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“Psychotherapy is a planned and disciplined way of increasing self-awareness through a relationship.”
- Nancy McWilliams, PhD

Psychoanalytic therapy exposes the unconscious conflicts that fuel your symptoms—so you can resolve them, not just manage them.

If you find yourself trapped in the same emotional struggles again and again—despite your conscious efforts to change—you may be grappling with unconscious patterns that originated long ago. These patterns often operate outside awareness, shaping your relationships, emotions, and choices in ways that leave you feeling stuck or unfulfilled. Quick fixes or surface-level solutions may provide temporary relief, but without understanding the deeper roots of these struggles, real change remains elusive.

Psychoanalytic therapy offers a different path—one that helps you recognize and resolve the hidden conflicts that drive these repetitive cycles. Through our work together, you can expect not just symptom relief, but fundamental shifts in how you experience yourself and relate to others. Many people find that as unconscious fears and defenses come into awareness, they gain greater freedom to make choices aligned with their true desires, not past conditioning.

Symptoms like anxiety, depression, or unsatisfying relationships often stem from buried emotional experiences. By exploring these in therapy, you can develop a deeper sense of self, more authentic connections with others, and a renewed capacity to face life’s challenges with resilience. While medication may be useful in some cases, the focus of our work is on building lasting internal strengths—so you rely less on external fixes over time.

The goal is not just to feel better temporarily, but to change in ways that endure. The insights you gain will continue to unfold long after therapy ends, leading to a richer, more meaningful life.

  • Psychoanalytic therapy is not about "fixing" surface problems—it’s about discovering why those problems persist. Together, we’ll explore the unconscious patterns that shape your life: the recurring conflicts, emotional blind spots, and self-defeating habits that linger because they once made sense. These patterns often originate in earlier life experiences but operate invisibly, influencing your relationships, choices, and even how you see yourself.

    Meeting once or twice weekly, we’ll create a space where these hidden dynamics can emerge—through your reactions to me, your dreams, the stories you tell, and the feelings that arise between us. As they come into awareness, what once felt inevitable becomes something you can actually change.

    This work is distinct from symptom-focused therapies. While relief from anxiety, depression, or relationship struggles is often a welcome outcome, the deeper goal is transformation: greater emotional freedom, more authentic relationships, and a clearer sense of who you are beyond old defenses. Many patients find the insights they gain continue to unfold long after therapy ends.

    Who Benefits Most?

    Psychoanalytic therapy is particularly valuable for those who:

    • Notice the same struggles repeating across relationships, jobs, or life stages

    • Feel haunted by a sense of "stuckness" or emptiness, even when outwardly successful

    • Want to understand themselves more deeply than "coping strategies" allow

    • Sense their symptoms (anxiety, depression, etc.) are trying to communicate something—but don’t know what

    It’s for people ready to look beneath the surface, not just manage distress. If this resonates, you might find—as many do—that what began as "therapy" becomes a pivotal chapter in your life story.

  • Psychoanalysis isn’t just therapy—it’s a living exploration of who you are beneath the surface. By meeting multiple times weekly (typically 3-5 sessions), we create an environment where unconscious patterns—the ones that shape your emotions, relationships, and very sense of self—can finally be seen, understood, and reshaped.

    Unlike shorter-term therapies, this intensity allows what’s hidden to emerge in the room: in your reactions to me, in your dreams, in the spaces between words. The process can feel surprising, even unsettling at times—because real change often does. But over time, what felt like rigid parts of your personality become flexible. What felt like "just the way I am" reveals itself as a relic of old adaptations.

    Psychoanalysis is for those who:

    • Have tried other treatments but still feel haunted by the same struggles

    • Sense their symptoms (depression, anxiety, emptiness) are trying to tell them something

    • Want more than crisis management—a fundamental shift in how they experience life

    • Are curious about their own mind, even when that curiosity feels daunting

    The rewards extend far beyond symptom relief. Many patients describe feeling more alive in their relationships, more creative in their work, and more at home in their own skin—changes that persist because they’re rooted in self-knowledge, not just behavior modification.

    Why Frequency Matters

    Meeting several times weekly isn’t an arbitrary requirement. It’s what allows the work to breathe:

    • Rarely does a week pass without something meaningful emerging

    • The rhythm itself becomes a tool—like turning up the magnification on a microscope

    • You’ll notice patterns that would remain invisible in less intensive therapy

    Psychoanalysis has evolved over a century because it works—not just for "fixing" problems, but for discovering who you might become without them.

