Can the Changes I Make in Therapy Actually Last?
- Jamie Cromer Grue
- 12 hours ago
- 9 min read
How Psychoanalytic Therapy Builds the Inner Capacities for Lasting Change and Continued Growth
Have you ever felt different in therapy, clearer, stronger, more hopeful, only to wonder whether that change would survive outside the room?
What happens when the next conflict arises?
When an old relationship pattern reappears?
When grief, illness, transition, or uncertainty unsettles the life you have worked to build?
These are important questions because feeling better during therapy is not the same as creating change that can be carried forward.
No therapy can protect us from future suffering. But psychoanalytic therapy offers something more enduring than a temporary solution to a particular problem. It can help us develop a different relationship with our minds, our emotions, our histories, other people, and the parts of ourselves we do not yet fully understand.
The goal is not to emerge permanently unshaken.
It is to become more able to understand what is happening, tolerate what we feel, use relationships well, and respond with greater freedom when life inevitably changes again.
Lasting Change Is More Than Symptom Relief
Symptoms matter.
Relief from anxiety, depression, compulsive behavior, relational conflict, or emotional distress can make life feel possible again.
But psychoanalytic therapy also asks:
What repeatedly gives rise to this suffering?
What meanings or expectations shape how I experience myself and others?
What feelings have been difficult to acknowledge?
What do my defenses protect me from?
What conflicts keep returning in different forms?
What happens when I need, depend upon, disappoint, love, envy, resent, or separate from another person?
What possibilities have not felt available to me?
Rather than addressing only the visible symptom, psychoanalytic therapy explores the psychological organization beneath it.
Lasting change may include:
Greater freedom from rigid defenses.
A wider capacity to experience and tolerate emotion.
More integrated views of ourselves and other people.
Greater flexibility within relationships.
Increased awareness of unconscious expectations and conflicts.
A more stable and compassionate sense of self.
A greater ability to pause and reflect rather than automatically repeat.
An increased capacity to make choices that feel authentic.
These changes are not always dramatic or immediately visible.
They may first appear in moments that once would have unfolded automatically: tolerating another person’s disappointment, recognizing anger before it becomes withdrawal, asking for help, remaining present during conflict, setting a boundary without immediately reversing it, or allowing ourselves to want something we once believed we could not have.
What Does the Research Show?
Psychoanalytic and psychodynamic therapies are sometimes misrepresented as having little scientific support because they are less easily reduced to a short, standardized protocol.
Research tells a more complex story.
Jonathan Shedler’s widely cited review found that psychodynamic therapy produced effects comparable to other treatments promoted as evidence-based. He also highlighted studies in which gains were maintained and, in some cases, continued to increase after treatment ended.
This pattern has sometimes been described as a sleeper effect: the full benefit of treatment may not be visible at termination because the capacities developed in therapy continue operating afterward.
The Tavistock Adult Depression Study offers an important example. Among people with longstanding, treatment-resistant depression, differences between long-term psychoanalytic psychotherapy plus usual treatment and usual treatment alone were modest at the end of therapy. More meaningful differences emerged during later follow-up.
The researchers concluded that assessments made only at termination or shortly afterward may miss delayed therapeutic benefits.
This does not mean that every person continues improving after psychoanalytic therapy or that other therapies cannot create durable change. Cognitive behavioral therapy and other evidence-based treatments can be effective, and long-term outcomes vary according to the individual, condition, treatment, and study.
The more supportable distinction is that psychoanalytic therapy deliberately aims beyond symptom management. It seeks to influence the deeper emotional, relational, and defensive patterns through which a person experiences life.
The Relationship Is Part of the Treatment
Psychoanalytic therapy is not simply a process of receiving interpretations from an expert.
It is a relationship.
We do not enter that relationship as blank slates. We bring expectations formed through earlier experiences of closeness, dependence, authority, conflict, disappointment, recognition, and repair.
We may expect the therapist to judge us, abandon us, control us, misunderstand us, need us, rescue us, or eventually become disappointed in us.
These expectations do not remain outside the room. They begin to shape the therapeutic relationship itself.
This is known as transference: feelings, expectations, and relational patterns developed elsewhere become alive within the treatment.
The therapist also has emotional responses. These responses, known as countertransference, can offer valuable information when the therapist has the training and reflective capacity to notice and understand them.
The goal is not to eliminate these dynamics. It is to make them available for thought.
