Process Group Therapy in San Francisco: How Groups Create Relational Insight

Process Group Therapy in San Francisco: How Groups Create Relational Insight

A Reflection on Process Group Work at Free Association Clinic

If you are searching for process group therapy in San Francisco, you may already know something important: many of the problems that bring us to therapy are not only “inside” us. They show up between us, in the subtle push and pull of closeness, distance, belonging, conflict, and repair.

A process group offers a simple, demanding invitation: bring your real experience into the presence of others, and let relationship become the material of therapy.

A softly lit therapy room features a circle of empty chairs around a coffee table, evoking openness and shared conversation.

Process Group Therapy in San Francisco: Why the Group Matters

Most of us learn how to be with people long before we learn how to talk about it. We adapt. We protect ourselves. We discover what gets approval and what gets punished. Over time, these adaptations can become so familiar that they feel like personality, or like fate.

Process group therapy gives you a place to study this “how” of relating, not as a theory, but as a lived experience. The group becomes a social world in miniature, one where your patterns have room to appear, and where new possibilities can be tried without pretending you are someone else.

In many ways, group work is not about becoming a better performer in relationships. It is about becoming more present in them.

What “Process” Means in Group Therapy

The word “process” can sound technical, but in a therapy group it is surprisingly ordinary. It means paying attention to what is happening right now: in the room, between people, inside you as you speak, and inside you as you listen.

A process group does not primarily revolve around a lesson plan. Instead, it revolves around the living moment.

Not a class, not advice, not a performancey

A healthy process group is not a seminar where the most articulate person wins. It is not a place where you are expected to impress anyone with insight, or to provide the perfect encouragement at the perfect time.

It is also not a place where “fixing” each other becomes the main activity. Advice sometimes appears, but it is not the point. The point is something more difficult and more human: learning how you actually impact others, and how others actually impact you.

The group as a living relationship

In a process group, the relationships matter. People notice things. People react. People misunderstand, and then sometimes they repair. Over time, the group becomes a container sturdy enough to hold honesty that might feel risky elsewhere.

This is where group work begins to differ from many of our everyday conversations. In daily life, we often move away from tension quickly. We change the subject. We reassure. We smooth things over. In group therapy, the invitation is often to slow down and stay with what is happening long enough for something real to emerge.

The Group as a Microcosm of Your World

One reason process groups can be powerful is that the patterns you bring into relationships do not remain abstract. They show up.

If you tend to disappear, you may notice how quickly you hold back, even when something matters to you.

If you tend to manage the emotional climate, you may feel how exhausting it is to keep everyone comfortable.

If you expect rejection, you may feel the impulse to reject first, or to never need anything.

This is not a moral evaluation. It is an opportunity to see yourself more clearly.

Repetition, avoidance, and the relational present

Many people come to group therapy with a sense of repetition: “I always end up in the same kind of relationship,” or “I don’t know why I keep doing this.”

In a process group, repetition becomes visible in real time, which means it becomes workable. The goal is not to shame the pattern. The goal is to make it speak.

Often, what looks like a “bad habit” is also a kind of loyalty to survival. Group therapy can help you honor why the pattern formed, while also making room for something new.

Feedback that lands, and feedback that misses

Group feedback can be transformative, and it can also be confusing. Sometimes what someone says about you lands with immediate truth. Sometimes it does not.

Both matter.

Process group therapy is not a popularity contest, and it is not a voting system for who you “are.” It is a practice of encountering the fact that multiple perspectives exist, and that your inner experience and others’ experience of you may not match.

Holding that tension, without collapsing into defensiveness or people-pleasing, is part of the work.

A cozy therapy corner displays an open journal, pens, and a candle on a wooden table, suggesting warmth and introspection.

What You Actually Do in a Process Group

For people unfamiliar with group psychotherapy, the biggest question is often practical: what do you do in there?

The short answer is: you speak, you listen, and you learn to stay close to experience.

Speaking in the first person

In process group therapy, it helps to speak in the first person whenever possible.

“I felt exposed when the conversation moved on.”

“I noticed I wanted to interrupt.”

“I’m afraid I’m taking up too much space.”

These are not theatrical confessions. They are ways of making the inner world available for relationship, instead of keeping it private and unchanged.

Learning to stay with experience

Many of us have learned to leave experience quickly. We intellectualize. We explain. We tell the story from above the story.

There is a place for reflection, of course. But process group therapy often invites a deeper move: to stay close to what is happening, long enough to feel it and understand it from within.

This is one of the quiet disciplines of group work: noticing when you are tempted to flee, and practicing a different kind of presence.

Repair, accountability, and freedom

Groups inevitably include rupture. Someone misses your point. Someone says something clumsy. Someone feels left out. Someone feels criticized.

This is not a failure of group therapy. It is one of its most important materials.

When repair becomes possible, when people can say, “I misunderstood you,” or “I think I reacted from my own history,” or “Can we try that conversation again,” the group begins to offer something rare: a lived experience of accountability without humiliation.

From an existential perspective, this is also where freedom becomes practical. Freedom is not only an inner idea. It shows up as the capacity to respond differently, right here, with real people.

Who Might Benefit From Process Group Therapy

Process groups can be a good fit for many people, but not for every situation. A thoughtful consultation helps clarify that.

Still, certain themes often suggest that group work may be especially meaningful.

When isolation becomes the default

Many people suffer in isolation even when they are surrounded by others. They have learned to keep their deeper feelings private, either because it felt safer that way or because no one seemed able to receive them.

A process group offers an alternative to isolation that is not superficial socializing. It offers contact with depth.

When relationships keep repeating the same story

If you notice recurring relationship patterns, in romance, work, friendship, or family life, group therapy can become a living laboratory for those patterns.

It is one thing to understand your history. It is another thing to discover how your present ways of relating keep recreating the same outcomes, and then to practice something different.

An abstract graphic of overlapping warm-toned speech bubbles symbolizes layered dialogue and communication.

What Process Group Therapy Is Not

It may help to name a few misconceptions.

Process group therapy is not a place where everyone must disclose everything. You choose your pace.

It is not a place where conflict is encouraged for its own sake. But conflict is not automatically avoided.

It is not a “support group” in the casual sense, though support often emerges.

It is not a shortcut. Group therapy can be profound, and it often asks for patience.

If you are also considering individual therapy, group work can complement it. Many people benefit from having both an individual space and a relational space, especially when relationship itself is part of the struggle. (Learn more about our individual therapy and our psychoanalytic therapy approaches.)

Beginning Group at Free Association Clinic

At Free Association Clinic, our process group therapy is designed to support honest exploration in a relational setting, in a way that is grounded, respectful, and clinically serious.

If you are curious but uncertain, that uncertainty is often part of the doorway. Group therapy can feel unfamiliar at first, especially if you have learned to manage yourself carefully around others. Over time, the group can become a place where you do not have to perform your way into belonging.


