Does My Therapist Think About Me?
Welcome to the first entry in Ask A Psychoanalyst! This series promises a deep dive into the complex clinical issues that dog TAP’s readership of practicing clinicians, trainees, students, and ordinary folks interested in mental health. Think of me as your friendly neighborhood shrink—minus the couch, plus a deadline.
I will do my best to make these discussions engaging and enjoyable. Some of my advice might sound elementary to highly trained therapists, and some of the concepts might be challenging to newcomers. Either way, these columns will be short and to the point, and I’ll aim to generate interesting discussions. Views are my own, not representative of any particular school or theoretical approach, and responses will never contain confidential information. We at TAP greatly appreciate your questions—please keep them coming. Reach me at advice@tapmag.org.
Onward.
—The Analyst (Dr. Stephanie Newman)
Dear Psychoanalyst,
My treatment feels unequal because I have only one analyst but she has so many patients. I think about our exchanges all the time. I wonder if she ever thinks about me outside of our sessions?
—M.
Northeastern US
Hello M.,
You wonder if your analyst thinks about you … You bet—but probably not in exactly the way you’d expect.
What you say is poignant, and I understand all too well—I’ve been there, felt that. It is painful to worry you are not important or to carry around a feeling of longing for more. Analysts are like patients: We have myriad associations to what is said (or not said) while in the office. We absolutely think about our patients—during sessions and after hours.
In my psychodynamic view of the world—which assumes a talk therapy in which patient and therapist seek insight into the interplay of past and present, an individual’s character, and internal parts of the self—it is through words and a new relationship with the analyst that understanding is achieved. When patients say what comes to mind and process with the analyst, insight into internal dilemmas and relationships, a sense of patterns and how they play out in daily life, emerges.
Sessions unfold differently than normal conversations: You talk, we listen. What might feel unequal—patients might not get answers to personal questions or responses to requests for advice—creates an environment and reflects an attitude in which everything is fair game for analysis. Even a simple question, say, “Can I plug in my cell phone? It’s low on battery,” is viewed as clinical material, a communication from patient to analyst. Every word bears deeper understanding. Every thought, feeling, interaction is seen as the nitty gritty of treatment, and every moment provides an opportunity to learn about the patient. So, plugging in a phone means something different here than it might at a dinner party. When I explored the request with one patient, what came to light was a need for “juice.” Our interactions, my presence, energized this patient; simple presence was the juice. Our contact was even more helpful than my insights. We eventually traced this “need for juice” back to a parent who made time for hugs but was too distracted for other types of interaction.
While this interpretive approach probably sounds odd to non-clinicians, it’s real; the way analysts listen is different. Our expectation of the clinical situation invites and values associations: We definitely think about you—it’s a question of what and when.
Years back, my psychology classmates and I were tasked with reading about “the third ear,” a metaphor for how analytic clinicians listen to what is below the surface. A neutral analyst, blank screen, so the theory goes, provides a pathway for whatever is going on with the patient to emerge over time and allows knowledge to deepen. Intrigued, I went into my next analytic session (as a patient) thinking about life behind the couch. I associated as usual and noticed that the room was otherwise silent, but a brief chuckle, a well-placed cluck of sympathy, and the experience of being heard let me know that my analyst’s presence was very real. In ordinary conversation, monologuing might be experienced as dull or deadening, a conversation-ender, but not in psychoanalysis world. I perceived that the room was alive, despite the one-sided nature of the talk. We were in sync, and I was not alone. It was energizing. My analyst wasn’t just listening. He was listening for unconscious fantasy and transference, for present and past, for thoughts and feelings about people from past and people from today. “Boy,” I thought, “you are very busy back there.”
A joke but also the truth: We are, in fact, very busy, very active listeners. Analytic talk therapists pay attention to what we are hearing or not hearing and what feelings or reactions are evoked in us on the surface and many deeper levels. And we routinely think of our patients hours or days after a session, whenever associations pop into our minds. This is normal and useful in clinical work, as our associations are seen as data points. Say an analyst sees five people in a row, business as usual, with no particular internal reactions evident, but during the following session the analyst begins to feel something very different like a sad or bereft feeling. The response might provide information about the patient. And before I offend any classical analysts—who might argue that the analyst’s reactions do not factor in, it’s only a patient’s words, feelings, associations that are grist for the analytic mill—remember, “opinions are my own,” and I limit this note to thoughts and reactions perceived by a well-trained, highly-tuned ear.
It’s also worth mentioning that we don’t necessarily share with patients what we think about them. Disclosure is a whole other topic better left for a future discussion.
Now to the heart of the question, your curiosity about the essence of the analytic relationship: You have one therapist but she has many patients, rendering the relationship unequal. And if you haven’t thought of this yet—it might sound obvious now that I say it—but I’d guess your experience is a reflection of transference, the clinical phenomenon where many powerful thoughts and feelings from your internal world, present and past, get put onto the analyst. The fact that this has developed is great! It means something important is happening in the treatment. Your analyst is important to you, and you want to be important to her. Please talk to your analyst about the unequal feeling. Getting to the bottom of what you imagine, perceive, and put onto her will offer clues into your deepest feelings and other aspects of your internal world. As you probably know it can be freeing to open up and be listened to without criticism and judgment. I hope you will give your analyst a chance to show you her stuff on this—I’m betting it will take your treatment and understanding to new places.
In Ask a Psychoanalyst, Stephanie Newman, PhD, responds to reader questions about therapy, relationships, and psychopathology of everyday life. Submit your questions to advice@tapmag.org. Your identity will be kept anonymous.
This column is for general educational and informational purposes only and is not a substitute for professional advice, diagnosis, or treatment. Always seek the advice of your own therapist, physician, or other qualified health provider with any questions you may have regarding a mental health condition. Reading or submitting to this column does not create a therapist-client relationship.Published June 2025