A person who expects conflict to lead to abandonment may gradually experience disagreement followed by continued presence.
Someone who hides need may discover what happens when dependency can be acknowledged without humiliation.
Someone who has always cared for others may notice the discomfort of receiving sustained attention.
Someone who anticipates criticism may begin to distinguish between being thoughtfully challenged and being shamed.
The relationship becomes more than a place to discuss change.
It becomes one of the places where change is experienced.
We Hear Ourselves Differently When Someone Is Listening
Speaking aloud in the presence of another person is different from thinking privately.
We may hear the words we repeatedly use. We may notice where our voice changes, where we become vague, where we rush, where we intellectualize, or where we suddenly feel sleepy or blank.
We may become aware of what we say easily, and what we continually leave out.
The analyst listens not only to the content of the story but also to its emotional movement, contradictions, repetitions, omissions, metaphors, and changes in tone. The analyst may hear an expectation or conflict that has become so familiar to us that it feels like an unquestioned truth.
Over time, we begin to internalize this way of listening.
The questions, observations, interpretations, and curiosity developed within the analytic relationship gradually become part of how we understand ourselves.
Insight Is Important, but It Is Not the Whole of Change
We can understand a pattern intellectually and still repeat it.
We may know that we choose emotionally unavailable partners and remain drawn to them.
We may understand why boundaries evoke guilt and still find ourselves saying yes.
We may recognize that achievement has become tied to worth and still be unable to rest.
This does not mean the insight was false. It means the pattern exists at more than one level.
Emotional learning develops through repetition.
We recognize the pattern after it happens. Later, we notice it while it is happening. Eventually, we may become able to pause before automatically repeating it.
Then stress, loss, or transition may activate the old response again.
This process is not a straight line.
Awareness → experience → resistance → reflection → another choice
Then perhaps:
Another choice → new feelings → renewed resistance → deeper understanding → another experiment
Psychoanalysis refers to this repeated return as working through.
Working through allows insight to become emotional, relational, and increasingly embodied. We revisit familiar territory, but ideally with greater awareness, more compassion, and an expanding capacity to respond differently.
Why Change May Continue After Therapy Ends
One of the most meaningful possibilities in psychoanalytic therapy is that growth may not stop when treatment ends.
During therapy, we gradually learn to listen differently.
We become more able to recognize patterns, tolerate uncertainty, hold conflicting feelings, question familiar explanations, and remain curious about experiences that were once too painful or threatening to approach.
The analyst’s way of listening gradually contributes to an enduring self-analytic capacity: the ability to reflect on our own minds without expecting complete certainty or immediate resolution.
We may become more able to ask:
What is happening inside me?
Why might this feel so familiar?
What am I expecting from this person?
What feeling is difficult to acknowledge?
What am I protecting?
What am I repeating?
What else might be true?
What choice is available now?
The analytic relationship eventually ends, but the capacities developed within it may continue.
The person does not leave therapy with every conflict resolved or every part of herself completely known.
She leaves with a different relationship to what remains unknown.
What Helps, or Hinders, Lasting Change?
No form of therapy guarantees change.
Many things influence the outcome: the therapist’s training and capacity, the relationship between therapist and patient, the time available for the work, the patient’s life circumstances, and the conflicts or protections that make change feel dangerous.
Training matters.
Psychoanalytic therapists have specialized education in psychoanalytic theory and technique beyond their original professional preparation. Psychoanalysts undertake an even more intensive course of study that typically includes several years of seminars, extensive supervised analytic work, and their own personal analysis.
Personal analysis is not simply an academic requirement. To accompany another person into difficult emotional territory, an analyst needs the ability to reflect on her own responses, tolerate powerful feelings, remain curious without reacting impulsively, and recognize how her own inner life enters the work.
These capacities become especially important when resistance, defenses, transference, and countertransference emerge. When recognized and thoughtfully understood, these experiences can deepen the treatment. When they remain unexamined, they can contribute to misunderstandings, enactments, and impasses.
Training does not guarantee that every therapist will be effective or that every therapist and patient will be a good match.
Sometimes an impasse becomes an important part of the work. It may reveal a familiar relational expectation that can be understood and repaired within the relationship.
At other times, it may become clear that the therapist lacks the needed experience, the relationship does not feel sufficiently safe or productive, or another form of treatment would be more helpful.
Seeking another therapist is not necessarily a failure of therapy.
Sometimes it is an expression of growing self-knowledge.
