things and the more the symptoms faded. I really feel that as horrible as panic attacks, anxiety, depression, etc. are, they were the voice of my subconscious trying to be heard, to unbury, to feel, to face, to help me heal.

    1. Substitute the word “unconscious” for “subconscious” and you have an excellent, accurate description of how unbearably traumatic experiences are repressed out of awareness and into the unconscious.

      1. You have given me a powerful gift with your comment, of validation from someone I’ve come to respect. I cried good tears when I read it, which isn’t easy for me. I was so afraid to post that, Dr. Burgo. There are so many of us out there who only have access to doctors who want to prescribe pills, which would have stopped the process and I didn’t want that, so we have to figure it out ourselves. I always saw the irony of my broken mind being the only tool I had to heal my broken mind, trying to think through it. I still don’t fully have confidence in my mind. I had glitch in my GPS, and my first thought was that I had lost my mind, not that the GPS had malfunctioned. That’s what I’m working on now, trying to stop those fears, gain confidence and trust in my mind that was broken. You have just given me so much help with your comment in that. And I will remember “unconscious vs. subconscious.” Thank you so much.

  8. Dr. Burgo, have you encountered clients who question your psychodynamic approach to therapy? Many people nowadays have experienced “brief therapy” in community mental-health agencies or EAP settings, where the therapist is directive and counseling focuses on behavioral interventions for relatively few sessions. How would you respond to clients who ask to be “taught skills” rather than explore their lives in greater depth?

    1. I frequently get requests for short-term, directive therapy. I always say the same thing: There are many excellent practitioners out there who do that kind of work. If that is what you’re looking for, I am definitely not the therapist for you.

  9. Hi dr burgo,
    Many thanks for the video and recent posts.
    I find them informative , enlightening and very interesting but now that poses a real dilemma for me. As a new comer to Pyschotherapy , only 3 sessions under my belt , I have experienced in one way or another almost all of the feelings that happen early on ; transference .. Thought I was losing my mind because I felt like I was falling in love with him ( am happily married ) , resistance ; abusive emails sent to him , hoping he’d tell me to go for a hike so I had an excuse to stop this , Neediness ; hell , I really his help and I felt drawn back to him no matter what I told myself. Dependency and abandonment ; Christ , what if the poor soul decides to sit under a palm tree with his wife and take a break ? .
    Oh my god , the more I read, the more I can relate and I’m starting to self diagnose and in every session I’m concentrating on what my therapist is trying to achieve in his questions and conversation and I’ve only been 3 or 4 times , why has this happened so quickly ? Now I wish I hadn’t of read any postings and been none the wiser and if I do tell my therapist all this will he have to back track and re evaluate our ” relationship ” . You’ve no idea of the head ache I’ve now given myself , I could almost laugh if I didn’t think it was serious !

    1. I think you need to discuss these reactions with your therapist. If he’s knows what he’s doing, he’ll make good use of the information and help you understand some new about yourself.

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