Health News

It's Ba-a-ack! Psychoanalysis Returns From the Near-Dead

Dec. 19, 2000 -- All across the globe, more and more men, women, and children are lying on couches and talking until they're blue in the face, but not in the head.

This is why the overall mood was so upbeat at a recent meeting of the American Psychoanalytic Association in New York City.

Psychoanalysis is based on the observation that people are often unaware of the many factors that make up their personal emotions and behavior. These unconscious factors may create unhappiness, troubling personality traits, difficulties in work or in relationships, or disturbances in mood and self-esteem. Typically, a patient comes to therapy four or five times a week, lies on a couch, and attempts to say everything that comes to mind. These conditions permit the emergence of aspects of the mind that are not normally accessible. Sigmund Freud (1856-1939) is considered the father of psychoanalysis.

The approach fell from grace about 10 years ago due in large part to cost-cutting efforts by managed care companies and the availability of Prozac and other drugs for emotional disorders.

Until 1996, the number of patients in psychoanalysis declined by 1% per year, but "my impression, from anecdotal data, is that it's going back up," says Leon Hoffman, MD, a New York City-based child psychoanalyst and chair of the American Psychoanalytic Association's committee on public information.

New York City psychoanalyst Arnold David Richards, MD, agrees.

"There are more people practicing psychoanalysis than ever before, and there are probably more patients," says Richards, editor of the Journal of the American Psychoanalytic Association. "For many years, there was just a small group that practiced psychoanalysis, but now, other mental health professionals, such as social workers and psychologists, can receive special training in the discipline ... and there are also more analytic institutes doing this type of training than ever before."

Ten years ago, he says, fewer candidates were applying to become analysts, institutes were going broke, and psychoanalysts had lost their power in medical school psychiatry departments.

Fueling this apparent resurgence, Richards says, is a growing sense that "a pill can't change a person's life or change the way a person deals with complicated personal and interpersonal problems.

"And training-wise," he adds, "doctors are realizing that learning which pill to prescribe isn't that helpful, because after you write up the prescription, what do you do for the next 40 minutes?"

To keep up with changing times, psychoanalysts are also finding new markets for their trade. For example, some analysts treat entire corporations, with the intention of helping them unlock their profit-making potential. Others are honing their craft in nursery schools by helping teachers and parents realize how certain behaviors may mask psychological patterns or problems.

That's not to say the road ahead is completely clear. Two hurdles that remain are time and money. To address the problem of money, many analytic institutes now adjust fees on a sliding scale to make therapy affordable to all.