Conclusion

Process group therapy is, in a sense, therapy in the presence of the world. It is where the questions of relationship, authenticity, conflict, and connection become immediate rather than abstract. For many people, that immediacy is exactly what makes group work transformative.

If you are exploring process group therapy in San Francisco, we invite you to learn more about our Process Group offering, or to contact Free Association Clinic to schedule a consultation and talk through fit.


James Norwood, PsyD
Associate Director, New School for Existential Psychoanalysis (https://www.freeassociation.us)
Clinical Director, The Free Association Clinic for Existential Psychotherapy and Psychoanalysis (https://www.freeassociationclinic.com)
Founder/CEO, inpersontherapy.com (https://inpersontherapy.com)

References

Yalom, I. D., & Leszcz, M. (2005). The Theory and Practice of Group Psychotherapy (5th ed.). Basic Books.
Foulkes, S. H. (1984). Therapeutic Group Analysis. Karnac Books.
Bion, W. R. (1961). Experiences in Groups. Tavistock Publications.
MacKenzie, K. R. (1990). Introduction to Time-Limited Group Psychotherapy. American Psychiatric Press.

Why Your Therapist Sometimes Doesn’t Give Advice

Why Your Therapist Sometimes Doesn’t Give Advice

If you’ve found yourself typing “why won’t my therapist give advice” into a search bar, you’re probably not looking for a philosophy lecture. You’re looking for traction. You’re in a situation where the stakes feel real, where the cost of getting it wrong feels high, and where you want someone to simply tell you what you cannot yet tell yourself, whether you should leave, stay, confront, wait, apologize, walk away, stop, start, risk, or protect what you have left.
And then, in the middle of that urgency, you meet a particular kind of response: not a verdict, not a plan, but a question, or a pause, or a shift toward what you are feeling rather than what you “should” do.

That can be infuriating. It can also feel strangely personal, as if the therapist is withholding out of coldness, indifference, or some private need to stay above the mess. In ordinary life, care often arrives packaged as advice, and when we are anxious or exhausted we can experience advice as the most basic form of kindness, because it temporarily releases us from uncertainty.

But existential and psychoanalytic therapy often works from a more skeptical view of help, one that is wary of the quiet kind of control that can hide inside “helping,” and wary too of the idea that psychological change is primarily produced by instruction. Free Association Clinic’s public language makes this orientation plain: the aim is not simply symptom management, but getting to the heart of the matter, in a way that helps you uncover meaning and reclaim what has become elusive in your life. (Free Association Clinic)

So the question is not simply whether your therapist gives advice. The deeper question is what the therapy is trying to protect when it does not, and what it risks when it does, because neutrality is not a gimmick and not a ban on human response. It is a mindset, and like any mindset it can be practiced well or poorly.

A woman gestures with uncertainty while talking to a therapist, with large question marks subtly layered over the background to suggest emotional confusion.

When you want an answer and you get a question

Most people come to therapy at least partly because the mind can become a closed room under pressure. You circle the same argument, you rehearse the same conversation in your head, you reach for the same solution that has failed before, and the repetition itself starts to feel like proof that you are stuck. When you finally bring that stuckness into the room, it is natural to want the therapist to act like an exit sign.

But a good question can do something advice cannot. It can return you to the part of the problem that is genuinely yours, which is not the part where you want the discomfort removed, but the part where you are divided, where you want two incompatible things, where you are trying to preserve love without risking loss, or preserve safety without feeling dead, or preserve self-respect without being alone.

In that sense, the therapist’s restraint is not meant to be passive. It is meant to keep your life in your hands.

If you want the broader frame FAC uses for this kind of work, start here: our approach to existential therapy

Neutrality is not the same as silence

In everyday language, neutrality can sound like a therapist who stays quiet, or a therapist who refuses to react. In classical psychoanalysis, though, neutrality points to something more demanding: an effort to engage without turning the session into an evaluation, without deciding too quickly what is important and what is trivial, what is respectable and what is shameful, what should be emphasized and what should be dismissed.

Freud’s phrase “evenly suspended attention” is useful here because it names a discipline of listening that is not ruled by the therapist’s preferences, impatience, or moral instincts. When neutrality is practiced well, it creates a particular condition in the room: you can say the thing you were bracing for judgment about, and instead of being corrected or steered into a preferred narrative, you are met with a serious kind of attention that makes truth more speakable.

That matters because people rarely hide their truth only out of secrecy. More often they hide because they expect evaluation, or they have learned that being fully honest will cost them love, status, belonging, or dignity. Neutrality is one way the therapist tries to reduce that cost, not by pretending everything is fine, but by refusing to moralize your inner life.

This is also why neutrality cannot be reduced to a rule like “the therapist never gives advice.” Neutrality is not an algorithm. It is a stance that asks a more difficult question, again and again: what is my talking, or my restraint, in service of right now, and is it serving the patient’s freedom, or is it serving my need to be effective, admired, reassuring, or in control.

Neutrality also should not be confused with indifference. A therapist can be engaged, warm, and emotionally present while still refusing to turn the session into a performance for approval, or a lecture on how to live. FAC’s own framing leans toward this kind of human seriousness: someone you can trust, who can stay with the pain of the human condition without turning you into a project. (Free Association Clinic)

Why a therapist may hold back from advice

There are practical reasons a therapist may be cautious about advice, and they have less to do with being mysterious and more to do with what advice can do to the relationship and to your agency.

Advice can be relieving, but it can also be misleading, because it often treats the surface dilemma as the real dilemma. You can ask, “Should I break up?” and receive a plausible answer, while the deeper problem remains untouched: why you choose the people you choose, what you are repeating, what you cannot bear to want, what you cannot tolerate losing, what you call love when it is really fear, what you call independence when it is really withdrawal. Advice may solve the moment while leaving the pattern intact.

Advice can also invite a subtle displacement of responsibility. If you do what the therapist says and it goes badly, the therapy can quietly become a court case. If you do not do what the therapist says, the therapy can quietly become a struggle over authority. Either way, the work gets pulled away from your desire and toward the therapist’s position.

This is where Thompson’s critique of “therapeutic ambition” matters. Therapeutic ambition is not the desire to be helpful. It is the therapist’s belief that they know what is good or bad for you in a way that licenses them to shape you accordingly, which turns help into a form of authorship. The danger is not advice itself. The danger is advice that carries the therapist’s private certainty about who you should be.

Neutrality is one way of refusing that certainty.

A calm and softly lit therapy room scene shows a pen resting on a closed journal, next to a box of tissues and a glass of water on a wooden table.

When advice is offered, it should not replace your responsibility

It is worth saying plainly: sometimes therapists do give advice. Sometimes safety is involved. Sometimes resources are needed. Sometimes a practical obstacle is blocking the work. Sometimes couples therapy or crisis-oriented work requires more structure and more direct intervention than individual depth therapy.
The issue is not whether advice ever appears. The issue is what kind of thing advice is treated as.

