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  • Writer's pictureOliver Roberts

Thoughts on Psychoanalytic Theory and Anxiety


therapy: psychoanalytic and anxiety

Understanding Anxiety and How Psychodynamic Therapy Can Help


Anxiety is a common mental health issue that affects millions of people worldwide. It can manifest in various forms, from generalized anxiety disorder to panic attacks, and can significantly impact one’s quality of life. Anxiety disorders often present with a range of anxiety symptoms, which can be effectively addressed through psychodynamic therapy.


As an anxiety therapist based in Los Angeles, I have had personal experiences with the effectiveness of psychoanalysis and also how much emotional distress and debilitating anxiety can be.


However, there are effective ways to manage and reduce anxiety, one of which is through psychodynamic therapy, an evolution of Freudian theory that I use to organize my thoughts and understand people.


What is Psychodynamic Therapy?

Psychodynamic therapy is a form of talk therapy that evolved from psychoanalytic theory, it seeks to help individuals gain insight into their feelings, thoughts, and behaviors to improve emotional well-being. This therapeutic approach is based on the notion that unconscious thoughts and feelings influence a person’s behavior and emotions.


The central concept of psychodynamic therapy is that unresolved or unconscious conflicts and childhood experiences manifest in a person’s current behavior and can be explored through free association or dream analysis. Psychodynamic theory, which underpins this therapy, emphasizes the importance of understanding these unconscious processes and their impact on an individual's level of functioning.


Developed from the Freudian theory, psychodynamic therapy has evolved over the years to incorporate various techniques and methods. It focuses on exploring the unconscious mind, defense mechanisms, and the phenomenon of transference and countertransference.

Psychodynamic therapies, which include a range of approaches based on psychoanalytic theory, emphasize emotional insight and the exploration of past experiences. By understanding these underlying factors, individuals can gain a better understanding of themselves and their emotions, leading to positive changes in their behavior.


The Psychoanalytic And Anxiety

Unlike other therapies that focus on symptom management, psychodynamic therapy seeks to address the underlying causes of anxiety and has developed theories of anxiety that allow for more understanding.


Psychodynamic therapy aims to bring unconscious processes to light, allowing individuals to understand how their past, traumatic experiences, and unconscious thoughts contribute to anxiety. By exploring the unconscious mind, the therapist helps you gain insight into the unresolved unconscious conflicts and emotional wounds that are fueling your anxiety.

This process involves self-reflection and analysis, providing a safe space to explore your thoughts, feelings, and behaviors.


Through this exploration, you can uncover patterns and themes that contribute to your anxiety. By bringing these unconscious processes to conscious awareness, psychodynamic therapy allows you to examine your thoughts and behaviors from a different perspective. This newfound insight provides the foundation for personal growth and the development of healthier coping mechanisms.


Unraveling the Layers of Anxiety: A Psychodynamic Approach

In this blog, I’ll explore five psychodynamic causes of anxiety that might be impacting you and what some of the things I explore in my clinical practice.


There is a lot of talk and many blogs and videos on managing, soothing, and understanding anxiety, especially in relation to attachment and trauma. However, we risk overlooking some of the core causes of anxiety that pioneers like Freud and Melanie Klein identified decades ago. These causes are an essential part of anxiety treatment 


I’ve summarized these core principles into five layers of anxiety, which fit together like a Russian nesting doll.


psychoanalytic and anxiety treatment

Reality Anxiety: The Outer Layer of Anxiety

The outermost layer of anxiety relates to reality and what goes on in the real world. This type of anxiety stems from everyday stressors, such as worrying about finances, upcoming exams, or traumatic events like car accidents or being mugged. For example, after being mugged, you might feel anxious walking home at night.


psychoanalytic and anxiety


What to Do About Reality Anxiety

As a therapist, I first assess if my client's reality testing is accurate. Reality testing means assigning appropriate amounts of anxiety to events. Distorted reality testing either assigns too much or too little anxiety. For instance, someone overly anxious about a driving test might feel crippled by fear, while someone with no anxiety might lack motivation to prepare adequately. Balancing anxiety levels is crucial for motivation without being overwhelmed.


Existential Anxiety

The next layer concerns existential anxiety, which is part of the human condition when we question the nature and purpose of life. This anxiety revolves around four issues: death,

freedom, isolation, and meaning.


psychoanalysis and anxiety

Addressing Existential Anxiety

To manage existential anxiety in psychoanalytic therapy, we might explore the types of anxiety that emerge around existential fear.


  • Death: The inevitability of death can cause anxiety as people ponder the futility of life. Discussing and exploring these fears can provide comfort.

  • Freedom: While freedom can be liberating, it can also be anxiety-inducing due to the responsibility of making life decisions. Structured environments, such as residential treatment for teenagers, can help mitigate this anxiety.

  • Isolation: The fear of being alone or misunderstood can lead to existential anxiety. Encouraging connection through group therapy or social activities can alleviate these feelings.

  • Meaning: The quest for life's purpose can be daunting. Helping individuals find their passions and establish routines or rituals can provide a sense of purpose and reduce anxiety.


