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Forty years ago, Harold Kelman (1945) explored the possibilities and limitations of analysis when the patient could be seen only once a week. Conditions were far different from what they are today. World War II had stirred up enormous interest in psychoanalysis when there were relatively few trained analysts. These were located almost exclusively in the larger cities. In addition to geography, considerations of time and money limited some patients to one session a week. Kelman felt that with a competent analyst and a patient who had “incentive, stamina and tolerance for analytic work,” analysis could be carried out on a once-a-week basis. He stated specifically that he considered this analysis and not psychotherapy. However, he felt that for the great majority of patients more frequent sessions were necessary.
Of course, it all started with Freud (1913), who saw patients every day but Sundays and holidays. Over the years, the number of sessions was reduced, but most analysts felt that unless there were three to five sessions per week, it was not analysis. Greenacre (1954) expressed this position very clearly. She recommended that treatment “should begin with five sessions a week, but that after the relationship between analyst and analysand has been consolidated, it may be reduced to three or four times a week.” She cautioned that infrequent spacing of sessions would prolong treatment and increase the risk of inadequately working through of negative transference. Furthermore, she felt that a greater number of patients seen at infrequent intervals would be too taxing for the analyst.
No one really knows what other analysts do in their day-to-day work with patients (Bird, 1972). There probably is a wide discrepancy between what they do and what they say they do. My own impression is that many