The awareness of emotion and its subsequent regulation is an essential part of psychopathology and psychotherapy. A body of evidence indicates that the anterior cingulate cortex (ACC) plays a key role in accessing and regulating emotion and thus participates both in the conscious awareness and the repression of emotion. Research is examined drawing a distinction between psychopathologies with excessive affect, which exhibit hyperactivity in ACC, and psychopathologies with flat affect, which exhibit a hypoactivity in the rostral ACC. This distinction may support therapeutic interventions that target the up- or down-regulation of emotion dependent on clinical disorder. Specific focus is made to psychoanalytic therapy, being built upon the tenet of accessing repressed emotions, for which the ACC appears functionally significant. The research reviewed provides insight into how the ACC may be a primary region in the suppression and repression of emotion. Suggestions for how the ACC may be activated in different types of psychotherapy are also made.