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 recommendation regarding communism, “to strangle the baby in its crib.” Initially, Freud conceptualized a patient lying on a couch and telling his inner thoughts to an analyst who sits behind him listening six days a week. The patient enters into a state of relaxation akin to wakeful dreaming which allows unconscious conflicts to emerge with the greatest clarity.
Over time, psychoanalysts have felt forced to introduce changes to the analytic structure in an effort to accommodate large numbers of patients and respond to pressure to reduce the expense of time and money resulting in what is known as psychoanalytic psychotherapy. The principal differences are that the patient usually sits up and is seen twice a week. The advantages of such an arrangement are clear: psychotherapy is more available and less expensive, the patient may retain a greater sense of autonomy while feeling somewhat similarly relieved.
For some patients such contact can be sufficient to produce dramatic and effective results. However, there are individuals whose repetitive self-destructive behaviors and low self-esteem have deep roots lying beyond the reach of psychotherapy. We know that mental conflict arises in the crucial relationships of early life and, despite the pain caused, often it finds or creates new editions in current life. The revelations uncovered in psychoanalytic work are unparalleled in fully demonstrating these unconscious sources and their problematic trends. These conflicts emerge in the relationship with the analyst and it is through the analytic encounter that the patient becomes capable of really creating satisfying new relationships and a new future for himself.
Psychoanalysts advocate for more sessions per week because the experience of one session following directly on another is what allows the patient to most fully engage in the analytic relationship. We live only once and, cumbersome or no, psychoanalysis offers definitive relief from neurotic misery and sadness that simply cannot be obtained elsewhere.