Psychoanalytic psychotherapy for patterns that keep returning
Psychoanalytic psychotherapy in New York for people who want to understand themselves more deeply, not just manage the surface of what hurts.
Some difficulties do not respond to advice or quick strategies because their roots sit below conscious awareness. In psychoanalytic psychotherapy we slow down and listen closely to what repeats: in your relationships, your moods, your dreams, your body and the way you speak about yourself. Over time those patterns become legible, and what is understood can begin to change. I offer this work in long, unhurried sessions across New York State.
“What we cannot remember, we often repeat. Psychoanalytic work makes room to remember, to feel, and eventually to choose differently.”
The aim is not to explain you away but to help you recognise the logic of your own inner life, so it stops running things from the shadows.
What psychoanalytic psychotherapy actually involves
Psychoanalytic psychotherapy is a talking therapy grounded in the idea that much of what shapes us happens outside awareness, and that bringing it into words can loosen its hold.
Psychoanalytic psychotherapy grew out of the psychoanalytic tradition but is usually less intensive than classical analysis. Rather than lying on a couch several times a week, we meet face to face at a rhythm that suits your life. The core remains the same: an open, curious conversation in which you are invited to say what comes to mind, including the thoughts that feel trivial, embarrassing or contradictory, because these are often where the most important material lives.
My own work is shaped by psychoanalytic inquiry alongside feminist philosophy, gender theory and an interest in culture, religion and visual art. That means I am interested not only in your early family life but also in the wider forces that have shaped how you think, desire and relate. I hold theory lightly. It is a lens for listening, never a box to place you in.
Because I am also a board-certified psychiatric nurse practitioner, psychoanalytic psychotherapy here can sit alongside psychiatric assessment and, where it genuinely helps, medication. Some people come purely for the depth work; others want both in one relationship, with one clinician who knows the whole picture.
The unconscious, in everyday language
The word unconscious can sound abstract, but its effects are familiar: choosing the same kind of partner again and again, freezing in front of authority, sabotaging something just as it begins to go well, or carrying a sadness that seems to have no story attached. Psychoanalytic psychotherapy treats these as meaningful communications rather than character flaws. We look for the hidden sense in them, often discovering that a pattern once protected you and simply outlived its purpose.
Transference and the therapy relationship
Old relationships tend to echo in new ones, including the relationship with your therapist. You might notice you expect me to be disappointed, distracted or critical, or that you work hard to be the perfect client. Rather than ignoring these reactions, we can gently look at them together. Exploring what happens between us, in real time and in a safe setting, is one of the most direct ways psychoanalytic work helps people understand how they relate elsewhere.
Why time and space matter
Depth work needs room. My 60 and 90-minute sessions and deliberately small caseload mean we are not racing the clock, and important material does not have to be cut off just as it surfaces. Many clients tell me that the longer session is where they finally arrive, past the rehearsed version of their story and into what they really feel.
Psychoanalytic therapy may suit you if you are ready to look deeper
Psychoanalytic psychotherapy suits people who sense that their struggles have a history, and who would rather understand that history than simply override it. You do not need to know any theory, have a clear goal or be in crisis. Curiosity about yourself, and a willingness to tolerate not knowing for a while, are enough to begin.
- Repeating painful relationship patterns
- A persistent sense of emptiness
- Self-sabotage you cannot explain
- Long-standing low mood or anxiety
- Difficulty with intimacy or trust
- Questions about identity and desire
- Grief that never quite settled
- Previous short-term therapy felt shallow
- Curiosity about dreams and inner life
- Clinicians wanting their own analytic therapy
Psychoanalytic depth within integrative care
My psychoanalytic work is rigorous but not cold. I am present, responsive and human in the room. I draw on classical and contemporary ideas, and I weave in somatic awareness and psychiatric care where they serve you, always with your consent and at your pace.
Free association
You are invited to speak as freely as you can, without editing for coherence or politeness. Slips, pauses and seemingly random thoughts often lead somewhere unexpected, revealing connections that a carefully planned narrative would miss entirely.
Dreams and fantasy
Dreams, daydreams and recurring fantasies are treated as rich material rather than noise. We explore them together without fixed symbol dictionaries, paying attention to the feelings they evoke and what they might be saying about your current life.
Attention to relationship
How you experience me, and how I experience being with you, becomes useful information. We can talk openly about moments of rupture, closeness or irritation, which often mirror dynamics in your wider relationships and offer a chance to work them through.
History and culture
Your story includes family, but also gender, sexuality, migration, faith, class and the culture you grew up in. My background in feminist thought and global culture means we can explore how these forces have shaped your inner world without pathologising them.
The body in the room
As a somatic practitioner I notice what the body expresses alongside words: a held breath, a tightening, a sudden tiredness. Bringing gentle attention to these signals can deepen psychoanalytic insight and help feelings become more bearable.
Psychiatry when helpful
If depression, anxiety or other symptoms make reflective work difficult, I can assess whether medication or supplements might help steady things. Any medication is introduced gradually and collaboratively, and never as a replacement for the depth work itself.
