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Sorry, Your Time Is Not Up

To many New Yorkers, August poses a potent question: What would life be like without therapy? Analysts have no shortage of answers to this question -- and it could take you a year's worth of 50-minute hours to explore them all. The story of one woman's struggle with -- as the shrinks say -- termination.

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Recently, I was lying on my analyst's couch, wishing I were wearing a wire. I didn't tell her this. I was in a rebellious mood. But the fantasy was there, vividand insistent, lingering above my head like a giant dirigible.

What lurked beneath it was obvious. Isn't it always? Clearly, I was pining for evidence -- something, anything, that would show the sinister brilliance with which my analyst had twisted my long, dull confessions into a long, sturdy rope to keep me lashed to her couch. I'd been trying to break up with her for months. She was having none of it. Our conversation was running its usual vaudevillian course.

"I really, really think we should discontinue this."

"Ofcourse you do. You started this whole process because you said you had trouble with commitment. This is a passive way of resolving your conflict."

"Passive?" I nearly rolled over to look her in the eye. "If I wrote you a check this instant and leapt off this couch, would you call that passive? Wouldn't that be a rather active, decisive moment in my treatment?"

"No." Her voice was calm. She is always maddeningly calm. "But it'd be a solution to your ambivalence about coming here."

She was right, of course. And wrong. I left that day in a terrible mood, formulating more persuasive rejoinders in my head, reenacting our singular, circular dialogue for friends.

Does it always come to this? That our shrinks become our jailers?

My desire to terminate psychoanalysis has, as my analyst so often likes to say, been multi-determined: by time, money, doubts about her efficacy, doubts about my analyzability, an emboldening sense of progress, a wistful sense of my own limitations, a realistic sense that all the hard work, scarily, begins now.

But a fear of commitment? Good Lord: I've been seeing this woman four times a week for nearly four years.

Thank God it's August.

When Freud first started seeing patients, his analyses seldom lasted more than a year. The Rat Man he treated for roughly nine months; Dora he treated for roughly three. Little Hans, who feared horses, he saw on only one occasion -- though he worked a good deal with his father; and Gustav Mahler, who was traumatized by his wife's extramarital dalliances with Walter Gropius, he saw for just four hours. (Sadly, the composer was still unable to finish Symphony No. 10.)

But the point of psychoanalysis, at least in its early years, was to relieve suffering neurotics of their symptoms, not to effect full-scale characterological change. And this, Freud believed, could be achieved merely by coaxing a few sleeping demons from their tombs. "The early thinking," explains Charles Tolk, training analyst at NYU Psychoanalytic Institute and chairman of its admissions committee, "was if you tell 'em what's in their unconscious -- 'Look, kiddo, you want to kill your father and sleep with your mother!' -- you'd done your job. Which made you more amusing at cocktail parties. But it didn't help."

It wasn't until the second half of the twentieth century that the multiple-year analysis became standard procedure, transforming all of us willing participants into a horizontal fleet of couch potatoes. A pair of studies just completed by Joan B. Erle and Daniel A. Goldberg, both from the New York Psychoanalytic Institute and Society, found that the median length of a Manhattan psychoanalysis -- "psychoanalysis" meaning four to five times a week on the couch -- was five to six years, for populations starting in both the mid-seventies and the late eighties.

Five to six years. One wonders whether these patients would have fared just as well if they'd spent every morning doing lanyards.

At any rate, longer spells on the couch have obviously prompted the psychoanalytic profession to grapple with the question of termination -- how to do it, when to do it, why. The topic has spawned curriculum changes at most training institutes and a whole new family of academic literature (including, satisfyingly enough, investigations into not just how patients do after termination but how analysts do -- suggesting that some of them actually miss us when we're gone). The latest thinking is that the "termination phase" of psychoanalysis should last six months to a year.

Again: lanyards.

Don't some people just sleep in one day and never return?

In fact, they do. Erle and Goldberg's studies also note that roughly one third of their 253 participants terminated in an "unsatisfactory way," which the authors later refer to in lay English: "quitting."

August, as one might expect, is a common time for patients to get itchy, because the city's mental-health professionals have hightailed it to the Cape, Tuscany, or wherever it is that the International Psychoanalytical Association is holding its biannual hoo-ha. I've been told -- by psychiatrists, mostly -- that many patients suffer from separation anxiety in August. Not me. I sleep in, work out, and exult in my bloated bank balance. Last week, I had the most electrifying fantasy, which visited me in the form of a single word: Nobu.

"A lot of analysts aim to have a termination take place during a summer holiday," says Stephen K. Firestein, professor of clinical psychiatry at NYU and author of Termination in Psychoanalysis, which was rereleased this July. "But in the long run, that's not the best way to do it. It seems to work out better if the termination takes place when the analyst is around, in case the patient has a difficult response."

I tell him I doubt I'll be one of those patients. He chuckles.


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