Written by Insight-Online Founder, Kate Harper
“I want to be less anxious.”
“I want better relationships.”
“I want more self-esteem.”
Clients often arrive in therapy with goals like these. Therapists may even write them into treatment plans. But these are not, in fact, therapy goals. They are life goals.
This distinction matters.
As therapists, Jonathan Shedler reminds us, we do not directly create self-esteem, eliminate anxiety, or guarantee healthier relationships. We do not control life outcomes. What we can do is help clients understand the emotional, relational, behavioural, and unconscious processes shaping these struggles in the present.
When therapists confuse life goals with therapy goals, treatment can become vague, outcome-focused, and frustrating for both therapist and client. The work becomes organized around trying to “fix” experiences rather than understanding them.
Therapy goals are different.
Therapy goals involve helping clients become curious about their internal world, relational patterns, emotional experiences, bodily responses, attachment expectations, defenses, and repetitive ways of organizing experience. In psychodynamic psychotherapy, the focus is not simply symptom reduction but developing insight into the patterns that maintain suffering over time. Jonathan Shedler describes psychodynamic therapy as helping clients identify recurring themes and patterns in thoughts, feelings, relationships, and self-concept.
Anxiety Is a Life Problem : Understanding Anxiety Is a Therapy Goal
A client may say:
“I just want to stop feeling anxious.”
Of course they do. Anxiety is painful.
But therapy cannot directly promise a life without anxiety. Instead, therapy begins by getting to know the anxiety.
Questions shift from:
“How do we get rid of it?”
to:
“What is this anxiety doing?”
“When did it begin?”
“Where does it appear?”
“With whom does it intensify?”
“What situations activate it?”
“How does it show up in the body?”
“What does the client do behaviourally when anxious?”
“When is the client not anxious?”
These questions move therapy from symptom elimination toward emotional understanding.
Anxiety is rarely random. Often, it is connected to attachment expectations, fear of rejection, shame, conflict, loss, unmet needs, or unconscious relational predictions shaped by past experiences. Psychodynamic therapy explores how earlier emotional experiences continue to organize present reactions and relationships.
A therapy goal is not:
“Become anxiety-free.”
A therapy goal may be:
- Increase awareness of anxiety triggers
- Identify relational situations connected to anxiety
- Recognize bodily signals associated with activation
- Explore avoidance strategies and defensive patterns
- Understand the emotional meanings underneath anxious states
- Develop capacity to remain emotionally present without immediate avoidance
Paradoxically, clients often become less anxious when they begin understanding their anxiety instead of fighting it. This also helps the therapist let the client know there is no quick fix to stopping the anxiety they have had for years. Therapy takes time.
Better Relationships Are Life Goals: Understanding Relational Patterns Is a Therapy Goal
Clients frequently say:
“I want healthier relationships.”
Again, this is understandable. But therapy cannot guarantee relationship outcomes. Therapy cannot guarantee someone else changes, stays, chooses them, or loves them differently.
What therapy can do is help clients understand how they repeatedly participate in relationships.
This requires specificity.
Instead of staying abstract, therapists help clients explore:
- What is a healthy relationship
- Tell me about your last relationship.
- Who left whom?
- What initially attracted you to this person?
- What needs were met?
- Which needs were repeatedly unmet?
- What conflicts kept recurring?
- How did you respond when hurt?
- How did your partner respond?
- What roles did you each take on?
- What felt familiar about this relationship?
- Tell me about your parents’ relationship; what did you observe/learn from them?
Many clients unknowingly recreate familiar attachment dynamics. People often repeat emotional patterns not because they consciously choose suffering, but because the nervous system organizes around what feels emotionally known and predictable.
Therapy goals become:
- Identify recurring relational themes
- Increase awareness of attachment expectations
- Explore fears of abandonment, engulfment, criticism, or rejection
- Recognize defensive relational strategies
- Understand how past relationships shape present interactions
- Notice how these patterns emerge within the therapeutic relationship itself
Jonathan Shedler emphasizes that psychodynamic therapy focuses heavily on recurring interpersonal patterns and the therapeutic relationship because these relational experiences often become visible in real time within therapy itself.
The goal is not simply “better relationships.”
The goal is greater awareness of how one participates in relationships.
Self-Esteem Is Often Too Vague
“I want more self-esteem” sounds clear on the surface, but clinically it is often too broad to work with.
What does “low self-esteem” actually mean for this client?
Therapists must help clients move from global labels toward specific emotional experiences and identities.
Questions may include:
- What does “not feeling good enough” mean to you?
- In which parts of your life does this show up?
- Do you feel inadequate as a parent?
- As a partner?
- As an employee?
- As a daughter or son?
- What situations activate these feelings?
- Whose voice does this criticism sound like?
- What feeling exists underneath the self-criticism?
Often underneath “low self-esteem” are experiences of shame, rejection, inadequacy, grief, humiliation, invisibility, or unmet attachment needs.
Without specificity, therapy can become organized around trying to artificially “boost confidence.” But psychodynamic work aims to understand the emotional meanings beneath self-evaluations rather than simply replacing negative thoughts with positive ones.
Research on psychodynamic psychotherapy suggests that long-term change comes not merely from symptom management, but from increased self-understanding, emotional insight, and recognition of recurring patterns.
Therapy Is About Increasing Awareness, Not Manufacturing Outcomes
Therapists can influence insight, emotional awareness, relational understanding, reflective capacity, and self-observation.
We cannot directly manufacture:
- self-esteem
- secure relationships
- happiness
- confidence
- symptom-free living
But we can help clients understand the internal processes shaping these experiences.
This shift changes the therapeutic stance entirely.
The therapist becomes less focused on “fixing” and more focused on helping the client become curious about themselves.
As Jonathan Shedler notes, the goal of psychodynamic treatment is to expand freedom and choice.
When clients understand their patterns more deeply, new possibilities emerge naturally:
- greater emotional flexibility
- less automatic reactivity
- improved relational awareness
- stronger capacity for reflection
- increased ability to tolerate emotional experience
- more freedom to respond differently in life
These changes often produce the life outcomes clients initially wanted but indirectly.
Final Reflection
Life goals matter. They are often the reason clients seek therapy in the first place. Clients often think we have a direct impact on them. We need to be transparent with clients. Our job is to help the client understand who they were, who they are, and who they want to be.
But effective therapy requires translating broad life desires into observable, emotional, relational, and experiential processes that can actually be explored within the therapeutic relationship.
“Less anxiety” becomes:
“Let’s understand your anxiety.” (understanding, normalizing it, therapist being compassionate = client internalizing this and beginning to feel less anxious about their anxiety).
“Better relationships” becomes:
“Let’s understand how you experience closeness, conflict, need, and loss.”
“More self-esteem” becomes:
“Let’s understand where shame, inadequacy, and self-criticism emerge in your life.”
This is where therapy begins.
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