Patients also arrive with understandable protections against change. A person may consciously want relief while another part of her fears dependency, exposure, disappointment, loss, or becoming different from the people she loves.
These resistances should not be used to blame the patient.
They are part of what the patient and therapist must become curious about together.
Lasting Change Does Not Mean Never Struggling Again
We remain human after therapy.
We continue to experience loss, conflict, anxiety, uncertainty, and change. Old responses may return when we are frightened, exhausted, grieving, or standing at an unfamiliar threshold.
Growth itself creates new vulnerability.
When we enter a new relationship, become a parent, change careers, set a boundary, accept a leadership role, experience success, face illness, or begin again after loss, we become beginners in a new developmental moment.
Perhaps the measure of therapy is not whether we are ever shaken again.
It is whether we become sturdier and more resourceful when the waves arrive.
Can we recognize what is happening?
Can we tolerate more of what we feel?
Can we ask for help?
Can we distinguish the present from the past?
Can we respond with greater freedom?
Sometimes this includes returning to therapy.
Going back does not erase earlier growth. It may mean recognizing when a new loss, transition, conflict, or developmental task deserves another sustained period of attention.
The purpose of therapy is not permanent self-sufficiency.
It is a deeper ability to understand ourselves, use relationships well, and recognize when we need another person beside us.
Looking Through This Window
Think about a way you have changed through therapy, a meaningful relationship, or sustained self-reflection.
Ask:
What first brought me to the work?
What has changed in how I understand myself?
What feeling can I tolerate now that was once difficult to approach?
What pattern do I recognize sooner?
What choice has become more available?
How have my relationships changed?
What still becomes difficult under stress?
What capacity now belongs to me?
Where might I still need support?
You do not need to prove that you are permanently changed.
Notice instead what has become more possible.
Lasting change is not the absence of struggle.
It is the growing capacity to meet life with greater awareness, flexibility, resilience, and freedom, and to continue learning from what unfolds.
Continue Exploring
What Is the Unconscious Mind, and How Does It Shape Everyday Life? Explore the hidden meanings, expectations, and protective patterns that psychoanalytic therapy helps bring into awareness.
Why Can’t I Follow Through, even When I Want to Change? Understand why resistance and ambivalence often become part of the process of meaningful change.
Can You Analyze Yourself? Discover what self-reflection can offer, and what becomes visible only within a sustained relationship.
References and Further Reading
Shedler, J. (2010). “The Efficacy of Psychodynamic Psychotherapy.” American Psychologist, 65(2), 98–109. A review of evidence supporting psychodynamic therapy, including findings that therapeutic gains may be maintained and, in some studies, continue to develop after treatment ends.
Fonagy, P., Rost, F., Carlyle, J. A., et al. (2015). “Pragmatic Randomized Controlled Trial of Long-Term Psychoanalytic Psychotherapy for Treatment-Resistant Depression: The Tavistock Adult Depression Study.” World Psychiatry, 14(3), 312–321.A study of long-term psychoanalytic psychotherapy in which some of the most meaningful differences became apparent during the follow-up period rather than immediately when treatment ended.
American Psychoanalytic Association. “Standards and Principles for Psychoanalytic Education.” Professional standards describing personal analysis, formal study, supervised analytic work, and continuing professional development as central components of psychoanalytic education.
International Psychoanalytical Association. “Requirements for Qualification and Admission to Membership.” International standards addressing personal analysis, supervised clinical work, theoretical education, and qualification as a psychoanalyst.
About Jamie Cromer Grue
Jamie Cromer Grue (Jamie Cromer, LCSW, ACSW, FABP) is a licensed clinical social worker, board-certified psychoanalyst, and Training and Supervising Analyst. She is also a Certified Ayurvedic lifestyle instructor and the founder of Windows to Wisdom.
Jamie brings more than 30 years of clinical experience to an integrated approach drawing from psychoanalysis, holistic wellness, contemplative practice, creativity, and the wisdom of everyday life. Through Windows to Wisdom, she makes complex ideas about the inner life more accessible, inviting people to listen more deeply to themselves, recognize meaningful patterns, and develop greater self-awareness, resilience, and freedom.
Jamie’s psychoanalytic knowledge and clinical experience inform the public education offered through Windows to Wisdom. Windows to Wisdom is separate from her clinical practice; reading these materials or participating in its programs does not constitute therapy or establish a therapist–patient relationship.
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