In existential and psychoanalytic therapy, advice is not usually seen as the catalyst for change, because lasting change rarely comes from being told what to do. It comes from coming into contact with what you actually want, what you actually fear, what you keep sacrificing, what you keep repeating, and what you keep calling “circumstances” when it is also your own participation in your life.

So when advice is offered in a depth-oriented relationship, it should feel less like instruction and more like a natural expression of helpfulness within a relationship that still refuses to bypass the central task: discovering your own desire and taking responsibility for your choices. In other words, help is allowed, but it is offered in a way that keeps the burden of authorship where it belongs, with you.

If that sounds demanding, it is, and it is also respectful. It assumes you are not a child in need of direction. It assumes you are a person trying to regain contact with yourself.

How this connects to neutrality and “non-judgment”

Many people hear “non-judgmental” and imagine a therapist who approves of everything, or who refuses to have a point of view. Neutrality is not approval. It is not permissiveness. It is an effort to keep the therapist’s evaluative reflex from becoming the governing force in the room, so that the patient’s truth can become clearer rather than immediately organized around what will earn praise or avoid disapproval.

That is why neutrality is bigger than advice. A therapist can give advice and still remain neutral in the relevant sense, if the advice is not carrying moral verdicts and not attempting to form the patient in the therapist’s image. A therapist can also refuse advice and still violate neutrality, if the refusal is used as a power move, or as a way of avoiding real engagement.

The question, again, is not “Did my therapist tell me what to do?” The question is “Is my therapist helping me face my life as mine, without condemnation and without takeover?”

A notepad labeled “Advice” with action steps sits beside another labeled “Thoughts” with introspective questions, symbolizing the contrast between external guidance and inner reflection

A practical check: when neutrality is working, it feels like thinking is possible again

When neutrality is working, many people notice something simple but profound: they start thinking again, in a way that is not just rumination. They become more honest about their motives. They catch themselves repeating patterns earlier. They feel less compelled to perform for approval, including the therapist’s approval. They begin to tolerate uncertainty long enough to find the real problem, rather than prematurely solving a substitute problem.

When neutrality is not working, the room goes dead, or you feel chronically shamed, or you feel emotionally stranded in a way that never becomes meaningful. In those cases, the right move is not to silently endure. The right move is often to say it plainly, in the room, and see what happens.

If you are looking for therapy that takes meaning, honesty, and responsibility seriously, Free Association Clinic offers existential psychotherapy and psychoanalysis, with in-person sessions in San Francisco and telehealth options described across service pages.

Schedule a first session: https://freeassociationclinic.com/contact-us/
Learn about insurance and superbills: https://freeassociationclinic.com/insurance/

How Free Association Clinic approaches this stance

FAC describes its work as existential psychotherapy and psychoanalysis, oriented toward uncovering meaning behind struggles and restoring what can feel lost in life, including passion, love, and joy.

In practice, that means the therapist is not primarily trying to direct your life from the outside; they are trying to stay close enough to your experience, and steady enough in their attention, that you can begin to see what you are doing, what you are avoiding, what you are protecting, and what you are asking of other people without realizing it.

If you want the clinic’s overview pages, use:

how we work / introduction: https://freeassociationclinic.com/introduction/
existential therapy: https://freeassociationclinic.com/existential-therapy/
psychoanalysis therapy: https://freeassociationclinic.com/psychoanalysis-therapy/
our staff: https://freeassociationclinic.com/about-us/

Practical details and insurance

FAC’s insurance page states the clinic is in-network with: Aetna, Blue Shield of California, Blue Cross Blue Shield, Optum / UnitedHealthcare, and Cigna / Evernorth, and also offers superbills for out-of-network reimbursement.

Details: https://freeassociationclinic.com/insurance/

Common questions

Should my therapist ever give advice?
Sometimes, yes, especially for safety, crisis steps, or practical barriers that need to be addressed. The bigger distinction is whether advice is being used to replace your responsibility, or whether it is offered as a human form of help inside a relationship that still returns authorship to you.

Does neutrality mean my therapist has no feelings?
No. Neutrality is not emotional emptiness. It is the effort not to use the therapist’s feelings to steer your life, punish you, rescue you, or recruit you into their values. Therapy can be very human, and it should still feel like someone is with you.

Why is my therapist so quiet?
Sometimes quiet is a way of making room for your experience rather than filling the space with the therapist’s preferences. But quiet should not become a weapon, and neutrality should not require you to endure emotional absence. If the quiet feels abandoning, say so.

How do I know if therapy is working if I am not getting answers?
In depth work, progress often shows up as increased honesty, sharper awareness of your patterns, and a stronger capacity to tolerate uncertainty without collapsing into avoidance or impulsive action. Over time, you find yourself living the same life in a different way, with more self-knowledge and less self-deception.

What if I want a more directive approach?
That is legitimate. Some people want skills-first or structured treatment, and sometimes that is exactly what is needed. Fit matters. A mismatch can feel like failure when it is really a mismatch of method.

Ready to start?

If you are ready to begin, you can request an appointment here

People Pleasing and Losing Yourself

e

People Pleasing and Losing Yourself

You agree to something you do not want, and what makes it painful is that you can hear yourself consenting as it happens. You say yes with a tone that sounds sincere, because part of you is sincere: you want the other person to stay pleased, you want the relationship to stay stable, and you want the moment to pass without consequence.

Then you are alone and the consequence arrives anyway, not as drama, but as something duller and more corrosive: irritation, dread, a low-grade anger with nowhere obvious to go, followed by the familiar question that is not really a question at all. Why did I do that again?

If you recognize this pattern, you have probably been told to set better boundaries. Sometimes that advice is accurate, but it often feels thin because it is aimed at the surface of the problem; it treats people pleasing as a skill deficit when, for many people, it is closer to a way of existing with other people, a posture toward life that can look like kindness from the outside and feel like self-erasure from the inside.

A woman sits solemnly on a bed holding a white mask, surrounded by crumpled tissues, symbolizing emotional vulnerability and hidden identity.

The private aftermath is the truth of the pattern

People pleasing is usually not the presence of generosity. It is the presence of a bargain.

The bargain is rarely stated out loud, which is part of why it keeps operating. It tends to sound like this: if you are disappointed in me, I am not safe; if you are angry, I have done something wrong; if you withdraw approval, I might lose you; if I ask for what I want, I will be exposed in a way I cannot tolerate. When that bargain is running, the yes is not really about your desire, and it is not even about your values; it is about managing the other person’s reaction so you can keep your footing.

Resentment follows for a simple reason. You are spending your life stabilizing the emotional weather around you, and even when you succeed, you succeed at the cost of disappearing. The anger is not a character flaw; it is often the part of you that still knows you traded yourself away for peace.

