The Theoretical and Practical Aspects of Frequency of Sessions: The Root of the Controversy

I work with my patients every day except on Sundays and public holidays—that is, as a rule, six days a week. (Freud, 1913, p. 127)

Freud only modified the six-day schedule to five in order to accommodate into his existing practice the people who had started coming to him for a “training analysis” (Kardiner, 1977).

When Freud (1912, 1913) wrote about the specifics of his technique, he referred to them as “technical rules” (1912, p. 111). Thus in 1922, when the International Psychoanalytcal Association (IPA) formalized the definition of “psychoanalysis” as a form of treatment, it defined it as a process that involved five sessions per week, as did the early textbooks on psychoanalysis (e.g., Fenichel, 1945; Greenson, 1967; Menninger, 1958). Psychoanalysts who worked in Europe and South America employed the five-day-a-week schedule; however, psychoanalysts in the United States began to experiment with different schedules. Some retained the five-day-a-week schedule; some reduced the number to four, some reduced the number even more.

In spite of the fact that when Freud worked he always saw patients on a daily basis, it must also be recognized that when he wrote about why he did so, he did not offer a theoretical rationale for the daily sessions; instead, Freud wrote:

… this technique is the only one suited to my individuality, I do not venture to deny that a physician quite differently constituted might feel himself driven to adopt a different attitude to his patients and the task before him. (1912, p. 111)

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Any line of investigation which recognizes … [transference and resistance] and takes these as the starting point of its work has a right to call itself psycho-analysis. (1914a, p. 15)

… analytic technique must be modified in certain ways according to the nature of the disease and the dominant instinctual trends in the patient. (1910a, p. 145)

For slight cases or the continuation of a treatment which is already well advanced, three days a week will be enough. (1913, p. 127)