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The author sets out to question the practice by many analysts of routinely seeing patients five times a week for fifty minutes. He is understandably moved to reflect on this when his experience is that, in the matters of time and frequency, no discussion is possible and his colleagues work in that way because that is how they ‘like to work’ and because that is how their own analysts worked.
He makes what would seem to be a valid plea for the analyst to recognize the problem with the routine practice of favouring four to five times-weekly treatment no matter how suitable the work is for the patient. His concerns are for patients who clearly use such analysis for purposes other than emotional growth (what I would call addictive use) such as ‘having a reliable person they can talk to’.
He is occupied at one level with the ethics of the psychoanalyst who might take advantage of a patient's dependency, greed or naïvety. The author seems to favour strictures in order to control the analyst's unconscious or conscious greed or excess of zeal in addition to unquestioning adherence to an inherited form, assuming that analysts can lack the integrity and judgement to determine the most effective way of working with their patient. This is understandable if, as he says it is his experience, his colleagues apply a universal approach ‘because that is how I like to work’, a Procrustean, one-size-fits-all ‘technique’.
Naturally the patient's life circumstances - the reality of external reality, as it were - must be understood. The example of an analyst who saw his patient's failure to attend the fifth session as ‘resistance’ when there were real external circumstances is also a caricature, an analyst who can see only internal reality, yet the analyst may not have been entirely incorrect either. As an analyst, would he have been doing his job if he had not thought from many angles about the reasons for his patient refusing a fifth session? It is the analyst's responsibility to reflect