Psychoanalysis was developed by Sigmund Freud at the end of the 19th century and has been practiced now for well over a hundred years despite many determined efforts, to borrow from Winston Churchill’s advice regarding communism, “to strangle the baby in its crib.” Initially it was conceived of a patient lying on a couch and telling his inner thoughts to an analyst who sits behind him six days a week. The patient enters into a state of relaxation and wakeful dreaming which allow unconscious conflicts to emerge with the greatest clarity. Monetary and time constraints now unfortunately limit psychoanalysis to four and three times a week. It is important to understand that additional sessions are not just “a little more,” but actually allow a patient to engage in the process at a far more powerful level of experience.
Over time, psychoanalysts have felt forced to introduce changes to the analytic structure so as to accommodate large numbers of patients resulting in what is known as psychoanalytic psychotherapy. The principal difference is that the patient usually sits up and is seen once or twice a week. The superficial advantages of such an arrangement are clear: psychotherapy costs less in time and money, the patient retains much greater sense of autonomy, and the patient feels, at least on the surface, somewhat relieved. The self-help movement, the rejection of authority, the rise of cognitive schemas of mental life, CBT, DBT, medication, meditation, mindfulness and insurance company efforts to curtail mental health costs are all factors that have contributed to an effort to speed up treatment and to limit the contact between patient and doctor. Many of these newer treatments have even been promoted as alternative or superior to psychoanalytic work.
The difficulty remains that the emotional problems people demonstrate in their lives, their repetitive, self-destructive and damaging behaviors, occur for reasons that frequently lie beyond the reach of such measures. Mental conflict is embedded in our unconscious minds, arises in early childhood and is always finding new editions in current life. The revelations uncovered in analytic work are unparalleled in fully demonstrating these unconscious paradigms which must be addressed for the patient to really outgrow.
Of course, it is important, even as I make the case for psychoanalysis if not intensive psychotherapy, to acknowledge that I am a psychoanalyst who makes my living doing this special kind of work. As an acerbic and brilliant patient of mine once put it: “Never ask a barber if you need a haircut.” But it is not always true that declarations are guided principally by self-interest. Becoming a psychoanalyst takes, at a minimum, ten years of training and clinical work. From an efficiency monetary perspective this is a nightmare! But the capacity to offer definitive relief from neurotic misery and the satisfaction of doing so simply cannot be obtained elsewhere.