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Why does psychoanalysis take so long

By Jane S. Hall, CSW, FIPA

Kaspars Grinvalds/Shutterstock

Source: Kaspars Grinvalds/Shutterstock

Overheard conversation at Restaurant in Manhattan

Ann: “Three years?? You’ve been going to your shrink for three years!!? What on earth for. I know you’re not crazy!”

Maria: Not crazy but I feel stuck. I just want to meet someone right for me and yet every time a guy showed interest I ran. I even dated a married man – so yup – And now I’m in psychoanalysis, going four times per week and even using the couch because it frees me up.

Ann: OMG, I cannot believe you’d want to spend all that time talking to a shrink. It must cost a fortune too!

Psychoanalytic therapy takes time

No it need not cost a fortune but yes, it does take time. Let me try to explain why.

“Sue”, a patient of mine, began her therapy in her late twenties but problems with commitment had been brewing since childhood. Her Dad was killed in a car accident when she was five-years-old. This sudden and tragic loss affected her in many ways but especially apparent was her fear of loss. Leaving her mom became scary and she had trouble going to school for a year. In fact fears of separation haunted her making connection with others problematic. It is not as though Sue made a conscious decision to avoid closeness, but powerful unconscious forces (defenses) took on the role of protecting her from future trauma.

The unconscious is where our defenses are born. Defenses protect us from situations that could be painful and the historical context in which they are formed is key. A defense might be adaptive at the time it is formed but eventually becomes problematic. Like if you are still wearing the shoes of a five-year-old when you’re 20 it will cause all sorts of problems that limit and impede your journey through life. Changing those shoes isn’t so easy. Because these defenses are unconscious, it is not possible to alter them without assistance. This is where psychoanalytic work is most helpful. You see, the analyst has experienced her own analysis, along with years of study so he/she is a trustworthy guide.

Sue had developed a combination of defenses which formed her character or personality. She avoided situations that might hurt her – like close relationships. She denied certain feelings for fear they would overwhelm her. And she even learned to shift her feelings to other people (we call that projection) because it felt safer that way. And the defenses were adaptive in many ways. She became a leader and was good at bringing people together because of her empathy with vulnerable, injured people with whom she could identify. When faced with a dangerous situation Sue jumped right in, ignored the warning signs and forged ahead where others would have been more cautious.

This covered her wishes to depend on others. And she unconsciously avoided people who were nice to her lest she end up counting on anyone. Sometimes she just didn’t hear a compliment or realize that someone was attracted to her. And when on a date, she tuned out the potential partners and found herself attracted to people she knew would hurt her – like married men. After a few disastrous flings she decided to seek help.

She tried a cognitive behavioral therapist who gave her homework and tips to practice which seemed sensible but after a year with no improvement, she asked a relative who was in analysis for a referral.

How does psychoanalytic work help?

When Sue began therapy she was sort of clueless but as she began talking, twice a week at first, a picture slowly began to emerge. Her therapist was thoughtfully quiet but it didn’t feel like the lonely silence she had heard about. In fact, the quietness gave her space that felt good. As they proceeded, a partnership developed. It was like being on a journey with a competent guide.

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Traveling back and forth from past to present, Sue began to welcome emotions she had once pushed aside and it felt good. Increasing sessions from two to three times a week enabled the work to deepen. After the second year Sue added a fourth session and chose to use the couch. Not looking at her therapist was a major step. The trust and consistency of the relationship had helped to lessen her anxiety – she didn’t have to look at her analyst to know she was listening.

Sue began dating a person who seemed appropriate to her – based on mutual attraction and trust. It was as if her relationship with her therapist over the years extended to relationships outside of the room. There were still ups and downs but by continuing her analysis she learned how her current anxieties resonated with old fears. Things began to make sense and Sue no longer felt rushed or pressured.

When a person feels thwarted, inhibited or even just plain sad, there are reasons. In order to change and grow the roots of problems need light and expression with words. Staying on the paved roads of behavior focused therapy is useful for some, but Sue chose a more adventurous journey that she hopes will lead to lasting change.

