When the Symptom Isn't the Problem: Psychodynamic Therapy in Washington, DC and What Lies Beneath
A Washington, DC Psychodynamic Therapist on Why Our Minds Create Symptoms
Most people come to therapy because they want a symptom to go away.
Perhaps it's anxiety that won't let you relax.
Depression that leaves you feeling empty.
Obsessive thoughts that seem impossible to quiet.
Relationship patterns you keep repeating despite your best intentions.
The symptom feels like the problem.
And certainly, symptoms can cause enormous suffering.
But psychodynamic therapy asks a different question:
What if the symptom is actually trying to solve a problem?
At first, that idea may seem surprising.
Why would panic attacks, perfectionism, people-pleasing, or emotional numbness be considered solutions to a problem?
Because our minds are constantly trying to help us survive emotionally.
The Mind Is Always Trying to Protect Us
Our emotional lives are remarkably creative.
When we can face difficult feelings directly—grief, anger, disappointment, fear, guilt—we gradually learn to think about them, express them, and integrate them into our lives.
But sometimes those feelings are simply too overwhelming.
Perhaps expressing anger once felt dangerous.
Maybe needing someone led to disappointment.
Perhaps showing sadness was met with criticism or indifference.
When certain emotions become too painful or frightening to experience directly, the mind often finds another way to manage them.
Sometimes that "solution" becomes a symptom.
Symptoms Are Often Attempts to Cope
This doesn't mean symptoms are intentional.
Nor does it mean they are helpful.
It means they often represent the best solution the mind could find at the time.
Perfectionism may protect someone from feeling overwhelming shame.
Constant busyness may keep painful emptiness at a distance.
Anxiety may keep someone alert who would otherwise be overcome with debilitating sadness.
Emotional numbness may protect against grief that once felt unbearable.
People-pleasing may preserve relationships when saying "no" once carried emotional consequences.
The symptom is real.
The suffering is real.
But the symptom may also be trying to protect something that has never been fully understood.
Every Solution Has a Cost
The difficulty is that yesterday's solution can become today's problem.
The perfectionism that once helped someone feel accepted may eventually become impossible when one is overwhelmed with their new baby’s needs.
The emotional distance that once protected against disappointment may begin to interfere with intimacy.
The anxiety that once kept someone vigilant may begin to limit their life.
In other words, the symptom may continue long after the original danger has passed.
What was once adaptive becomes restrictive.
Psychodynamic Therapy Isn't Just About Making Symptoms Disappear
Understandably, most people want relief.
And symptom relief matters.
But in psychodynamic therapy, we also become curious about what the symptom has been doing for you.
Not because we want to keep the symptom.
But because if we remove it without understanding its purpose, we may miss the emotional conflict that gave rise to it.
Rather than asking only, "How do we get rid of the anxiety?" we might also ask:
What makes the anxiety necessary?
What feelings become difficult when the anxiety isn't there?
What has this symptom been protecting you from experiencing?
These questions aren't about blaming yourself.
They're about understanding yourself more deeply.
Learning Through Emotional Experience
Insight alone is rarely enough to create lasting change.
Many people already know why they struggle.
They understand where their perfectionism came from or why they fear rejection.
Yet they continue to react in the same ways.
Psychodynamic therapy recognizes that we don't change simply because we understand something intellectually.
We change through emotional experience.
Within the therapeutic relationship, people gradually have new experiences of being listened to, understood, disappointed without being abandoned, angry without destroying a relationship, or accepted without having to be perfect.
Over time, these experiences begin to reshape the expectations we carry about ourselves and about other people.
As new ways of relating become possible, the old symptom often becomes less necessary.
The Goal Is Greater Freedom
Psychodynamic therapy isn't interested in fighting against symptoms.
It's interested in understanding them.
When we understand the emotional work a symptom has been doing, we create the possibility of finding healthier, more flexible ways of meeting those same emotional needs.
The goal isn't simply to eliminate anxiety, depression, or compulsive patterns.
It is to help people develop a richer emotional life—one in which feelings can be experienced, thought about, and expressed rather than carried through symptoms alone.
Often, as that happens, the symptom no longer has to do the job it was once created to do.
Start Psychodynamic Therapy in Washington, DC
If you've noticed the same symptom or pattern showing up again and again — even after you understand where it comes from — psychodynamic therapy offers a different kind of work: understanding what that symptom has been protecting you from, so it no longer has to do that job alone. You can start working with Nina Van Sant, LICSW by following these simple steps:
Meet with a caring psychoanalyst
Start getting to the bottom of your symptoms and find greater freedom!
Other Services Offered with Nina Van Sant, LICSW
In addition to psychoanalysis, I’m happy to provide other services to help clients who are navigating a wide range of mental health concerns. Other services offered include infertility-related stress, postpartum therapy, and therapy for teens and older adults at different developmental stages. I also work with expats and international professionals who are managing cultural adjustment, relocation stress, and the emotional weight of major life changes. You can visit my blog or about page for additional support!