  • Medication can sometimes help when symptoms are too overwhelming to engage in meaningful therapy. But pills don't solve psychological problems—they create conditions where real psychological work becomes possible. When we consider medication, we'll discuss:

    • How it might help you better access the therapeutic process

    • What it can (and can't) accomplish

    • Your concerns and questions about taking medication

    I prescribe conservatively and always in the context of our ongoing psychodynamic work. The goal is never medication for its own sake, but helping you develop the internal resources that may eventually make medication unnecessary.

    We'll monitor carefully, using the lowest effective dose for the shortest time needed, while keeping our focus on the deeper work of understanding what your symptoms mean and how they connect to your life story.

MEET DR. DE GUZMAN

“Putting your real feelings into words—and having them understood, not just heard—changes how you carry your struggles.”

As a psychiatrist and psychotherapist, I provide psychoanalytic therapy (and medication when appropriate) to help adults understand and change the unconscious patterns that perpetuate their difficulties. Treatment focuses on identifying how past experiences and relationship templates distort current functioning—not just gaining “self-awareness,' but actually altering these patterns through the therapeutic process.

FAQs

  • I offer psychoanalytic (also called psychodynamic) psychotherapy, psychoanalysis, and medication management for adults aged 18-64. My focus is on helping individuals address challenges like depression, anxiety, relationship issues, life transitions, grief, self-esteem, creative blocks, and personal or professional struggles—unlocking deeper self-understanding and lasting change. I work with people, not a checklist of symptoms or diagnoses.

  • My practice specializes in working with adults (ages 18-64) because this allows me to maintain focused expertise in the developmental challenges, life transitions, and psychological needs specific to this stage of life. While I deeply respect the value of geriatric and child/adolescent care, these populations often require specialized training and resources that fall outside my scope of practice.

  • Psychoanalytic treatments—psychotherapy or psychoanalysis—suit anyone ready to dig into long-standing patterns or pain. You might struggle with work or love, repeating self-defeating cycles not by chance but by design. Or perhaps trauma, anxiety, or depression limits your joy and freedom—issues other treatments only patched. If you’re wanting root-level change, this is for you—especially if finding stable, loving relationships feels out of reach. 

  • Psychoanalytic therapy is not about quick fixes or superficial change. It’s about understanding the deeper patterns that shape your life—often outside your awareness—so you can break free from them.

    Many people come to therapy because they feel stuck in the same emotional struggles, repeating unsatisfying relationships, or grappling with symptoms like anxiety or depression that don’t respond to willpower alone. These difficulties often trace back to unconscious conflicts—old wounds, buried fears, or forgotten experiences that continue to exert power over present choices.

    Psychoanalytic treatment helps bring these hidden forces into awareness. As you begin to recognize how the past lives on in the present, you gain freedom from its grip. Relationships become more authentic, emotions more manageable, and choices more aligned with who you truly are. Over time, the work leads to enduring change—not just relief from symptoms, but a deeper sense of vitality, purpose, and connection.

    The process isn’t always easy (real growth rarely is), but it’s profoundly rewarding. Many people discover that what felt like personal flaws were actually self-protective strategies—ones they no longer need. What emerges is a fuller, freer version of themselves.

  • Psychoanalytic/psychodynamic therapy and psychoanalysis both stem from the same foundational principles, focusing on exploring unconscious patterns, early experiences, and inner conflicts to foster self-understanding and growth. The key differences lie in their structure and intensity. Psychoanalytic therapy is typically less frequent—often once or twice a week—and may be shorter-term, tailored to address specific concerns or symptoms while still drawing on psychodynamic insights. Psychoanalysis, by contrast, is a more intensive, in-depth process, usually involving sessions 3-5 times a week over a longer period. It often includes the use of the couch and emphasizes free association to uncover deeper layers of the psyche, aiming for profound personal transformation. In my practice, I offer both, customizing the approach to your unique needs and goals.

  • Not at all. Think of psychoanalysis like air travel: the Wright Brothers’ first flights were revolutionary but crude compared to today’s jets. Similarly, contemporary psychoanalytic therapy has evolved far beyond old stereotypes. My approach is active, relational, and grounded in modern research—we work as collaborators, not caricatures. While we still explore how your past influences your present (and yes, the couch is available if helpful), the process feels more like a dynamic conversation than a one-sided monologue. No cigars, no silence—just clinically proven methods to help you understand yourself at the deepest level.