About the Author: Jane S. Hall, LCSW, FIPA, Past President of the Contemporary Freudian Society, member of the International Psychoanalytic Association, American Psychoanalytic association, and AAPCSW. She is a Training and Supervising Analyst who teaches, lectures, and consults around the world on how to deepen psychoanalytic work and other topics for the past thirty years. Hall is the author of Roadblocks on the Journey of Psychotherapy (2004), Deepening the Treatment (1998), and various articles, and is on faculties of three NY institutes. Hall is in private practice in New York City.

When a person comes to see a psychoanalyst, …


… they are in some form of pain. They feel sad, grief, worry, anger, unable to find sense or meaning in life, creativity, success. They feel unable to organize themselves, to find love, sex, friendships, and more.

More often, it is difficult to even put these thoughts together. They are in a rut and just can’t seem to find a way out.

Psychoanalysis is about helping a person find a way out of that rut. Sometimes a path quickly becomes clear. Sometimes it doesn’t. Sometimes there isn’t one, and the hope is to build a path to a better, more meaningful, world.

Many forces and emotions can impact and overwhelm us. Ideas and preconceptions formed over the years affect how we see the world. To say they are complex is an understatement. But when we begin to see them, we also begin to realize their impact and how often we allow them to keep us prisoner.

Psychoanalysis helps a person find the choices they didn’t realize they had.

You might wonder, …


“Can I do this work on my own? Why would I need to do this with someone else?”

You can do a lot on your own. Journaling, meditating and exercising mindfulness, finding benefit in hobbies and exercise, and more can all be beneficial. However, meeting with someone else in a space that you feel is trustworthy, to hold your thoughts, concerns, and worries is quite a different experience. The problems that plague you in the outside world of relationships will more than likely find their way into your relationship with your analyst. And when they do, the nature of the relationship is that you can now examine it.


“Isn’t psychoanalysis proven false?”

Contrary to popular belief, not at all. The concepts of a world of thought and emotion influencing our motivations, resistance to change, templates of relationships, and more are quite alive and well. Though more modern therapies may seem somehow “new and improved” or even try to say psychoanalysis is not useful, at their core, they all utilize psychoanalytic principles that have grown and evolved since the late 1800’s.


“Wasn’t Freud a quack?”

Freud did a lot to consider the mind in his time and era. He had his own foibles and anxieties, some of which found their way into his work. All creations suffer the same fate; an artist indelibly leaves a personal stamp despite best efforts otherwise. Meanwhile, what Freud started has since grown, evolved, and developed into the modern day with the help of many bright minds. Comparing psychoanalysis now and then is like comparing a high-performance car to a buggy.


“Yeah, but isn’t psychoanalysis anti-women? And what about that killing your father and having sex with your mother thing? And why does everything relate to sex?”

Many of the principles and ideas have shifted and evolved over the years. Metaphorical concepts, such as the Oedipal relationship, are about navigating triangular relationships. Feelings of competition, jealousy, admiration, and more are readily seen. These may pertain to your situation, or they may not.

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Also, not everything is about sex. Much more central is the concept of meaning. What is meaningful to you, how that came to be, how that motivates you and shapes your worldview, how that impacts your approach to others, and more are the central focus. Of course, sex can be important, too, as that might just happen to be meaningful to you.

Further, many powerful feminist voices have come from psychoanalysts, including S. Freud’s own daughter, Anna Freud.


“Why does psychoanalysis take so long? Cognitive Behavioral Therapy takes weeks.”

Cognitive Behavioral Therapy (or CBT) is a very useful therapeutic style. It tends to focus on diagnoses or particular thought patterns. From there, one uses a manualized or standardized approach to address those concerns. A solid CBT therapist can be flexible where needed, empathic, and very helpful in teaching someone to manage many symptoms using this approach.

