A New York psychoanalyst reveals her concerns about the profession in A Letter to Freud: On the Plight of Psychoanalysis
Dinah M. Mendes's letter covers several topics, but I was struck by the sections that deal with the contemporary challenges facing American analysts. She paints a rather sad picture of analysts who spend years in training, only to find a shortage of people out there who want their treatment:
She goes on to examine the increasing popularity of psychodynamic psychotherapy, approaches which draws on Freud's ideas but is much shorter (and hence cheaper) than classical psychoanalysis which involves hourly sessions, three times per week, over a period of years -At psychoanalytic training institutes it is often difficult for candidates to secure control or training cases—prospective analysands who sign on with analysts-in-training, usually at a low rate (sometimes as low as $10 a session). Here the issue is not the cost of the analysis but the low valuation of the opportunity offered—what might be regarded as the gift of self-knowledge.The gratifications of instantaneous communication—texting, Facebook, and blogging—are immediate and obvious and erode the value of the slow and arduous route to communication and understanding offered by psychoanalysis. We seem to be transfixed in our culture by the allure of performance and public presentation, and a climate in which the exterior signifies the interior, where what you see and hear is what is true and real (no matter how often this fantasy is belied) is not receptive to the ideals of psychoanalysis.
All this, she says, can be seen in the context ofTo judge from the mushrooming of new institutes of psychotherapy and shorter training programs within established psychoanalytic institutes, many people are interested in becoming psychotherapists, while there are fewer candidates for traditional psychoanalytic training and for psychoanalysis as a treatment choice.For those who elect full-scale psychoanalytic training, the supply of certified psychoanalysts exceeds the demand in the population, and as psychotherapists they compete with psychotherapists of all stripes and denominations. The analytic institute can feel like a sequestered haven in which psychoanalysis is an “in house” specialty, tendered by training analysts (who have to earn their institutional stripes) to analytic candidates...In my years of training, the contemporary challenges facing the would-be practitioner of psychoanalysis were rarely if ever openly addressed, although many recent graduates find themselves with few and sometimes no analytic cases...
A zeitgeist in which the intrinsic and often intangible value of knowledge and education, and of self-knowledge and self-examination, has been supplanted by the appeal of material and pragmatic goals.Of course this is all anecdotal. I wonder if any analysts amongst my readers have thoughts on this?
Mendes, D. (2011). Letter to Freud: On the Plight of Psychoanalysis The Psychoanalytic Review, 98 (6), 755-774 DOI: 10.1521/prev.2011.98.6.755
23 comments:
One could spend a lifetime examining oneself ... and then die.
Self-examination? Apparently a psychoanalyst is required to do psychoanalysis.
nope, psychoanalysis is dead. psychoanalysis is not a science and even not therapy. neuroscience is a new science of the psyche
We in the mental health professions are often reluctant to accept the verdicts of the marketplace. The author of the piece you quote laments the problem that few people want what she believes she has to offer (and at $10 per session they are just about giving it away), and embarks upon the well-trod path of devaluing the very consumers she hopes to attract. If only they were smarter, less distracted by shiny baubles, more discerning, they would be flocking to analyst's services.
I'm reminded of a story about EMI some years ago, conducting focus groups with youth on their music listening habits, hoping to learn how to deal with the dropoff in the market. As a reward for participation, there was a table of free CDs for them to take anything they wished. The CDs were left untouched. This, more than anything else learned in the focus groups, told them the story. The market is dead.
Perhaps a more useful approach would be for the analyst to ask why few want to buy what she brings to the market. What are the customers (and that's what they are) shopping for? Does your product provide that? Does it do so more effectively than the rival products, at either a better price or greater convenience? If it does, have you conducted the research that would enable you to say so with authority?
There IS a problem with people seeking easy solutions, or magic (just shift your eyes back and forth and your trauma will be gone!), or happiness via consumerism. But until we stop insulting the public and begin listening to them, we cannot move forward.
I'm a strong believer in the healing power of the therapeutic relationship. Whether one has to undergo traditional old-school psychoanalysis in order to achieve that is another matter.
Psychoanalysis is sometimes referred to as "the Rolls Royce of psychotherapies". Some might say that's because it's bloody expensive and its appeal is looking a bit dated. Is it necessarily better to see a psychoanalyst than, say, a Rogerian counsellor?
psychoanalysis theories are not falsifiable, hence non scientific. If you want to know more about psychoanalysis, watch this amazing documentary, in French with English subtitles:
http://vaincrelautisme.org/content/le-mur-la-psychanalyse-l-epreuve-de-l-autisme
Mental health services are now covered by the federal government in Australia, in large part because CBT provides effective and measurable outcomes that follow a manageable timeline. The cost effectiveness of CBT (and other cost effective therapies) means that mental heath services are now accessible to more people in Australia than ever before. This feature of CBT will never be matched by Psychoanalysis (which may very well be helpful) which will always be therapy for the rich.