  • Nothing could be further from the truth. Contemporary psychoanalytic/psychodynamic therapy is among the most rigorously studied treatments we have—not just for symptom relief, but for creating lasting change. Research shows its benefits actually grow over time, like a psychological investment that keeps yielding returns. Why? Because while other therapies may teach coping skills, psychoanalytic therapy helps rewrite the emotional “operating system” that drives those symptoms in the first place.

    We now understand through neuroscience what Freud could only hypothesize: that making the unconscious conscious literally rewires the brain. Today’s psychodynamic practice integrates cutting-edge attachment research, trauma science, and outcome studies—but retains its genius for addressing what other therapies often miss: the hidden meanings behind symptoms, the repetitive relationship patterns, and the parts of yourself that feel “stuck” no matter how much you try to change.

    What looks like “just talking” is in fact precision work—helping you decode your mind’s own language of symptoms so real transformation can begin.

  • I see patients in-person in Pasadena, serving San Gabriel Valley and Greater Los Angeles. I also provide telehealth for patients throughout California.

  • No, I’m an out-of-network provider and don’t accept insurance, Medicare, or Medi-Cal. You’ll sign a contract agreeing to private pay, and I’ll provide a Superbill for each visit. Please check with your insurance provider for details about reimbursement.

  • At this practice, I have made the deliberate decision not to contract directly with insurance companies, as this allows me to provide the highest quality, individualized psychoanalytic care tailored specifically to your unique needs.

    By operating outside the constraints of insurance-driven models, I can offer the flexibility to design a treatment plan that honors the depth and complexity of your personal path, free from arbitrary session limits, rigid protocols, or the need for pre-approvals that often prioritize cost over care. This approach ensures that our work together remains focused on fostering meaningful, lasting transformation rather than adhering to external requirements that may not align with the intensive, exploratory nature of psychotherapy or psychoanalysis.

    My commitment is to create a therapeutic space where your emotional growth and self-understanding take precedence, allowing us to engage in the process at the pace and depth that best serves you.

    For those seeking insurance reimbursement, I’m happy to provide a detailed Superbill that you can submit to your insurance provider for potential out-of-network benefits, empowering you to access the care you deserve while navigating your coverage options.

    • Initial Consultation (80 minutes): $650  

    • One-Time & Second Opinion Consultation (110 minutes): $895

    • Psychotherapy or Follow-up (50 minutes, with or without medication management): $425 

    • To support deeper analytic work, I provide sliding-scale fees on a case-by-case basis for those committed to frequent, in-depth therapy.

  • Payments are due at the time of service. I’ll provide you a Superbill—a detailed receipt you can submit to your insurance for possible out-of-network reimbursement. Contact your insurer to confirm coverage, as reimbursement varies and isn’t guaranteed. Please note that insurance providers will not reimburse for any fees related to late cancellations, missed appointments, refills, paperwork or other administrative fees.

  • Coverage varies—ask your insurer:

    • “What are my out-of-network mental health benefits?”

    • “What's the reimbursement rate for CPT codes 90792 (initial), 90834 (psychotherapy), and 99213/99214 with add-on 90836 (psychotherapy and medication management)?”

    • “Is full or partial reimbursement guaranteed?”

    • “Does my plan require me to meet a deductible before my benefits kick-in? If so, what is the amount?”

    • “What is my out-of-pocket maximum, after which the entire bill will be covered?”

    • “What claim forms must I submit? To where and by when must these claims be sent?”

  • The first session (and often the next few) is a consultation phase, not yet therapy. It’s a chance for me to begin understanding your struggles, and for you to see how I work. We’ll explore your reasons for seeking therapy, your history, and whether my approach fits your needs. Think of it as a mutual assessment—therapy requires a strong foundation, and we need to determine if we can build one together.

  • It varies. Some people feel clear after one session; others need 3–4 meetings to decide if we’re a good fit. Deeper or long-standing issues often require more time to unpack before we can define the goals and methods of therapy. There’s no rush—this step ensures therapy (if it happens) has direction and purpose.

  • Effective therapy isn’t a one-size-fits-all solution. It requires a working alliance: a shared understanding of what we’re addressing and how. Without this, therapy risks becoming vague or superficial. The consultation phase helps us clarify:

    • The psychological roots of your difficulties (which may differ from your initial concerns).

    • What can realistically change in therapy.

    • Whether you’re willing to engage in the work required for lasting change.

    If we can’t reach this alignment, it’s ethically responsible not to proceed—because therapy without a clear foundation rarely helps.

  • This is common, especially early on. Part of my job is to help you see patterns you may not yet recognize (e.g., how unconscious conflicts or personality traits contribute to your struggles). But therapy only works if you want to change these patterns. If we can’t agree on the purpose or approach after a few sessions, I’ll refer you to a colleague who might be a better fit.