When kindness becomes self-loss

There is a version of people pleasing that is simply social intelligence, the ordinary tact of living among others. But the kind that leaves you resentful and unreal tends to have a different texture: it feels compulsory, and it keeps widening until it is no longer confined to a few situations. You begin to notice that you adapt before you think, that you apologize for taking up time or space, that you do not know what you want until you are finally alone, that you can sense what everyone else needs while your own desire feels quiet, distant, or embarrassing.

This is the moment many people say, “I don’t know who I am.” It can sound melodramatic until you take it seriously, at which point it becomes a precise description of what has happened: your life has become organized around being acceptable, and acceptability is not the same as being real.

When kindness becomes self-loss

There is a version of people pleasing that is simply social intelligence, the ordinary tact of living among others. But the kind that leaves you resentful and unreal tends to have a different texture: it feels compulsory, and it keeps widening until it is no longer confined to a few situations. You begin to notice that you adapt before you think, that you apologize for taking up time or space, that you do not know what you want until you are finally alone, that you can sense what everyone else needs while your own desire feels quiet, distant, or embarrassing.

This is the moment many people say, “I don’t know who I am.” It can sound melodramatic until you take it seriously, at which point it becomes a precise description of what has happened: your life has become organized around being acceptable, and acceptability is not the same as being real.

Authenticity is not a trait, and it is not a hidden object

From an existential psychoanalytic view, authenticity is not a stable personality feature that you either possess or lack, and it is not a pure “true self” waiting underneath your social roles like a buried treasure. Authenticity is a way of existing, which means it is something you appropriate in the middle of real life, and it is something you can lose again and again, especially when you begin living by public opinion, by others’ expectations, and by the quiet tyranny of what you imagine you are supposed to be.

This matters clinically because it changes what you are trying to do. If you keep waiting to discover a ready-made identity, you may never do the harder work of taking up your own life in the presence of other people, where the risks are real and the consequences are not imaginary.

People pleasing is one of the most efficient ways to avoid that work, because if you become what others want, you never have to find out what you want; you can remain socially successful while privately absent.

A woman appears cheerful as she speaks to her reflection in a shattered mirror, which shows a somber expression, illustrating a divide between outward expression and inner truth.

Winnicott’s false self, or the self that keeps the relationship safe

Winnicott gives language that many people recognize immediately once they hear it, because it names the lived experience rather than offering advice. He described a false self that develops when a person learns, often early, that spontaneity is risky, that certain feelings are not welcome, and that the safest way to stay connected is to present what the other person can tolerate.

This false self is not simply “fake.” At its best, it is protective and socially useful; it helps you navigate a world that requires adaptation. In the best of cases, it can be a means by which a more intimate relationship is reached. The trouble begins when the false self becomes your primary way of being, when it stops serving you and starts running you, because then your life becomes a performance built around maintaining connection and avoiding rupture. However, the connection it affords is a catch 22, the relationship might be stable, but it is based on a lack of intimacy. You may look functional and agreeable while feeling internally strained, resentful, empty, or strangely unreal, as if you are living through a socially acceptable version of yourself while something more alive stays hidden, not because it is mystical, but because it has learned it is safer not to appear.

People pleasing often fits this picture with uncomfortable accuracy. It is compliance in the service of attachment, and it is frequently fueled by the fear that if you stop being good, you will stop being loved.

The paradox of being liked

People pleasing is often praised, and that praise can become part of the trap. If everyone experiences you as easy, reasonable, helpful, thoughtful, then the role hardens into identity, and identity becomes a kind of prison because you start defending the image you have created. You become allergic to disappointing people, not only because you fear their anger, but because their disappointment threatens the self you have built to survive.

The paradox is that the more you specialize in being liked, the harder it is to feel known, and the harder it is to feel real. Being liked can function like an invisibility cloak: you avoid conflict, and by avoiding conflict you avoid the moments that require you to take a stand, to state a preference, to risk being misunderstood, to tolerate someone’s frustration, and to remain present anyway.

Why advice fails, and what therapy changes

Most people pleasers already know the advice. They can recite it, sometimes with impressive sophistication. Yet when they attempt to follow it, something inside them reacts as if a boundary is not a sentence but a threat. That reaction is the point. It tells you that the pattern is not maintained by ignorance, but by fear, and fear does not yield to checklists.

Psychoanalytic and existential therapy take seriously that people pleasing often began as adaptation. It may have been how you kept connection, reduced threat, stayed in good standing, or found a place for yourself in a family or culture where approval felt conditional. Even when your current life is safer, the old bargain can remain in force, and the false self can keep doing its job long after it stops protecting you.

Therapy matters here because the problem is relational, and therefore the work has to become relational too. The impulse to be the “good patient,” to make the therapist comfortable, to hide anger, to soften your language, to say what you think is expected, to stay agreeable at the very moment you are not agreeable, is not a distraction from the treatment; it is often the treatment, because it allows the false self to become visible as it is happening, and it allows you to experiment with a different way of being in a relationship where the stakes are real but the goal is not approval.

In existential work, authenticity is not comfort; it is exposure. It is the willingness to let your desire, your anger, your limits, your grief, and your ambivalence be part of the relationship, not because you want conflict, but because a life without that truth is not a life you can actually inhabit.

Learn more about existential therapy: https://freeassociationclinic.com/existential-therapy/
Learn more about psychoanalytic therapy: https://freeassociationclinic.com/psychoanalysis-therapy/

A woman sits in silence at a table while faded, overlapping figures around her appear engaged in conversation, representing isolation amidst social noise.

Starting at Free Association Clinic

If your yes is keeping the peace while your private life fills with resentment, you do not need a more optimized personality. You need a different relationship to fear, guilt, and responsibility, and you need a place where the part of you that has been managing everyone else can stop performing long enough for something more genuine to appear.

Free Association Clinic offers in-person sessions in San Francisco and telehealth across California.

Request an appointment: https://freeassociationclinic.com/contact-us/
How we work / our staff: https://freeassociationclinic.com/about-us/

Insurance and practical logistics

The clinic is in-network with Aetna, Blue Shield of California, Blue Cross Blue Shield, Optum / UnitedHealthcare, and Cigna / Evernorth. If your plan is not listed, out-of-network reimbursement may still apply, and the clinic can provide a superbill.

Learn about insurance and superbills: https://freeassociationclinic.com/insurance/

Consultation: your first session is free if you choose not to continue. If you decide to move forward, payment is discussed during the meeting.

FAQ

Is people pleasing the same as being kind?
No. Kindness can include honesty and limits, and it can tolerate another person’s disappointment. People pleasing is often organized around safety and approval, which is why it can feel like care on the outside while feeling like disappearance on the inside.

