In TAP 36/3, Prudy Gourguechon reported that the Latin Americans believe that a frequency of three sessions per week can create a true analytic process. She quotes the conclusion of Alain Gibeault, IPA's Secretary: “Economic and cultural realities make this frequency far more practical for Latin American psychoanalytic practice.”
This is demoralizing news, reflecting
Prejudice: “They may require less than we do.”
The impingement of extraneous circumstances on clinical judgment and experience. How would we feel if someone said that their surgical operations needed lesser means?
A lack of conviction as to what constitutes the essence of psychoanalytic treatment.
The majority of cases evaluated by analysts anywhere in the world need not standard analysis but good psychotherapy. However, principles and techniques of psychotherapy are not taught in most psychoanalytic institutes. This practice [would] run counter to the idealization of “the gold” (Freud, 1919) of our professional traditions. Many analysts — not only Latin Americans — have found the hybrid solution of treating patients in anemic analyses for two or three sessions per week, without much concern for analyzability or differential clinical indications. This type of treatment, in which the development and resolution of the transference neurosis inevitably becomes more difficult, seems better designed for the analyst's self-image and economic interest than for the patient's benefit.
There are still cases for whom nothing but a standard analysis will do (5 percent of psychiatric patients, it has been reported). For these patients, mostly insightful individuals with chronic neuroses and severe character disorders, there must be institutional ways for making analysis available to them — yes, including significant fee reduction, which after all has always been a part of our medical traditions. We have to contend with enough adverse external circumstances; let's not compromise our inner strength.
Cecilio Paniagua
Madrid