The Discomforting Demands of Psychoanalysis: one step backwards so as to take two steps forward*

“[Patients] want help, to feel better, to be happier. Psychoanalysis, however, is often not quite what they had in mind. For one, it takes a long time. Also, it costs them a lot. The cost issue is interesting—actually, psychoanalysis is not particularly costly. It is rather that unlike most therapies or treatments in our society, patients have to bear the cost personally. Managed care organizations and insurance companies don’t like to pay psychoanalysts’ bills. Even more important for patients, however, it often seems as if psychoanalysis isn’t even designed to help them. Patients want answers, whereas psychoanalysts ask questions. Patients want advice, but psychoanalysts are trained not to give advice. Patients want support and love. Psychoanalysis offers interpretation and insight. Patients want to feel better; analysts talk about character change.”—Robert Michels, M.D., (Walsh McDermott University Professor of Medicine, and University Professor of Psychiatry at Weill Medical College of Cornell University)

* Or the deferred gratification and economies of scale in self-realization.

Source: Peter Brooks and Alex Woloch, eds., Whose Freud? The Place of Psychoanalysis in Contemporary Culture. New Haven, CT: Yale University Press, 2000.

Addendum: Regarding Michels’ first point, namely, that psychoanalysis “takes a long time,” it’s interesting to recall, with Paul Robinson, Freud’s later views on this topic. Freud in fact became quite pessimistic about the prospects of “success” for analytic therapy, hence the melancholy tone and telling title of his 1937 essay, “Analysis Terminable and Interminable,” wherein Freud “reveals grave doubts about the thoroughness and durability of analytic cures. Analysis, the essay concurs, cannot guarantee that the patient won’t suffer recurrence of his affliction, any more than it can provide immunization against the outbreak of a different neurosis.” “Mental illness,” writes Robinson, “now appears to Freud more elusive and intractable than ever before. Analysis, accordingly, becomes ‘an interminable task.’” Patients, on the other hand, are expecting to contract for a (once and for all) cure of what ails them.