Addressing Existential Anxiety

In Psychoanalytic therapy, we help individuals find purpose by exploring their passions. Creating structure or rituals can also alleviate anxiety, as can encouraging connection to address feelings of isolation. Dealing with anxiety about death involves discussing and exploring these fears in a supportive environment.


anxiety and the inner critic or superego

The Inner Critic: A Deeper Layer

Our inner critic is an internal voice that guides and corrects us, often mimicking the critical voices we heard during childhood. This critic can be harsh and punitive, and with a constant voice berating you, it leads to feelings of anxiety.



Managing the Inner Critic

Understanding and narrating what the inner critic says can be transformative. Clients often realize how irrational and harsh their self-talk is, which helps create distance between their thoughts and feelings. Redirecting focus away from the critic and towards positive actions can reduce anxiety.


Repressed Feelings:

Freud originally attributed anxiety to repressed sexual urges, but modern interpretations recognize that any repressed strong emotions, such as anger or rage, can cause anxiety. Suppressing these feelings creates internal tension and anxiety. It was often thought that a panic attack is caused by repressed feelings of anger.


Healthy Expression of Emotions

Encouraging the healthy expression of anger and other emotions is essential to alleviate this form of anxiety. Turning thoughts and feelings into words rather than actions can significantly reduce anxiety.


Attachment and Infancy: The Innermost Layer

Freud’s ideas about anxiety in infancy laid the groundwork for modern attachment theory. He identified three core anxieties: fear of losing the caregiver, fear of losing the caregiver’s love, and fear of losing the ability to engage the caregiver. These anxieties are foundational in understanding various psychiatric disorders, particularly anxiety disorders.

Childhood experiences exert a profound influence on our development and significantly shape our susceptibility to anxiety. Psychodynamic therapy recognizes the imperative of scrutinizing these early experiences to comprehend their impact on our adult lives. Psychodynamic psychotherapy, in particular, focuses on these unconscious processes and their influence on present behavior.


anxiety and attachment

During therapy, therapists may guide you in examining your relationships with primary caregivers and pivotal events from your childhood. By unpacking the ramifications of these experiences, you can glean insight into their contribution to your anxiety.

For instance, an emotionally unavailable caregiver may instill a fear of abandonment or distrust in others. Such early encounters can foster patterns of anxious attachment, exacerbating ongoing anxiety.


By scrutinizing these childhood experiences, psychodynamic therapy facilitates connections between past events and current symptoms, laying the groundwork for healing and growth.


Reparenting the Inner Child

Understanding and reparenting the scared inner child can bring significant changes in the treatment of anxiety. This involves nurturing and supporting the anxious parts of oneself, often with the help of a therapist trained in psychodynamic or attachment theory.


Seeking Professional Help For Anxiety

It’s challenging to determine the root cause of your anxiety without professional assistance. A therapist specializing in psychoanalytic therapy, cognitive behavior therapy, or cognitive behavioral therapy can help unravel these layers and guide you towards healing. As a family therapist in Los Angeles, I’m here to support you through this journey.


How Psychodynamic Therapy Addresses Anxiety

Unlike other therapies that focus on symptom management, psychodynamic therapy seeks to address the underlying causes of anxiety. By exploring the unconscious mind, the therapist helps you gain insight into the unresolved conflicts and emotional wounds that are fueling your anxiety. Randomized controlled clinical trials have demonstrated the efficacy of psychodynamic psychotherapy in treating specific anxiety disorders, such as panic disorder and social phobia, and in comparing it with other forms of therapy like cognitive behavior therapy.


This process involves self-reflection and analysis, providing a safe space to explore your thoughts, feelings, and behaviors. Through this exploration, you can uncover patterns and themes that contribute to your anxiety. By bringing these unconscious processes to conscious awareness, psychodynamic therapy allows you to examine your thoughts and behaviors from a different perspective. This newfound insight provides the foundation for personal growth and the development of healthier coping mechanisms. Supportive expressive therapy has also shown effectiveness in treating anxiety disorders, emphasizing the discussion of relationship experiences and emotional insight.


Practical Implications and Interventions

Understanding the psychodynamic underpinnings of anxiety equips therapists and individuals with valuable insights and strategies for intervention:


  • Reality Check: Assessing and adjusting reality testing to recalibrate anxiety responses to life events.

  • Existential Exploration: Facilitating exploration of existential concerns and fostering meaning-making to alleviate existential distress.

  • Inner Dialogue: Challenging the critical inner voice and promoting self-compassion through reframing and compassionate self-talk.

  • Emotional Expression: Encouraging healthy emotional expression and processing to address underlying sources of anxiety.

  • Attachment Healing: Exploring attachment dynamics and re-parenting the inner child to promote security and emotional resilience.


This blog post provides a comprehensive look at the psychodynamic causes of anxiety, helping you understand and address them effectively. By focusing on these core principles, you can begin to manage and reduce your anxiety, leading to a healthier, happier life.

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