How Many Times?

Abstract

Session frequency can be seen as definitive of psychoanalytic identity but contemporary relational and constructivist perspectives and trends towards psychoanalytic work being conducted at lower and varying frequencies are leading increasingly to a rift between psychoanalytic work as theorized and practised on the one hand and as ‘taught at’ specified frequencies within psychoanalytic institutions on the other. The value of high‐frequency work in the right conditions is considered, while automatic equations between high‐frequency, high‐intensity and high‐value clinical work are questioned. Pressure towards higher frequency work, sometimes to meet training requirements, may imperil the psychoanalytic stance it seeks to preserve, particularly the recognition of patients’ frequency preferences as a psychic phenomenon requiring understanding rather than manipulation. The roots of coercive attitudes to session frequency in unresolved issues relating to institutional psychoanalytic superegos are explored; implications for training, ethics and the status of psychoanalytic work are considered.

The Harmful Effects of Psychotherapy: When the Therapeutic Alliance Fails

“…Polden () highlights the uncertainties and anxieties that psychoanalytic psychotherapists have to negotiate on a daily basis in the consulting room and the difficulty in maintaining an analytic stance in the face of conflicting pressures. Like Leuzinger‐Bohbeler and Goretti, she suggests that for some patients, the therapist's pressure on the patient to increase the frequency of sessions and a classical analyst's prolonged silences in a session can be experienced by a patient as intensely persecutory, giving a vivid clinical example of the latter (Polden, , p. 593). She suggests that the analyst's tendency to rely under pressure on the overvalued idea of more intensive sessions is an attitude which forces the facts of the particular patient's needs to fit the analyst's belief, so compromising the creation of a genuine analytic space.…”