Psychoanalysis Then & Now

"We now feel we can cure the patient without his fully understanding what made him sick. We are no longer so interested in peeling the onion as in changing it." So said one of the nation's most famed psychoanalysts, attending last week's annual meeting in Chicago of the American Psychoanalytic Association, which was marking the 50th anniversary of the organized practice of psychoanalysis in the U.S.

Dr. Franz Alexander, long the leading trainer of analysts in Chicago, and now working in Los Angeles' Institute for Psychoanalytic Medicine, thus noted a continuing change in the beliefs and practices of U.S. analysts. The original Freudian concept of analysis as largely one-way talk based on "free association" and re counting of dreams, for a 50-minute hour, four or five days a week, for two to five years, is going out of style.

Adapt or Die. To Dr. Alexander, a "progressive Freudian" always ready to consider changes in method regardless of whether he or other analysts thought of them first, the important developments now in progress are:

P: Patients' sessions with the analyst are being made less frequent.

P:Analysts are interrupting patients more frequently, and instead of trying to act like "a blank screen" are deliberately letting their own personalities influence the patients' progress.

P: There is less interest in the patient's intellectual understanding of his emotional processes (which made every patient an amateur analyst), and more emphasis on the emotional experience of the analysis per se.

After 30 years of riding high in U.S. psychiatry, the pure theory and the "classical analysis" technique of Sigmund

Freud and his early followers were getting farther and farther removed from the real world, had to adapt or die. At recent rates, classical analysis cost about $5,000 a year. It was clear that selective use of psychoanalytic principles (or some other brand of "depth psychology"), combined with physical measures or drugs, were far more effective for many mental illnesses, including some neuroses.

Preaching v. Practice. Old-fashioned psychoanalysis, says Neurologist Percival Bailey, the Illinois State Psychiatric Institute's director of research, is no science but a pseudoreligious faith. "Its mystical ceremony of initiation resembles in many ways that of the shamans of the Kwakiutl Indians," he says. Bailey believes the analysts' "organized guild" to be "as powerful in its way as the Society of Jesus." And he accuses it of ignoring the plight of patients suffering from psychoses.

Most analysts (959 of them in the American Association, with even more in training) have flatly and publicly denied all such charges. But whatever they preach, they have modified their practice as they have seen basic analytic principles, stripped of the ritualistic humbug, put to good use in general psychiatry, especially in brief psychotherapy and in group therapy. While last week's conventioneers droned through discussions of such topics as the "denial of envy of the phallus of God," one of the most scholarly of U.S. analysts gave a corridor summation: "When the analysts get up at conventions like this, they hew to the line of dogma. But you don't know what they may be practicing in their offices."

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