Psychoanalytic and skills-based therapy
Neither is better in general; they ask different questions. Many people benefit from elements of both, and I can blend them when that serves you.
Psychoanalytic psychotherapy
- Asks why patterns formed
- Open-ended, exploratory sessions
- Works with dreams and fantasy
- Uses the therapy relationship directly
- Change through insight and feeling
Skills-focused therapies
- Asks what to do next
- Structured, goal-led sessions
- Works with thoughts and behaviours
- Relationship as a supportive base
- Change through practice and tools
Starting psychoanalytic psychotherapy
Beginning is simple, and nothing is decided until you feel it is the right fit.
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1
Free consultation 15 minutes
We speak briefly about what brings you to therapy and what you hope psychoanalytic work might offer. You can ask about my training, how I think and how sessions run. There is no obligation, and if another approach or clinician would serve you better, I will say so honestly.
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2
Initial sessions 60 or 90 minutes
Our first meetings are a chance to hear your story in your own words, including family history, relationships, health and anything you already sense is important. If psychiatric questions are part of the picture, I can include a fuller assessment at this stage.
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3
Finding a rhythm
Together we agree a frequency and session length that suits the depth you want and the realities of your life. Consistency matters in psychoanalytic work, as the regular space becomes something you can rely on and bring yourself to more fully over time.
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Ongoing exploration
The work unfolds rather than following a fixed plan. We review periodically how things feel, what has shifted and whether to add medication support, somatic work or more structured tools. Endings are discussed openly and planned together, never abrupt.
Francesca Rome-Marie, PMHNP-BC
I bring together psychiatry, psychotherapy, somatic work and whole-body health, informed by years in primary care and further study in gender theory, feminist thought, culture and visual art.
I keep a deliberately small caseload so that every client receives consistent, unhurried and genuinely attentive care, held within one relationship rather than split across several providers.
Clear, upfront rates
I don't accept insurance. Modern Holistic Psychiatry is an out-of-network provider, so sessions are paid for directly. Depending on your plan, you may be able to claim reimbursement through your out-of-network benefits.
Find out how much your insurance may coverNeed urgent support? If you're in crisis or thinking about harming yourself, call or text 988 (Suicide & Crisis Lifeline) or call 911.
Psychoanalytic Psychotherapy FAQs
What is psychoanalytic psychotherapy, and how is it different from psychoanalysis?
Both draw on the same ideas about the unconscious, defences and the meaning of repetition. Classical psychoanalysis usually involves several sessions a week, often on a couch, over many years. Psychoanalytic psychotherapy keeps the depth and curiosity but is more flexible: we sit face to face, meet at a frequency we agree together, and I am more actively engaged in conversation. For most people in New York balancing work and life, it offers a realistic way into analytic thinking.
Do I need to know anything about Freud or psychoanalytic theory?
Not at all. You bring yourself, and that is enough. I will rarely use jargon, and when a concept is helpful I will explain it in plain language. Some clients enjoy reading about the ideas behind the work and we can talk about that; others never open a book on the subject and still find the process meaningful. Theory is my tool for listening, not something you have to master.
How long does psychoanalytic psychotherapy take?
It is generally longer term than structured therapies because it aims at underlying patterns rather than single symptoms. Some people work with me for several months on a focused question; others stay for years because the space becomes central to how they think and grow. I cannot promise a timescale or outcome, but we review progress together regularly, and you are always free to pause or end the work.
Will you just stay silent while I talk?
No. The image of the silent, blank analyst does not describe how I work. I listen carefully and leave space for your thoughts to unfold, but I also respond, wonder aloud, offer links and share observations. I think warmth and engagement are compatible with depth, and a living conversation is often what allows difficult material to surface safely.
Can I combine psychoanalytic therapy with psychiatric medication?
Yes, and having both with one clinician can be a real advantage. As a psychiatric nurse practitioner I can assess whether medication might help with symptoms that are getting in the way, and we can think together about what taking medication means to you, which can itself be rich material. Any changes are gradual, monitored and agreed collaboratively, and therapy continues alongside them.
Is psychoanalytic psychotherapy affirming for LGBTQIA+ and non-traditional lives?
In my practice, absolutely. Older psychoanalytic writing sometimes treated queer, trans and non-normative lives as problems to be explained. I reject that history. My background in LGBTQIA+ healthcare, gender theory and feminist philosophy shapes a contemporary analytic stance that is curious about desire and identity without pathologising them. Your relationships, sexuality and gender are explored on your terms.
Is psychoanalytic therapy helpful for therapists and analysts in training?
Many clinicians seek their own psychoanalytic therapy, whether as part of training, to process the emotional weight of their work, or simply for themselves. I understand the particular dynamics of being a therapist in therapy, including the urge to analyse your own sessions, and I make room for you to be a person rather than a colleague in the room.
Begin psychoanalytic psychotherapy in New York
If you are ready to understand the patterns beneath the surface, book a free 15-minute consultation and we can talk about whether this work is right for you.