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Sorry, Your Time Is Not Up

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Which all sounds perfectly lovely. But let's be honest: How often are we messy, layered creatures ever this tidy?

When I first started psychoanalysis in December 1997, I didn't consider myself any sadder or more troubled than most of the people I knew. I suffered the usual plague of single-girl afflictions -- melancholy, anger, low self-esteem -- and, as an added bonus, a bizarre inability to visualize myself in a marriage, with my boyfriend of three-plus years or anyone else. But once-a-week therapy seemed palliative and bush-league; in my family, psychoanalysis is considered as normal and as natural as taking a swim.

Today . . . I'd say I've traveled some distance. I'm hardly a model of calm and inner clarity, but graded on a bell curve of neurotic people, I'd say I do pretty well. Of course, I'm still a rotten sleeper. I still make similar versions of old mistakes. And I'm still awfully self-critical. But are these reasons to keep spending thousands of dollars a year on psychoanalysis?

I asked Firestein this question. He said one of the main litmus tests for any patient who's feeling this way is "to ask themselves: 'Can I accept, for the balance of my life, to feel, act, and be the way I am this afternoon?' "

Which is fair enough. But the question assumes that if the answer is no, the only possible solution is to remain in analysis. This is precisely the argument my roommate got from his therapist last month when he tried to terminate his thrice-weekly sessions, pleading poverty (a reasonable claim, considering the staggering size of his student loans and the fact that he'd just bounced his last check to her -- oops). Her response was to catalogue, one by one, his problems and faults, demanding to know how he'd cope if he left.

"Do you realize what you're implying?" I ask. "You're implying that what we do for a living is just a form of acting out, and not a form of therapy itself."

I thought that this was pretty manipulative. He agreed, and said something about it to her the next time he saw her. She came as close as she ever has to apologizing, apparently.

But money . .. ! Money is a very real issue for many of us who see therapists, whether it's five times a week or one. Fortunately, our therapists are prepared to deal with our financial concerns. Very prepared. When my roommate told his therapist he was too poor to continue, for example, she responded that money was precisely the reason to continue -- after all, didn't he have trouble managing his finances? And how would he ever get to the root of this problem without exploring it?

"But then I'd be paying you $1,000 a month to discuss managing my money," he moaned. "I just bounced a check to you. I don't have $1,000 a month."

But at least my roommate says his analysis is still helping him. Me, I'm not so sure. In 1937, when he was 80 years old and dying from cancer, Freud wrote perhaps his best-known essay on the limits of his art-science in "Analysis Terminable and Interminable." It's a surprisingly pessimistic monograph -- doubtless discolored by his illness -- in which he speaks with fierce candor about the traits that would render someone immune to his craft: the intractability of the id, the rigidity of our defense mechanisms, the constitutional strength of our instincts. And he goes on to express real skepticism about the power of analysis to inoculate us from new versions of old problems, suggesting that some neuroses lurk forever inside us, awaiting their triggers, like tiny allergies of the soul.

For a person in therapy, this paper is pretty terrifying. And so is one particular result of Erle and Goldberg's studies: A full 33 percent of their participants were found, by their very own therapists, to be "unanalyzable" -- at the end of their treatments. (On a more reassuring note, the studies also say that 71 percent of the participants experienced a "good to excellent benefit" from their time in analysis -- though of course it was their psychiatrists making this assessment.)

Still, what does it say about a healing art when a substantial number of people don't respond to it? And when its practitioners continue to practice it -- and charge quite a lot for it -- even when they're obviously, at times, feeling the same pessimism about a patient's prognosis as the patient him- or herself?

I ask Phillip Freeman, a psychoanalyst who just taught the spring course on termination at Boston Psychoanalytic Institute, whether he's ever had a crisis of faith. "Like when Freud did?"he says, laughing. "How could you not? It's a very dicey business, psychoanalysis. I mean, what would it mean if we were two people talking about the unconscious and its symbolism and its ambiguity and we didn't fear that we had no idea what we were doing? Wouldn't there be something wrong?"

'Maybe I need behavioral therapy," I conjecture one idle day. I tell my analyst this because my insomnia -- a problem that started during analysis, thanks very much -- sometimes eases up if I simply pretend I'm my old, pre-sleepless self. "Wouldn't it be worth trying drama therapy or something? So I could get into the character of being a good sleeper?"


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