Why do I feel resentful after I people please?
Because the relationship stayed calm, but it stayed calm by costing you something. Resentment is often the aftertaste of self-erasure, especially when you agreed out of fear rather than desire.

Why do I feel guilty when I set a boundary?
Because guilt can be the emotional price of breaking an old rule, even when the rule is destroying your life slowly. Guilt does not always mean you harmed someone; sometimes it means you stopped conforming.

Is people pleasing a trauma response?
Sometimes. Sometimes it is a learned adaptation to conditional approval, volatile relationships, or environments where being low-maintenance was the safest role. The label matters less than understanding what your people pleasing protects and what it costs.

What if I don’t even know what I want?
That is common, and it often makes sense. If the false self has been steering for years, desire can go quiet. Therapy can help you recover it without forcing quick answers, and without treating your life like a self-improvement project.

Schedule a first session: https://freeassociationclinic.com/contact-us/

Deception and Trauma in Existential Psychoanalysis: Laing and Freud on Mystification

Deception and Trauma in Existential Psychoanalysis: Laing and Freud on Mystification

An essay in reading Michael Guy Thompson’s Essays in Existential Psychoanalysis (Chapter 11)

Deception and trauma in existential psychoanalysis are not treated as mere clinical “content” to decode, nor as the private property of an isolated mind. In Michael Guy Thompson’s Chapter 11, they become the ethical problem that quietly governs everything else: the question of what happens to a person’s relation to reality when reality is repeatedly bent, denied, or strategically withheld, and what it demands of a therapist who claims to practice psychoanalysis in the name of truth. Thompson’s wager is that R.D. Laing’s work, so often positioned as psychoanalysis’ rebellious counterpoint, becomes most intelligible when we notice how thoroughly Freud inhabits it, even where Freud is barely named.

This is not only a theoretical matter, and it is not a dispute to be settled by choosing a camp. For therapists, Thompson’s chapter presses on the uncomfortable point that technique is never merely technique, because every technique presupposes an ethic, and the ethic can be betrayed in the very procedures meant to protect it. For patients, it gives language to an injury that often resists language: the peculiar devastation of being made to doubt one’s experience, and of discovering, often too late, that one’s world had been organized around what was concealed. Thompson’s claim is that the trauma at issue here is not simply what “happened,” but what happened to the possibility of believing what happens.

The gulf Laing refused to accept

Thompson begins where existential psychoanalysis often begins, not with a doctrine but with a stance. He portrays the most telling feature of Laing’s clinical technique as a radical effort to eliminate the gulf that customarily hardens between therapists and their patients, so that the patient can feel, in the therapist’s presence, not the impersonal authority of a procedure but “another human being like themselves,” someone who shares the ordinary weight of living and the ordinary capacity for pain. The point is deceptively simple, and it becomes demanding precisely because it deprives the therapist of a familiar refuge: the refuge of role, the refuge of expertise performed as distance, the refuge of a professional posture that can quietly turn the other into an object. In Laing’s hands, the clinical encounter becomes an exposure, because the therapist’s relation to truth cannot be kept outside the room as a private virtue while technique proceeds inside the room as a neutral instrument.

Thompson does not sentimentalize this stance as “niceness,” and he does not treat it as a rejection of analytic discipline. He treats it as a more austere demand: that the therapist’s humanity is not an ornament of the work but one of its conditions, and that the ethical imperative is not an afterthought added to interpretation but the ground on which interpretation can be trusted. The deeper problem, in other words, is not whether a therapist can interpret cleverly, but whether the relationship being formed can bear truth without collapsing into coercion, and whether the therapist can bear the temptation to manage reality, even in the name of improvement.

A contemplative male therapist sits in a chair, hand on his forehead, surrounded by ghostly, cracked images of a screaming woman, a solemn child, and an older man—symbolizing emotional burden, intergenerational trauma, and the lingering presence of the past

Freud’s “Truth and Trauma” and the expansion of reality

If Laing’s technique begins with the abolition of the gulf, Thompson’s argument begins with a different abolition, the abolition of an easy story about Laing’s relation to psychoanalysis. Thompson insists that Freud’s influence on Laing was “pervasive,” though generally omitted, and he goes further, suggesting that Laing saw himself, quietly and without fanfare, as Freud’s intellectual heir, with a style of allusion that makes the inheritance hard to see unless one knows how to listen for it. What matters is not biographical gossip about influence but the alignment of a central preoccupation: deception and its relation to trauma.

Thompson’s route through Freud is precise, because it follows the transformation of Freud’s own theory of trauma. Freud begins, under Charcot’s influence, with a relatively direct idea, that hysterical symptoms follow from traumatic seductions, from sexual experiences imposed on the child, a theory whose apparent concreteness has a certain moral clarity. Yet the theory collapses under contradictory evidence, and Freud’s collapse becomes, for Thompson, one of psychoanalysis’ decisive expansions: if some patients trace symptoms to traumas that did not occur as events, then fantasies have force, and “psychical reality” must be taken into account alongside practical reality. That phrase is not an escape from truth but a widening of truth’s domain, because it names the way the psyche can be organized around scenes that have the status of reality for the person, regardless of historical verification, and because it locates trauma not only in external violation but in the psyche’s own struggle to bear what it anticipates, what it dreads, and what it cannot admit it already knows.

Thompson reads Freud’s later conception as a subtle account of how deception and conflict co-constitute each other. The child, vulnerable to disappointment, can repress what is too painful, replacing an objectionable reality with an inviting fantasy, and thereby “not experiencing” the disappointment in the ordinary sense while still suffering its effects; later, anxiety forms around the fear of discovering what one must not know, which is to say, around the dread of re-encountering something that, in reality, has already happened. Trauma becomes inseparable from concealment, and the psyche’s defenses become, in their own way, deceptions that purchase bearability at the cost of truth. It is in this terrain, where reality is not denied merely because a person is irrational but because reality is unbearable, that Freud’s theory can be extended without being reduced to moral judgment.

What matters clinically, and existentially, is that the question of truth is no longer reducible to whether something “really happened,” as if the psyche were a courtroom. The question becomes: what has the status of reality for this person, what has been split off in order to survive, and what kind of relationship is required for what has been disavowed to become bearable without humiliation or coercion. Freud’s move toward psychical reality, in this sense, is already an ethical move, because it refuses the contempt implicit in dismissing the person’s experience as mere fabrication, and it binds the analyst to a more difficult fidelity, fidelity to the reality that is lived, even when it is not easily verified.

From psychical reality to social phenomenology

This is the point at which Thompson’s chapter takes its most consequential turn, because he argues that Laing takes Freud’s conception of psychic trauma and applies it to delusional confusion, but does so “in a more dialectical framework,” and this dialectical shift changes the moral topology of the clinical scene. Freud had emphasized fantasy as a way the psyche avoids objectionable realities, and even when Freud attends to interpersonal deceptions, the conceptual center remains intrapsychic conflict. Laing, by contrast, asks what happens when deception is not primarily what I do to myself, but what is done to me, repeatedly, by others, and done in a way that aims not merely at my compliance but at the manipulation of my experience, and therefore my reality.