Context: I'm a recently qualified counsellor in the UK, studying psychotherapy.
"Giving it away?" At $10 a session, three times a week? Over $1000 a year? The tradition of psychoanalysis is stuck in the past, and with the privileged and wealthy. If people wish to spend boatloads of money examining themselves, great (it's certainly helped me) but it seems crazy to expect it of people, or depend on it for income...
And as already mentioned, psychoanalysis is not a science. There are quicker, better, cheaper ways of helping people with mental illness, and I'm not talking quick fixes either. I'm not talking just neuroscience either, which like psychoanalytic theory, seems to be more geared to explaining what is happening than the best way to help. The best therapies these days should be evidence based, carefully prescribed, and have the best interests (financial and otherwise) of the patient at heart. And of course, they can be informed by the wealth of theory, science and case history provided by neuroscience, attachment theory, analytic theory, if it is congruent and coherent to be so.
Freud, like many others of his generation, expected his ideas to be confirmed (or not) by advances in the biological sciences.
What appears to have happened is that his followers have continued on the path Freud and others began, and have ignored what we have learned of the biology of the 'mind' over the last half century.
A psychoanalyst told a journalist from the French journal "Libération" in November 2011 :
"When people learn that the social security will not pay for it, they do not come back. It is as if speaking had become subversive".
it shows how sincerely concern about the people trying to pay the rent that psychoanalyst was since it cost at least 50 Euros a session and can curtently be 100 several times a week.
I had one telling me proudly that a schizophrenic person would not eat to come to his cure and that the very high price was part of the cure. He suspected I was crazy when I answered that I worked for free to help some people...
NB: that psychoanalyst who complained to the "Libération" journalist that psychoanalyst is a psychologist
because in France when you are a psychiatrist you can easily make the social security to pay for psychoanalysis
-this not excluding the extra money many a French psychoanalysts ask in addition to what the social security reimburse for a psychiatrist consultation. Many French clients have a private insurance in addition to the social security.
May be that explain why so many French young psychiatrists are still interested in psychoanalysis.
I would not like it because you have to stay distant and still and silent all your working day
and you cannot see the facial expression and eyes of your client when he(she) speaks but it certainly is an easy organized way to make money because you allow regular slots of time to clients (20 mn or half an hour)always at the same days and times –unless you are off of office- and if the client take a vacation or has a sore throat he has to pay all the same next time he shows for the sessions.
PS: the French psychoanalyst lobby is so strong in France that the documentary Anonymous 10 January 2012 21:45 recommended as previously Nicole alias Caducei had done in the neuroskeptic Oct 2011 post on neuropsychoanalysis "Pack it in" had not been yet proposed to a television audience.
http://vaincrelautisme.org/content/le-mur-la-psychanalyse-l-epreuve-de-l-autisme
Holy cow! This was MY psychoanalyst when I lived in NYC. I saw her for almost 2 years for a depression that never got better. I eventually quit seeing her and got into cognitive behavior therapy (CBT) and it worked SOOOOOOO much better.
Wow. I'm not saying she's wrong, but psychoanalysis just didn't work for me.
DOUBLE Holy cow! This was also my psychoanalyst when I lived in the Big Apple! I saw her for a year for an anxiety problem and writing block and I achieved a complete remission of my symptoms! Psychoanalysis worked for me!
conservative, rigid psychoanalysts have expressed comparable complaints forever
regarding psychoanalysis, I think it is useful to define hypothese about the mind but not fixing it. In any case, that seem to be the conclusion of Eric Kandel in one of its publication (I think it is this one: http://www.ncbi.nlm.nih.gov/pubmed/15939967 but I will look it up tomorrow).
A.L.
Anonymous 12 January 2012 02:13
you wrote :
""I saw her for a year for an anxiety problem and writing block and I achieved a complete remission of my symptoms!""
Great I am sincerely glad for you.
my problem is that you also conclude:
""Psychoanalysis worked for me!""
when for French standards nobody will accept that one year is sufficient for a psychoanalysis to have time to occur.
Are you sure that you get a psychoanalysis and not a psychjodynamic psychotherapy?
I cite your supposed psychoanalyst via neuroskeptic:
//""he goes on to examine the increasing popularity of psychodynamic psychotherapy, approaches which draws on Freud's ideas but is much shorter (and hence cheaper) than classical psychoanalysis which involves hourly sessions, three times per week, over a period of years - ""//
And I conclude that you might be a fraud.