  • I ask:

    • Can I realistically help with your concerns? (Some issues require specialized care, like addiction treatment or eating disorder treatment.)

    • Are your struggles rooted in psychological patterns we can address through insight and relationship? (If your primary need is crisis support or skills training, other therapies may be more effective.)

    • Are you open to exploring your inner world, even when it’s uncomfortable?

    If the answer to these is yes, we’ll discuss next steps. If not, I’ll help you find alternatives.

  • Psychodynamic therapy isn’t a "quick fix"—it’s for people who want to understand and change the deeper roots of their suffering. If you need immediate symptom relief (e.g., for panic attacks or severe depression), we might discuss short-term strategies or referrals to supplement our work. But lasting change requires time and commitment.

  • No ethical therapist can promise results. But I can promise:

    • I won’t waste your time with platitudes or vague advice.

    • If I don’t think I can help, I’ll tell you—and refer you to someone who can.

    • The consultation phase ensures we only proceed if there’s a realistic path forward.

  • Yes, I offer medication management as part of psychotherapy, integrated into our work when it fits your needs. However, I don’t prescribe controlled medications (e.g., benzodiazepines, stimulants).

  • I don’t prescribe controlled substances or provide addiction services, despite prior experience in these areas. If this is your primary need, I’ll refer you to a local psychiatrist who specializes in those treatments.

  • Yes, I provide telehealth across California—online therapy and telepsychiatry tailored to your needs. We’ll connect via secure, HIPAA-compliant video, as long as you’re physically located within the State.

  • Book a free 15-minute phone consultation to see if we’re a fit. If we move forward, we’ll schedule an 80-minute initial session to dive into your goals and create a tailored plan.

  • Your session frequency hinges on what you’re aiming for—weekly visits for targeted growth or 3-5 times a week for deep psychoanalytic exploration. We’ll figure it out together, adjusting as your path unfolds. It’s not a quick patch, but it won’t drag on forever either.

  • I don’t typically offer split therapy (me prescribing medications for patients who have another therapist outside). My practice is primarily psychotherapy, and I offer medication management, if needed, for those undergoing psychotherapy with me.

  • If my approach isn’t right for you—say, you need couples therapy, disability evaluations, functional psychiatry, interventional psychiatry, or other major psychiatric conditions requiring further intensive treatment—I’ll refer you to a colleague who might be a better fit.

  • For life-threatening medical or psychiatric emergencies, call 911 or go to your nearest psychiatric emergency room. My practice isn’t equipped for crisis care.

  • No, I don’t offer disability evaluations, forensic evaluations, neuropsychological testing, accommodations, or service animal/emotional support animal evaluations. My focus is on psychoanalytic therapy treatment and psychiatric care.

  • Your appointment time is reserved exclusively for you. Cancellations or rescheduling require 48 hours’ notice, excluding weekends (e.g., a Monday 10 a.m. session needs notice by Thursday 10 a.m.). Otherwise, you’ll be charged the full fee. This helps maintain consistency for all patients.

  • Yes, I offer one-time, 110-minute second opinion consultations ($895). With my expertise as a consultation-liaison psychiatrist with extensive experience in evaluating patients with complex medical and psychiatric conditions, I’ll thoroughly review your current treatment, bridging medical and psychological insights. It’s a space to explore options and gain clarity—no ongoing commitment needed. This can be helpful if you:

    • Desire a different perspective on your diagnosis.

    • Are considering a change in medication or treatment.

    • Feel your current treatment is not effective.

    • Seek reassurance regarding your current treatment plan.

    • Require expertise in complex cases, particularly those involving medical comorbidities.

  • Though I’ve trained in interventional methods, I’ve chosen to specialize in psychoanalytic therapy—focusing on depth and insight over procedures like TMS or ketamine therapy.

  • No, I don’t provide integrative or functional psychiatry, which often focus on holistic or biological interventions like supplements or lab testing. Instead, I offer psychoanalytic therapy, psychoanalysis, and psychiatry—combining insight-driven therapy with psychiatric care to address unconscious patterns and emotional struggles through a modern, relational lens.

  • See my Policies page →

Get Started

Your first step begins with a no-cost, 15-minute phone call to explore if we’re a good fit. I’ll listen to your reasons for seeking treatment, discuss your goals, and answer any questions about my practice. This is a low-pressure chance to see if my integrated psychodynamic approach aligns with what you’re looking for. If it feels right, we’ll take the next step together.