Thompson names this shift with Laing’s term “social phenomenology,” defined as an “internal critique” of how others affect, and sometimes play havoc with, my experience. The emphasis is decisive: the psyche is not simply a private theater, because the stage itself is partly built by others, and the lines one is forced to speak are sometimes the lines of another person’s denial. Laing’s dialectical dimension, as Thompson describes it, is the tormenting structure of interpersonal reality: what I think you think about me, and what you in fact think but conceal, and the way this concealment invades my capacity to know what is happening, and to trust that what is happening is nameable. When this dialectic becomes chronic, the problem is no longer only repression or wish-fulfillment; the problem becomes confusion as an existential injury.

Thompson’s formulation is stark and, if taken seriously, unsettling. Laing concluded that schizophrenia can be understood as the consequence of deceptions employed on someone who assumes he is being told the truth, and who depends on what the other tells him to be true. The language is careful. It does not romanticize psychosis. It does not reduce it to an abstract “break” from reality. It suggests that what is shattered is the person’s footing in reality, and that the shattering can be precipitated by relational conditions in which truth becomes unstable, where the person is repeatedly forced into the impossible task of sustaining a reality that is denied by those on whom he depends.

This is also where Thompson’s contrast between Freud and Laing becomes clinically useful, because it clarifies two different models of trauma that do not exclude each other but interact. Freud often conceived trauma in terms of frustration that thwarts anticipated pleasure, a model that makes sense for neurosis and for the ordinary compromises of life. Laing envisioned a different form of trauma that could account for psychotic anxiety and withdrawal: states of confusion that follow when one’s reality has been savaged, not through self-deception alone, but through being duped or deceived by another, and the loss of reality becomes more poignant precisely because it compounds frustration with disorientation. In contemporary idiom, one might reach for “gaslighting,” but Laing’s point is more radical than a popular term can hold, because it concerns the conditions under which a person is forced to betray his own perception in order to remain attached, and the way attachment can become the vehicle of unreality.

To say this is not to collapse all psychosis into family dynamics, nor to transform existential psychoanalysis into a single-cause polemic. Thompson explicitly resists simplistic causality. What he insists on, instead, is that reality is not merely a given, it is something that is sustained, confirmed, or subverted between people, and that the clinical task cannot be faithful to experience if it treats relational deception as incidental.

A distressed woman holds her head in anguish while a faded silhouette of a couple whispering looms behind her, split by visible cracks—conveying themes of psychological distress, secrecy, relational conflict, and emotional fragmentation

Mystification in therapy, a vocabulary for interpersonal deception

Thompson’s reading of Laing’s oeuvre sharpens the point further by showing that deception between persons is not a marginal theme in Laing, it is a sustained preoccupation across his most prolific decade. Thompson notes, with some irony, that The Divided Self is the only major work of Laing’s in which interpersonal deception does not play a major role, since it is oriented toward the existential experience of going mad rather than toward the social context that later becomes central. The shift is visible in Self and Others, where Laing turns toward the effect human beings have on one another in the etiology of severe psychological disturbance, and it is here that Thompson locates an important philosophical inflection: Laing’s engagement with Heidegger’s “On the Essence of Truth” and with the pre-Socratic term aletheia, truth as what emerges from concealment. Laing does not simply borrow Heidegger’s notion of truth, he twists it toward the interpersonal, emphasizing the interdependency between candor and secrecy, and thereby locating truth not as a detached property of propositions but as something that appears and recedes within conversation, within the fragile drama of what is disclosed and what is withheld.

This is where mystification becomes more than a provocative term, and becomes instead a conceptual instrument. Thompson underscores that Laing coined a vocabulary, terms such as collusion, mystification, injunction, untenable positions, and did so in order to name how ordinary interactions can distort truth so effectively that they affect each other’s reality, and therefore sanity. Thompson’s claim is not merely that Freud cared about deception and Laing cared about deception, but that Freud lacked this interpersonal vocabulary even where the problem was present, and that Laing supplies what psychoanalysis, in Thompson’s view, too often evaded: the possibility that pathology is not only a private compromise with desire, but also a response to a world in which reality is negotiated through power, denial, and coercive “care.”

Thompson’s account of Laing and Esterson’s family studies makes the clinical stakes concrete without collapsing them into accusation. In Sanity, Madness and the Family, Laing and Esterson demonstrate families in which massive forms of trickery and mystification are employed against the identified patient, sometimes with chilling casualness, and Thompson recounts the case of “Maya,” where parents deny to their daughter what they have openly admitted when she is absent, a denial that functions not simply as lying but as a systematic twisting of the child’s hold on reality. Thompson is careful to note the controversy that follows, and he observes that Laing did not claim that such incidents conclusively “cause” schizophrenia, only that they were ubiquitous in the families studied, leaving readers to draw their own conclusions. He also insists that mystification is not unique to “pathological” families, because it is inherent in the hypocrisy of everyday life, and the difference is often one of degree, persistence, and consequence.

Laing’s later work extends the analysis to other relational fields, including couples. Thompson’s discussion of Interpersonal Perception is striking because it presents the book as “radical even now,” precisely insofar as it exposes how duplicity and deception can be woven into love relationships through confused communication patterns that resemble, in magnified form, what occurs in families of schizophrenics. Laing’s “politics of experience” then names the wider terrain: how others confirm or disavow my experience, how they determine what my experience is permitted to be, and how severe disturbance is not only an internal defect but can be the consequence of human deviousness, sometimes unwitting, sometimes masked as altruism. Thompson’s point, again, is not that the world is nothing but cruelty, but that truth is always vulnerable to being politicized, and that psychic life cannot be understood without acknowledging this vulnerability.

If “mystification in therapy” is to mean anything, then, it cannot mean only that patients lie, resist, or distort. It must also name the more uncomfortable possibility that therapy itself can become a site of mystification when the therapist uses interpretation to override experience, or uses technique as a way of winning, or treats the patient’s reality as raw material to be managed. Thompson’s Laing is not simply warning against bad clinicians, he is exposing a structural temptation within the therapeutic situation: the temptation to convert an encounter into an operation, and thereby to reproduce, under the banner of help, the very distortions that have injured the person’s relation to reality.

Truthfulness in psychoanalysis, not as virtue, but as condition

Thompson’s chapter culminates where it began, with ethics, though the ethics here is not an external code but the condition under which psychoanalysis remains psychoanalysis. He argues that if we hope to resolve the dilemma of living amid disappointment and betrayal, the first step is not to explain the person away but to have one’s experience of the past confirmed rather than dismissed as “pathology.” The clinical rationale is existential, because the wound is often compounded by the denial that the wound exists, and the denial becomes a second trauma, a forced estrangement from one’s own perception.

