Whither Psychoanalysis?

In recent years, psychoanalysis has been increasingly experiencing a state of crisis. Patients no longer flock to psychoanalysts’ offices as they did 20 years ago. Potential analysands are critical of and impatient with the long, laborious, expensive psychoanalytic process. The term “psychoanalysis” is usually illdefined and inaccurately used by the media and the enlightened public. Usually they refer to classical, orthodox, Freudian psychoanalysis, ignoring the broader connotations of the word.

For me, psychoanalysis is both a psycho-philosophical concept and a therapeutic procedure. The former includes the notions of unconscious processes and of psychic determinism. Among others, Horney added concepts of alienation from the self and self-realization. The therapeutic procedure comprises a broad range of technical modalities, including frequencies of one to five sessions per week. Therapeutic techniques also include dream interpretation, the working through of patient-analyst (transference) relationships, and the analysis of past and present experiences. Goals underscore constructive change, character growth, and the reduction or elimination of symptoms.

Psychoanalysis is both a treatment for definite psychiatric pathology and a character growth process aimed at reducing the patient's alienation from the real self (Horney). In Freudian terms, the aim is the ultimate resolution of the oedipus complex. Usually, patients come to psychoanalysis because they are suffering from disabling psychiatric symptoms. They can be gradually educated to seek to attain the more constructive goals of analytic therapy. Before World War II, psychoanalytic patients usually came from the more affluent segment of the population. The choice of treatment modalities was meager. While there were other forms of therapy, psychoanalysis offered the greatest hope for those who could afford it. After 1945, a golden age ripened with unprecedented economic prosperity and a tremendous expansion of the p