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Early in this century a completed and thorough analysis could be accomplished in 6 months. Toward the middle of the century, analyses were averaging 5 years, which meant about 1,000 sessions. When patients would ask, “How long is this going to take,?” I would sometimes respond, sardonically, or whimsically, or arbitrarily, “a thousand and one sessions.” I would try to gauge the motivation and capacity of the patient by how he or she responded to this paraphrase of the Arabian Nights.
In the 1960s and 1970s, it was not unheard of to learn of analyses lasting over a decade. The explanation was “negativetherapeutic-reaction,” “very resistant,” “ego-defect,” or transference-countertransference impasse. It was said that some patients were so damaged by preoedipal neglect, deprivation, or trauma that lifelong analytic therapy was indicated and appropriate.
As time went by, into the 1980s and 1990s, long analyses became more and more suspect. The analysand was unanalyzable, the resistance was too great, analysis was not the appropriate treatment. We have learned that many severe borderlines and psychotics were not approachable by psychoanalysis, nor were manicdepressives and most obsessive-compulsives. Some of these conditions responded better to supportive therapy or cognitivebehavioral therapy and some patients experienced dramatic relief of severe intrapsychic distress and behavioral disturbance with appropriate medication.
In my own practice, now approaching its fortieth year, I have experienced several extremely long analyses in which the patient was making incremental progress approaching 2 decades and I began to explore other ways of understanding this unusual situation, in which the patient seemed involved, conscientious, and making progress, but was not pushing for termination.