Psychoanalysis has fallen on hard times. Freud’s gender theories are trashed for their sexism, and his original instinct theories are regarded skeptically. Psychiatrists don’t study it, and the only attention it gets in universities is from a handful of literature professors. Health insurers prefer the quick fix of psychoactive drugs, although they help less than their popularizers would lead us to believe.
But drugs can draw attention away from individual and social realities, supporting the exaggerated claims—of both Big Pharma and overconfident scientists—that human experience can be reduced to biology. This atmosphere lends further support to insurers’ self-interested turn to time-limited and mechanical psychotherapeutic approaches, like cognitive-behavioral therapies. While they can be helpful, they target a limited range of symptoms while ignoring the powerful emotional experiences—familial and social—that so often play a prominent role in causing those problems in the first place. Increasingly, psychotherapy is offered in impersonal formats reproducible through manuals. Presented as an effort to make treatment more efficient and reliable, this approach reflects insurers’ prioritizing their profits and the growing pressure on public sector providers to reduce the costs of already underfunded mental health services.
Psychoanalysts bear some responsibility for this turn. During the mid-twentieth century, when analysis was the dominant method for mental health treatment in the United States, its practitioners felt little obligation to carefully monitor how much difference they were really making. Although there were efforts to make psychoanalytic therapy available to groups beyond the middle and upper classes, the coin of the realm remained refined, costly, long-term intensive analytic therapies, often involving the traditional use of the couch.
Still, many who distrust some aspects of analysis seek it out when they need emotional help. And over the last decades, a new flexibility has emerged in psychoanalytic practice. Analysts increasingly recognize that a variety of formats can be applied to a wide range of emotional difficulties, without compromising the core analytic values of reflectiveness, empathy, and careful attention to feelings and meanings. A number of researchers are trying to show that empirical evidence supports psychoanalytically oriented approaches. Others have been finding new ways to adapt these methods to people who have often been marginalized by mental health systems, including such diverse groups as infants and young children, trauma victims, and recent immigrants.
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