From this vantage, the ethic of truthfulness in psychoanalysis is not a moral ornament, and it is not reducible to the therapist’s sincerity. It is the scaffolding of the analytic relationship, and it binds the therapist as much as the patient. Thompson notes that therapists, in their zeal to effect change, can resort to questionable tactics and transform therapy into a contest where the clever protagonist “wins,” a perversion of the work that is especially insidious because it can masquerade as clinical effectiveness. Laing’s technique, Thompson suggests, can be reduced to a single preoccupying concern, how honestly therapists are behaving with their patients, and how honest they are capable of being, a concern he links explicitly to Freud’s “fundamental rule,” the pledge exacted from the patient to be candid about what comes to mind.

Thompson then refuses the easy fantasy that the fundamental rule is simply a compliance instruction. Freud discovered that patients are loathe to disclose, because disclosure threatens their secrets and what those secrets might reveal about themselves. Laing adds a different emphasis, that many patients have learned, through experience, that it is wrong to think or feel as they do, so that concealment is not merely defensive but historically instructed, and the person may have “forgotten” what they think and lost the sense of who they are. In that context, truthfulness is not an order one can give. It is a relationship one can slowly make possible, if and only if the therapist’s neutrality is not coldness but a form of acceptance, and if the encounter is grounded in mutual respect rather than coercion.

Thompson ends the chapter with Freud’s blunt warning, the line that is easy to quote and harder to live: “psychoanalytic treatment is founded on truthfulness,” and it is dangerous to depart from that foundation. The point is not sanctimony. It is that psychoanalysis, when it is faithful to itself, cannot proceed by lies and pretenses without betraying its own authority, because the authority at stake is not social status but the credibility of the relationship in which truth can be spoken.

For existential psychoanalysis, this returns us to the first problem, the fragility of reality. If psychotics are not only anxious but confused, then the imperative is to understand the nature of their confusion and to avoid doing or saying anything that increases it, which means that deception, whether in the family, in the culture, or in the consulting room, cannot be treated as peripheral. Thompson recounts Laing’s insistence that victims of duplicity can be devastated when truth is discovered after long concealment, because they can feel as though their reality has been taken from their grasp, leaving them lost between the world they thought was real and the world that is suddenly thrust upon them. In that light, therapy is not the imposition of a “correct” story but the slow repair of a person’s relation to reality, which is also the slow repair of a person’s capacity to trust experience without surrendering it to someone else’s authority.

A man in a suit stares at his reflection in a shattered mirror, his expression tense and searching. The broken glass distorts his face, suggesting inner conflict, identity fragmentation, and the painful journey of self-confrontation. Books behind him, including Freud’s Interpretation of Dreams, hint at psychoanalytic themes


Conclusion

Chapter 11 is not merely a comparison of Laing and Freud, and it is not a rehabilitation of Laing through Freudian credentials. It is a meditation on deception as an existential force, on trauma as what happens when reality becomes unstable, and on truthfulness in psychoanalysis as the ethical core without which technique becomes, at best, empty, and at worst, an instrument of mystification. Thompson’s contribution is to show that Laing’s work does not stand outside psychoanalysis as an ethical protest, but stands inside it as a demand for fidelity to experience, and as a warning about what happens when care becomes a vehicle for disconfirmation.

At Free Association Clinic, this question remains central to our understanding of depth psychotherapy, whether the struggle presents as anxiety, depression, relational deadlock, or the more diffuse suffering of not having one’s experience believed. If you want to learn more about our psychoanalytic therapy and existential therapy services, or about how these questions appear in the work of couples therapy, you can also contact us when you are ready for a conversation.


James Norwood, PsyD
Associate Director, New School for Existential Psychoanalysis (https://www.freeassociation.us)
Clinical Director, The Free Association Clinic for Existential Psychotherapy and Psychoanalysis (https://www.freeassociationclinic.com)
Founder/CEO, inpersontherapy.com (https://inpersontherapy.com)

References

Thompson, M. G. (2024). Essays in Existential Psychoanalysis: On the Primacy of Authenticity. Routledge.
Freud, S. (1914/1957). On the History of the Psycho-Analytic Movement (J. Strachey, Ed. & Trans.). Hogarth Press.
Freud, S. (1915/1958). Observations on Transference-Love: Further Recommendations on the Technique of Psycho-Analysis III (J. Strachey, Ed. & Trans.). Hogarth Press.
Freud, S. (1924/1961). The Loss of Reality in Neurosis and Psychosis (J. Strachey, Ed. & Trans.). Hogarth Press.
Heidegger, M. (1977). On the Essence of Truth. In Basic Writings (D. F. Krell, Ed.). Harper & Row.
Laing, R. D. (1960). The Divided Self. Pantheon Books.
Laing, R. D. (1969). Self and Others (2nd rev. ed.). Tavistock Publications.
Laing, R. D., Phillipson, H., & Lee, A. R. (1966). Interpersonal Perception: A Theory and a Method of Research. Tavistock Publications.
Laing, R. D., & Esterson, A. (1964/1971). Sanity, Madness, and the Family: Families of Schizophrenics (2nd ed.). Basic Books.
Laing, R. D. (1967). The Politics of Experience and the Bird of Paradise. Penguin.

Freedom and Responsibility in Existential Psychoanalysis: Sartre’s Influence on Clinical Practice

Freedom and Responsibility in Existential Psychoanalysis:
Sartre’s Influence on Clinical Practice

A Reflection on Michael Guy Thompson’s
Essays in Existential Psychoanalysis

The relationship between psychoanalysis and existentialism has long been marked by tension. Psychoanalysis, particularly in its Freudian form, delves into the unconscious, focusing on hidden drives and repressed desires that shape behavior. In contrast, existentialism centers on consciousness, freedom, and personal responsibility. As Michael Guy Thompson (2016) highlights in Essays in Existential Psychoanalysis, existential psychoanalysis diverges from traditional psychoanalysis by emphasizing the individual’s conscious engagement with life and their ability to choose. This philosophical divide has created an ongoing dialogue between the two disciplines, but it has also led to misunderstandings.

Sartre, perhaps more than any other existential philosopher, has had a complex relationship with psychoanalysis. While his ideas have not deeply influenced clinicians in general, existential psychoanalysts have found his work crucial for rethinking the foundations of therapeutic practice. Sartre’s existential critiques, especially his thoughts on freedom and responsibility, have provided a unique perspective that informs how existential psychoanalysts understand their patients and guide therapy (Thompson, 2016).