Psychoanalysis, however, involves meeting someone with a higher frequency and over a longer course of time, sometimes 3-5 times per week over the course of years. As a result, the changes tend to be deeper, longer lasting, and more influential in one’s world.

As an example, someone complaining of depression may come of out a CBT therapist’s office with concrete actionable tasks to do, which can certainly help depressive feelings. The same person walking out of a psychoanalyst’s office, however, may begin making larger changes in work and relationships that in turn will help with depressive feelings.

Some in the mental health community will even argue that CBT is a gold standard for certain diagnoses, such as Obsessive Compulsive Disorder (OCD). While I do believe CBT can be tremendously helpful in such cases, I have personally seen some who found yet further benefit in psychoanalysis.


“Can’t I just meditate or be mindful?”

Meditation is absolutely powerful and useful. But it is more orthogonal to therapy than it is competitive. Meditation is an ancient practice that can improve psychological health much like solid exercise. I believe it has been helpful to me and can be quite beneficial to many, many others.

But it won’t necessarily address the problematic interactions and learned behaviors of the years. Meditation is wonderful for learning how to be with your emotions, not react to them, listen to them, and use them in your decisions. Psychoanalysis helps you to understand the impact of your decisions and how you form them. The practices overlap but are not at all exclusive of each other. In fact, a primary practice of psychoanalysis known as “free association” can readily be recognized as a type of meditation itself.


“Psychoanalysis is expensive.”

The cost of psychoanalysis is not inconsequential. The finances of meeting with a fully trained analyst regularly can compete with a college education. However, there are ways to reduce costs.

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Many years of training go into creating an analyst. To be a therapist at all, can take about 2 years post college. To be a psychoanalyst, though, can take at least 7 years post college and more often takes quite a few more. As a personal example, if you count medical school, I did 18 years of post-college study and work until I graduated as a psychoanalyst.

Having said that, some health insurances will cover at least some of the costs involved. It may be worth speaking with your insurance provider to discuss the possibilities.

Further, there are training institutions that offer low fee work. Sometimes those fees can be quite significantly lowered. It’s worth calling a psychoanalytic institute in your area to find out if they have students in training. They should have a seasoned supervisor involved with your case.

To put things in perspective, the cost of an average brain surgery is between $50k-150k. Of course, that can mean the difference between life and death. In psychoanalysis, sometimes the stakes are the same. Often, though the difference is between living a miserable life, and finding one that is rich and meaningful. Interestingly enough, some people find that because of the better decisions they are making, they wind up earning a significantly larger income than before the analytic work and then make up the cost. In that way, it can be a financial as well as emotional investment.


“What about medication?”

Medication can be very useful depending on the person.

At times, I’ve compared medication to a brace. If you injure your ankle, you might put on a brace. Therapy helps move the objects that contributed to the injury in the first place as well as strengthens the body. The brace helps to minimize further injury and supports you in the work. The analogy is not without its limits, but it is helpful.

However, medications can also be turned to as a fix for something that is better addressed in therapy. For example, someone may feel that they have ADHD as they have difficulty focusing and are falling behind at work and with home tasks. However, sometimes, the work environment may indeed be overwhelming and, more importantly, there are difficulties in learning how to advocate for one’s self that are more at play. Learning those skills would then help create an environment that can make work not only tolerable but sometimes even enjoyable and more meaningful. At other times, the symptoms of difficulty with focus are more related to anxiety, and once again, may be addressed with therapy.

A good therapist will help you learn to acknowledge emotion and find when medication may or may not be a good option.


“Why meet so often? What’s the difference with regular weekly therapy?”

Similar to an exercise or learning a skill, you get what you put in. Further, some things don’t happen without a certain intensity. To compare using an analogy, one’s physical health is much different when working out once per week versus four times per week. One’s ability to learn a language is vastly different when studied once per week versus multiple classes per week.

Learning your own emotional landscape is no different.

With that said, there are many who benefit quite well from 1-2 sessions per week. Some do fine with even less. It really depends on how you use the therapy, your relationship with your therapist, and what you’re looking for.