You might be intered in knowing that in order to defend their lucrative territory and their social image the psychonanalyts who were interviewed in the documentary "Le mur" (the wall) are preventing it to be distributed and on the 26th of January a tribunal in Lille will have to decide its fate.
In it a-for example-a pschoanalyst use a plastic crocodile mouth to illustrate the attitude of the bad mother of autistic children...
And now they are claiming that that documentary is biased...
http://www.lemonde.fr/m/article/2012/01/13/autisme-la-psychanalyse-au-pied-du-mur_1628735_1575563.html
Nb Neuroskeptic : I was waiting for Nicole alias caducei (the pack itin post in October 2011) to tell us about it.Since she didn't I thought I have better to tell it to your audience hoping that more than 20 people for 16 different organizations of autisms activists will show in Lille on the 26th of January.
Ivana: Thanks, I hadn't heard of that documentary, that's an amazing story. Wow...
An interesting article on this topic...The Efficacy of Psychodynamic Psychotherapy -Jonathan Shedler PhD, American Psychologist (2010)
This is one lay reader's opinion:
Years of experience, observation, and reading have made me change my mind about psychotherapy.
I now agree with Tana Dineen that it is the "snake oil" she describes.
My partner and I spent years and thousands of dollars on "therapy." It was a total waste.
I observed another friend who went into "therapy" after a breakup and watched him descend into a spending frenzy on "camps" and such things where we spent weekends bludgeoning effigies of his dead father because of the "emotional abuse" my friend supposedly suffered at his father's hands.
My own partner learned, long after his terminated "therapy" and much to our dismay, that he is manic depressive, not the product of an "abusive" upbringing, but that he cannot take anti-depressants because of problems with his liver.
So here we are, right back where we were fifteen years ago, with the same difficulties, but much, much poorer as a result.
My only consolation has been that this journey has brought into contact with such writers as Tana Dineen, Robyn Dawes, Frederick Crews, Richard Ofshe and Ethan Watters, who have excoriated the "profession" of psychotherapy for the scam that it is.
Correction:
I observed another friend who went into "therapy" after a breakup and watched him descend into a spending frenzy on "camps" and such things where he spent weekends bludgeoning effigies of his dead father because of the "emotional abuse" my friend supposedly suffered at his father's hands.
Anonymous 16 January 2012 11:45
Still, the best honest informative general audience book about schizophrenia I have ever read - apart Sylvia Plath "the Bell jar " - is
"The center cannot hold" by a schizophrenic sufferer American law professor (Eryn Sacks)who writes in it how much she benefited from being in a psychoanalysis -the real thing- when she was an oversea undergrad at Oxford...
I am not friend at all with the French psychoanalysts neuropsychoanalysis and cli_nging withb outdated autism theories putting the blame non the mothers (I happen, to think that as far as communists and psychonalysts are concerned the French ones are the worst quality.)
Still some psychonalysts are doing a good job and some behaviorists are unsufferable paternalistic people using a recipe without warmth and imagination to make money.
Life is complicated and full of crooks and demagogic frauds when money and fame are involved but it applies for bestselling authors and gurus in the health field.
For one Daniel Carlat "Unhinged" or Robert Whitaker- a journalist not a psychiatrist but a good one- "Anatomy of an epidemic" you get a lot of lesser quality work.
Books are published for commercial reasons without any scientific peer control.
And do not forget that I think the trend to invent false memories of incest had been known for some sectarian psychotherapists like the scientologists in need of making people separating from their families...
So if you see a psychoanalyst who work with pharmacologists and behaviorss etc.. like at the Maudsley or in canada, you might be safe from sects and sectarian people.
Psychoanalysis changed my life : it made me a better person, more aware of myself and the others, more able to love, deeper and more spiritual... It unleashed my creativity and allowed me to become a writer. Like a second birth.
The problem of price is central in north america, but not in France : I used to see one of the most famous psychoanalysts in the country, and it was 40 euros (55$)/session, twice a week. A completely fascinating and mind-opening and mind-blowing experience, that I recommand to everybody able to overcome their prejudices.
Yann Carvoz,
Was it not the great Faulkner who wrote that: No he never read Freud but share that advantage with shakespeare and Homere?
Also, question is: Did you realize that to bring out for the galaxy -at least- benefit your full creative power without your paying for it your psychoanalyst psychiatrist had to write implicit lies to the French social security services by making you passed for a person in need of treatment of amental illness?
Like some French plastic surgeons who put breast implants ( like in very thin girls who want to be thin but sexy with big breast like covergirls) writing on the papers for the social security paying for the procedure that it will be a plastic surgery on breast so heavy that the poor girl will get backhache from it without the plastic surgeon reducing the breast dimension and weight.
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