“How long will it last?” is one of the questions people most often ask when they are about to begin psychotherapy–especially if it’s their first time.
The answer I usually give isn’t the one people want to hear, because I answer with a question: “How long should yoga last?” “How long should you study piano?” “How long should you learn chess?”
Of course, the answer to that question will depend on the psychotherapist and the modality she or he uses. A behavioral psychotherapist who emphasizes eliminating symptoms may answer that the therapy will be completed when the symptom is gone, which may be a matter of weeks or at most a year. A cognitive psychotherapist may reply, “The treatment will last long enough to replace your negative thinking with positive thinking.” Someone who specializes in short-term therapy may say, “We will set goals and the therapy will be over when we reach those goals, which will be no more than a month or two.”
Of all the modalities, psychoanalytic psychotherapy may last the longest. Sigmund Freud often compared psychoanalysis to an archeological dig. When do you stop digging? Indeed, the deeper you dig, the more you find. And when do you stop examining what you dig up? And when do you stop trying to put it all together?
In Freud’s day psychoanalysts saw their analysands (as they were called) six times a week. Psychoanalysis was an intense intellectual and emotional experience. It was, in fact, the most intense relationship in an analysand’s life. In the beginning, the pioneers of psychoanalysis thought a year of psychoanalysis was enough. Then they extended it to two years. Then they began to realize that psychoanalysis could be, in Freud’s words, “interminable.” Although many of Freud’s theories have been questioned, the talk therapy he began has continued up to the present in many forms.
Today, psychoanalytic psychotherapists know that a client’s particular issues will determine the length of the treatment. Since we generally only see patients once or twice a week, the treatment will take longer than it did in Freud’s day because it is not as intense. Sometimes it can take a year, sometimes it can take several years and sometimes it can be “interminable.”
The length of psychoanalytic psychotherapy has to do with the psychoanalytic approach. It is the opposite of a goal-oriented modality. Psychoanalytic psychotherapy uses free association as the cornerstone of the treatment. We ask clients to say whatever is on their mind on any particular day. This serves a number of purposes. First, it promotes spontaneity. Many people have become overly defensive and distrustful, due to experiences they encountered growing up, and for them spontaneity begins the growth process and builds trust between the psychotherapist and the client.
Free association also serves to get a client to a deeper level of thinking. A client may free associate about the artifacts she sees on my library shelf and then may remember an artifact on her father’s desk during her childhood, and this memory may lead to other memories which in turn may lead to long-buried emotions that underlie recurring conflicts in her life. If I were simply to instruct her to remember such things, she might feel put on the spot and unable to do so.
As this free association continues, week after week, it goes ever deeper into the areas of the mind that were formerly unconscious. It reaches into regions that the client has avoided. When it reaches that level, the client’s instinct is to pull away, and hence the treatment may become a grind. It is like any relationship; there is the honeymoon period, in which there is a new and exciting beginning of intimacy. And then the honeymoon is over and the client begins behaving in therapy the same way he behaves outside of therapy; he begins to have the same abandonment fears, the same trust issues, the same anger problems, the same mood swings, and the same obsessions that he has in his life in general.
Such issues do not just disappear overnight. You can remove a symptom, but that does not remove the underlying unconscious conflict that caused the symptom. The symptom will just come back in a different form. A person may come to grips with his drinking problem, but may then become continually irritable. A person may get control of his tendency to act out anger, but then will fall into a depression.
Psychoanalytic psychotherapy is not right for everybody. Indeed, research has shown that different people respond to different approaches. People who respond to psychoanalytic psychotherapy are people who want to understand themselves. How long will that take? You can stop an archeological dig at any time. Or you can keep digging and see what else turns up. It’s your choice.