Anxiety & Panic Therapy in Washington, DC

Psychoanalytic therapy treats anxiety and panic as a signal rather than a malfunction — something is being warned about, and the work is to find out what. I am a licensed clinical psychologist and board-certified psychoanalyst in Washington, DC, with over fifty years in practice. Sessions are held online by secure video.

Anxiety that will not settle takes several forms. Some people describe a low continuous hum of dread with no particular object. Some have panic attacks that arrive without warning and feel physically catastrophic. Some find their life quietly narrowing as they avoid the situations that set it off.

What these have in common is that the intensity is out of proportion to anything you can point at. That disproportion is not a flaw in your reasoning. It is the most useful piece of information in the room, because it says the alarm is being triggered by something other than the situation in front of you.

I treat anxiety and panic in weekly psychotherapy and in psychoanalysis, with patients from adolescence through old age. If you want the longer background first, I have written a complete guide to anxiety.

“The disproportion is not the problem to be corrected. It is the clue.”

How anxiety shows up

Worry that runs continuously and will not switch off
Panic attacks — racing heart, breathlessness, a sense of catastrophe
Physical symptoms with no medical cause found
Avoiding places, people or situations
Broken sleep, or waking at three in the morning
Dread that attaches itself to whatever is nearest
Irritability, and difficulty concentrating

The problem

When you know the fear is out of proportion and it makes no difference

Almost everyone with persistent anxiety already knows the fear does not match the facts. Knowing it changes very little, which is the part people find most demoralising — as though reason ought to work and their reason specifically has failed.

It has not failed. Anxiety is generated below the level where argument operates. Freud’s most useful contribution here was to describe anxiety as a signal: an alarm the mind raises when something forbidden, frightening or long-buried starts moving toward awareness. The alarm is doing exactly what it was built to do. It is simply not telling you what it is about.

That is why coping strategies help and rarely finish the job. Breathing exercises, avoidance, a drink, a benzodiazepine — each quietens the alarm without addressing what set it off, so the alarm keeps returning, frequently in a new form once the old route is blocked.

The method

How psychoanalytic therapy treats anxiety and panic

We work backwards from the anxiety to what it is signalling. You talk freely; I listen for what appears just before the anxiety spikes, and for what reliably goes unmentioned. Over regular sessions the connection tends to become visible — the panic that always follows a certain kind of conversation, the dread that arrives on the way to something you thought you wanted.

What is usually found underneath is a conflict rather than a danger: anger toward someone you also love, a wish you regard as unacceptable, an old fear of being left. Once that becomes speakable, the alarm has less work to do. The relief is not from the anxiety being managed but from the signal no longer needing to be sent.

This is the same method used in psychoanalysis, applied at whatever frequency the difficulty needs. Most people begin with weekly psychotherapy.

Which treatment fits

Which treatment fits anxiety

Anxiety is treated with the same method at different intensities. We decide together in the free consultation, and revisit it honestly if the treatment is not moving.

Psychoanalytic psychotherapy

Once or twice a week at a fixed time. Where most people begin, and enough for a great many difficulties.

Psychoanalysis

Three to five sessions a week. The more thorough instrument, for difficulties that have returned after previous treatment.

Couples therapy

Ninety minutes with both people present, when the trouble lives between you rather than inside one of you.

Expected results

What treatment for anxiety can and cannot promise

No honest clinician can put a date on this. What I can describe is what tends to change, and roughly in what order.

The volume drops

Sleep and baseline tension are usually the first things to shift, frequently within the first months.

Panic becomes legible

Attacks that seemed to come from nowhere acquire a history, and a trigger you can see coming.

Avoidance narrows less

Life stops contracting around the places anxiety has claimed.

Relief that holds

Because the conflict has been addressed rather than the alarm silenced, the symptom is less likely to reappear elsewhere.

An honest caveat: if your anxiety is severe enough that you cannot work, sleep, or leave the house, medication may be needed alongside therapy to make the work possible — I will say so and help you arrange a psychiatric consultation. And if panic symptoms are new, get them checked medically first; chest pain and breathlessness deserve a physical examination before they are treated as anxiety.

Your therapist

About Dr. John J. Hartman

Dr. John J. Hartman, licensed psychologist offering online therapy for anxiety and panic in Washington, DC

I have practiced psychotherapy and psychoanalysis for over fifty years, and have spent much of that time teaching it — at UCLA, Michigan, and the University of South Florida, where I am currently Adjunct Professor of Psychiatry. As a Training and Supervising Psychoanalyst at the Florida Psychoanalytic Center, I am one of the analysts responsible for training other analysts.

A.B. Harvard College, magna cum laude with highest honors, Social Relations
Ph.D. University of Michigan, Clinical Psychology
Certificate Michigan Psychoanalytic Institute
FABP Board-certified psychoanalyst, American Board of Psychoanalysis
Training & Supervising Analyst Florida Psychoanalytic Center
Licensed Washington, DC (PSY200001229) · Florida · Michigan
PsyPact Telehealth authorized in participating PSYPACT jurisdictions, including Maryland and Virginia

Full credentials and appointments · scholarship and publications

Fees

What treatment costs

Individual sessions are $325 for 50 minutes; couples sessions are $475 for 90 minutes. The first 15-minute consultation is free and carries no obligation, and a sliding scale is available — ask whether you may be eligible.

Payment by cash, check, Venmo, Zelle, or wire. I do not bill insurance, but if your plan covers out-of-network mental health care you may be able to submit my bills to your insurer for reimbursement. Office hours are Monday to Friday, 10:00 am to 5:00 pm, by arrangement. Full fees and insurance details.

Common questions

Questions about therapy for anxiety and panic

What kind of therapy is best for anxiety?

It depends on what the anxiety is doing. Cognitive behavioural therapy is structured, time-limited and effective for many people, particularly for a specific phobia or a recent onset. Psychoanalytic therapy is the better instrument when anxiety is long-standing, has returned after previous treatment, or keeps changing form once one symptom is removed.

Can therapy stop panic attacks?

Frequently, yes — though not by talking you out of them. Panic tends to ease when the conflict producing the alarm becomes speakable, and in my experience the attacks lose their unpredictability first: they become connected to something, and something connected is far less frightening than something arbitrary.

Do I have to take medication?

Not necessarily. Many people are treated for anxiety without it. Where anxiety is severe enough to prevent sleep, work or leaving the house, medication can make therapy possible — I do not prescribe, but I will tell you plainly if I think a psychiatric consultation is warranted.

Can I see you if I do not live in Washington, DC?

Yes. All sessions are online by secure video. I am licensed in Washington, DC, Florida and Michigan, and through PsyPact I can treat residents of participating PSYPACT jurisdictions, including Maryland and Virginia.

Find out what the anxiety is about.

The first 15-minute consultation is free and carries no obligation. Online sessions only, for residents of Washington, DC, Florida and Michigan, and — through PsyPact — participating PSYPACT jurisdictions including Maryland and Virginia.

Call (813) 787-2048 Prefer to write first? Email Dr. Hartman

Online Therapy for Anxiety and Panic in Washington, DC