To Three or Not to Three: That is Not the Question
A controversial psychoanalytic training relic regarding the adequate (or required) frequency of analytic sessions has recently been exhumed, culminating in the International Psychoanalytical Association (IPA) making a policy change in its recommendation to component societies. This change gives each society the individual prerogative of establishing a three session minimum and a five session maximum per week for psychoanalytic training. This change (not the first of its kind in psychoanalytic history) has fueled tensions between various sections of the international psychoanalytic community and the steam that this movement has created is not yet run out.
To understand the tenacity of this continued steaming one needs to consider several factors. First we start with Freud who never endorsed a mandate of four or five sessions but realized that three sessions were perfectly fine for many people. It was only for more disturbed patients that he felt a higher frequency was necessary. For various historical reasons (e.g. American models vs. European models) that go beyond the scope of this essay Freud’s flexible thinking in this regard was lost and a higher frequency became concretized, creating an analytic moat that, for some, could not be crossed.
Second, the defense of high frequency philosophy has been supported by some legitimate clinical concerns regarding the potential re-hardening of defenses (e.g. “Monday Crust”, “thread loss”) that can occur between widely spaced, infrequent sessions. Others, like Kernberg (2001), even warned of a “slippery slope” of decreasing traditional frequency (“If three then why not two or one?”). In addition, there is perhaps the less often mentioned and less conscious fear for some analysts regarding the economic loss in a reduced frequency scenario.
There is little doubt that more frequent intervention between analyst and analysand bodes much better for improvement over time as recent research has shown (Shedler, 2010). This having been said there has been general agreement among some of the warring factions ( e.g. British vs., French) that three sessions per week is an effective minimum. Yet some are still wedded to insisting “one size fits all” and that the highest frequency standard should be applied everyone. We forget that Freud never said that frequency was the not sine qua non of psychoanalytic work. It is one important factor to be considered but perhaps not unalterable. I might suggest other factors as well that may be at least as important as session frequency for establishing a good, effective psychoanalytic process.
If, for a moment, we entertain the idea that three to five sessions per week helps to maintain the analytic frame and encourages an analytic process to occur, let us move to another vertex and look at other process enhancing variables, i.e. analyst factors. These characteristics would include the analyst’s ability to engage the unconscious, interpret the transference (and countertransference) and analyze defenses. Extending these analyst factors even further we might see other, critically important aspects of the analyst’s personality that lend particularly well to effective analysis. Controtto (2011) has written about this matrix of personality variables, including the analyst’s emotional inheritance (or character), his/her identification with a use of a psychoanalytic theory and sensitivity to cultural factors, including the public’s perception of analysis and, I might add, awareness of socio-economic factors in his/her community (e.g. mobility, income etc.). This last factor has often been particularly overlooked but has been a significant point of argument for a more flexible standard of session frequency by many analytic societies in South America and parts of Europe. I believe that societal and economic changes in the American culture now require analysts to reckon with this issue.
We might think of amalgamating those aspects of the analyst’s personality with the deft ability to apply a flexible, containing frame of frequency into a constellation we might call the analytic personality or therapeutic personality. The factors mentioned (there might be others that I cannot think of right now) that constitute such a personality would surely heighten the probability of a successful analytic endeavor. Such a model could put excessive turf quibbles about how often someone is seen per week in perspective.
While thinking about the analytic personality I was reminded of an encounter with a fellow doctoral candidate I trained with in the mid 1970’s. We were discussing various analytic theories and the training requirements to be met in order to become a psychoanalytic therapist. As we talked my colleague suddenly stopped the discussion and said, “I’m not interested in being a therapist. I’m more interested in becoming a therapeutic person.” His statement felt, at the time, somewhat revolutionary and has always stuck with me.
Another psychoanalytic topic continues to re-emerge on the controversy horizon, the designated term of and complementary status of “Training Analyst” (TA). It is beyond the scope of this essay to investigate this topic thoroughly. However, it can be said that the long accepted role of the TA has steadily come into question to a point where certain psychoanalytic factions believe that this traditional status should be eliminated. The reasons for this movement are many and include the belief that the TA designation has created collegial rifts in many analytic institutes, that it promotes differential political power in training programs and that it has achieved some sort of elevated, undeserved, overvalued invincibility. Some prominent analysts (e.g. Kernberg 2004) have even stated that exclusivity that TAs enjoy in providing training analyses should be erased and that candidate analyses should be totally free of institutional influence.
Whatever side of the debate one may fall on it seems best to carefully re-examining this topic with the understanding that psychoanalytic societies and institutes are human organizations and not immune to all the dangerous vagaries of organizational dynamics. Moreover, there may be some destructive aspects to be considered regarding the “anointed” position that TAs may hold in a particular institute. Kirsner has written on the phenomenon of this elevation whereby the TA is held up to be the holder of true psychoanalytic knowledge and is therefore the only one truly qualified to provide a proper analysis for analytic candidates (and perhaps the public as well). Interestingly, Freud was somewhat equivocal on this issue of privileged position whereby on the one hand he advocated the inclusion of non-medical professionals in psychoanalytic training but then tightly held quite an elitist group (even distributing secret rings to members) of his most dedicated and “knowledgeable” followers.
There is no sure fire process of vetting that guarantees that one is a “qualified” analyst (just as there is no error proof method of determining any other professional ability). However, it does strike me that the intense adhesion to high frequency sessions (4-5) by some may be mirrored in the often concretized, but perhaps not justified knowledge and power sometimes implicitly awarded to TA status. Nonetheless, we need to have some method for assessing whether one is really capable of delivering a “proper analysis”, whether that is a training analysis or not. I do not know the answer for this. However, I would again suggest including wider consideration of the personality factors mentioned earlier in this essay as we make our determinations. To this list of factors we might prioritize other necessary ingredients such as the analyst’s experience in providing successful analyses over some time period as well as additional assets like those mentioned by Kirsner (2000), including the capability of high level cognitive functioning and abstract thinking ability, the analyst’s “person intelligence” (publicly coined as “emotional intelligence”) and his/her facility in the use of psychoanalytic theory. Whether that constellation is termed Training Analyst, Personal Analyst or something else does not matter. It is whether the analyst has an “analytic personality” or as my dear graduate school colleague keeps reminding me it is whether the analyst is a “therapeutic person.”
Article written by: David Jachim
Controtto, F. (2011). On the Frequency of Psychoanalytic Sessions: History and Problems. Ital. Psi. Ana., 5: 123-134.
Kernberg, O. F. (2001). alcune innovazioni nella formazione psicoanalitica.,47, 551-565.
Kernberg, O. F. (2004). Discussion: “Problems of Power in Psychoanalytic Institutions.” Psychoanalytic Inquiry, 24 (1): 106-121.
Kirsner, D. (2000). Unfree Associations. Process Press: London.
Shedler, J. (2010). The Efficacy of Psychodynamic Psychotherapy. American Psychologist: 98-109.