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This paper by Abraham Brafman makes the plea that we question more rigorously the number of sessions that it is right to offer a patient, and what it is we are doing when we agree to increase sessions. The paper raises many questions and so we decided to use it as a kind of ‘Clinical Commentary’ and invite responses from clinical practitioners. Four psychoanalysts and psychoanalytic psychotherapists from different orientations and organizations were given a wide brief to respond to the paper in the way that it struck them, and we hope that the paper and these commentaries will provide stimulating thought on this important issue. Abraham Brafman has also added a short afterword.
Linda Pethick
A patient being seen in twice-weekly psychotherapy asks to increase the number of weekly sessions: how should one respond? Thinking about this question, it struck me that, before it can be answered, it is necessary to discuss a number of other issues, particularly how the initial decision is reached regarding the number of weekly sessions recommended to a patient.
When I started my psychoanalytic training in 1960, psychotherapy was just beginning to be recognized as a valid therapeutic method. Analytic training involved five weekly sessions of fifty minutes each and trainees practised this pattern after qualification. Psychotherapy, by contrast, involved fewer weekly sessions and, predictably, discussions followed attempting to define what differentiated psychotherapy from psychoanalysis. The importance given to the transference relationship seemed to be the most often quoted difference. The argument went that psychoanalysis led to a transference regression that helped the patient to obtain insight into the early origin of his