Sartre’s Influence on Existential Psychoanalysis

Jean-Paul Sartre’s influence on existential psychoanalysis is both deep and personal. In Being and Nothingness, Sartre lays out a framework for understanding human freedom that has profoundly impacted existential psychoanalysts. Sartre believed that human beings are fundamentally free, and much of our psychological suffering stems from our refusal to confront this freedom. Unlike Freud, who emphasized unconscious drives that control behavior, Sartre focused on the choices we make and the responsibility for those choices (Thompson, 2016).

Thompson (2016) explores how Sartre distinguishes between reflective and pre-reflective consciousness, a central component of Sartre’s critique of the unconscious. Pre-reflective consciousness refers to the immediate, lived experience of our actions and feelings, where we are aware of our choices but have not yet reflected on them. Reflective consciousness, on the other hand, involves stepping back to evaluate or acknowledge these choices. For Sartre, much of human behavior operates at the pre-reflective level, meaning that individuals are aware of their actions, but may not explicitly acknowledge or examine them.

This distinction helps Sartre challenge Freud’s notion of the unconscious. Freud posited that repressed, unconscious forces drive much of our behavior without our awareness. In contrast, Sartre argued that people are always aware—at least pre-reflectively—of their choices and actions. According to Sartre, what Freud called the unconscious is not truly unconscious; rather, it consists of choices or actions that we avoid acknowledging in order to evade responsibility. Sartre’s concept of bad faith describes this avoidance, where individuals deceive themselves to escape the weight of their freedom and responsibility (Thompson, 2016).

Freedom and Responsibility in Therapy

Sartre’s concept of freedom is central to existential psychoanalysis. According to Sartre, we are “condemned to be free,” meaning that we are constantly making choices, whether we like it or not. This freedom, however, comes with responsibility—a responsibility that many people try to evade. In Essays in Existential Psychoanalysis, Thompson (2016) explores how Sartre’s understanding of freedom challenges traditional psychoanalytic approaches, which often see patients as victims of unconscious forces. Instead, existential psychoanalysts, drawing on Sartre, focus on helping patients recognize their freedom, even when that freedom comes with existential anxiety.

While Sartre believed that individuals must confront their tendency to avoid responsibility through bad faith, he did not specifically advocate for therapy as the primary means to achieve this. Instead, Sartre saw the recognition of one’s freedom as a philosophical and existential challenge. Therapy, from an existential perspective, can help patients engage with this task, but its role is to support patients in understanding their choices rather than offering solutions (Thompson, 2016).

The Influence of R.D. Laing on Existential Psychoanalysis

One of the most significant figures to integrate Sartre’s ideas into clinical practice was R.D. Laing, a Scottish psychiatrist whose work on schizophrenia revolutionized the field in the 1960s and 1970s. Laing viewed mental illness not simply as a biological disorder, but as a reflection of an individual’s struggle with their own freedom. According to Thompson (2016), Laing’s The Divided Self can be seen as an integration of Sartre’s existential psychoanalysis with object relations theory.

Laing’s approach marked a departure from traditional psychoanalysis, as he emphasized understanding the subjective experience of those with mental illness. Like Sartre, Laing believed that even individuals experiencing extreme psychological distress must be understood in the context of their relationships and choices. His work serves as an example of how Sartre’s existential philosophy can be applied in a therapeutic setting, encouraging clinicians to focus on the patient’s experience of freedom and responsibility (Thompson, 2016).

Sartre’s Critique of Freud’s Unconscious

A key aspect of Sartre’s critique of Freud’s theory of the unconscious lies in his rejection of the idea that there are multiple agencies, such as the id, ego, and superego, controlling human behavior. Sartre challenged the notion that anything other than the individual is responsible for their actions. He argued that positing separate psychic agencies implies that behavior is caused by something other than the person themselves. Sartre believed that people are fully responsible for their choices, even when they avoid acknowledging them.

Thompson (2016) explains that Sartre’s distinction between reflective and pre-reflective consciousness is crucial to understanding this critique. Pre-reflective consciousness refers to our immediate awareness of choices and actions, even if we don’t explicitly reflect on them. Sartre argued that what Freud referred to as the unconscious is not a separate, hidden force, but rather choices and actions that we fail to acknowledge because doing so would confront us with our freedom and responsibility. Sartre’s concept of bad faith—the idea that individuals deceive themselves to avoid facing the truth of their freedom—underscores his rejection of the idea that any unconscious agency drives human behavior (Thompson, 2016).

This critique ultimately reframes what Freud called the unconscious. Rather than assuming that human beings are driven by repressed, unknown desires, Sartre argues that we are aware of our motivations on some level but choose to ignore or suppress them through bad faith. For Sartre, psychoanalysis must engage with these pre-reflective choices, helping individuals recognize and take responsibility for their actions (Thompson, 2016).

Freedom and Change in the Therapeutic Process

Sartre’s existential psychoanalysis provides a powerful framework for understanding change in therapy. As Thompson (2016) notes, Sartre’s focus on freedom encourages patients to confront how they avoid responsibility in their lives. However, Sartre did not suggest that therapy alone can help individuals live more authentically. The role of therapy in existential psychoanalysis is to guide patients toward recognizing their freedom and taking responsibility for their actions, rather than trying to unearth hidden drives or uncover a “true self,” a concept that Sartre rejected. For Sartre, we constantly create and recreate ourselves through our actions; there is no fixed essence or predetermined “self” to be discovered (Thompson, 2016).


Conclusion

The relationship between existentialism and psychoanalysis has not always been smooth, but thinkers like Jean-Paul Sartre and R.D. Laing have shown how these two fields can come together to offer a deeper understanding of the human condition. Sartre’s emphasis on freedom and responsibility provides existential psychoanalysts with a framework for helping patients confront the choices they make and the responsibility they carry for their lives. At the Free Association Clinic for Existential Psychoanalysis, we draw from these rich philosophical traditions to guide our therapeutic practice, helping patients explore their freedom and engage more authentically with their lives.


James Norwood, PsyD

Associate Director, New School for Existential Psychoanalysis
Clinical Director, The Free Association Clinic for Existential Psychotherapy and Psychoanalysis
Founder/CEO, inpersontherapy.com

Heidegger, M. (1962). Being and Time (J. Macquarrie & E. Robinson, Trans.). Harper & Row.
Husserl, E. (1982). Ideas Pertaining to a Pure Phenomenology and to a Phenomenological Philosophy (F. Kersten, Trans.). Martinus Nijhoff.
Kierkegaard, S. (1980). The Sickness Unto Death (H. V. Hong & E. H. Hong, Trans.). Princeton University Press. (Original work published 1849)
Laing, R. D. (1965). The Divided Self: An Existential Study in Sanity and Madness. Penguin Books.
Nietzsche, F. (1966). Beyond Good and Evil (W. Kaufmann, Trans.). Vintage Books.
Sartre, J.-P. (1956). Being and Nothingness (H. Barnes, Trans.). Washington Square Press.
Thompson, M. G. (2016). Essays in Existential Psychoanalysis. Routledge.