The second distinguishing characteristic of psychoanalytic therapy, after its rooting of the symptoms of emotional distress in the history of our personal lives, is that it considers the human mind as a place of conflicts between different wishes and drives, and it treats the symptoms of emotional suffering as expressions of these underlying conflicts.

Life all the time presents us with painful choices and dilemmas. For instance, we often feel we should behave in a caring and considerate way towards people whose behaviour may be hurting or injuring or confining us.

To return to our previous example, a man might feel under an obligation to care for his ailing mother, even if he has himself never received much genuine love from her. He might spend years looking after a difficult, selfish woman for whom he feels little real affection. And the price he may pay for this is having to put on hold the development of relations that are important to his own long-term wellbeing.

In dilemmas like this, which arise in one form or another all the time in life, discovering just where is the correct balance between doing our duty to a parent, or a partner, or a child, and fulfilling our duty to ourselves, can be very difficult.

The emotional conflicts produced by this kind of problem are not trivial; often they make people anxious and depressed, and they can cause physical illnesses in addition.

Freud was very skilled at tracing the different ways in which we can get caught in personal conflicts like this. Such conflicts often take unexpected forms, or forms that we do not like to acknowledge. Freud said that we, in his term, defend ourselves against acknowledging many such conflicts in ourselves, because we feel ashamed of some of the impulses in ourselves that generate them, and we don’t know how to resolve them. When we defend ourselves against conflicts like this they are said to be repressed out of our conscious awareness. Freud regarded overcoming this defence as the main aim of psychotherapy. He believed the most important thing in life is to have the courage to face the truth about our real motives. All modern forms of psychotherapy that place an emphasis on being honest with ourselves show Freud’s influence.

Because it is focused on personal conflicts like these between emotions, we say psychoanalytic therapy is concerned with the dynamics of the mind. For this reason psychoanalytic therapy is often also referred to as psychodynamic therapy. These two terms mean the same thing.