Long-Term Psychoanalysis: Does It Really Work?

Here’s hoping that psychotherapist and advice columnist Jonathan Alpert signed on for the Whistleblower Protection Program before he wrote the opinion piece in Sunday’s New York Times entitled “In Therapy Forever? Enough Already.”

According to Alpert, who's also the author of Be Fearless: Change Your Life in 28 Days, too many patients remain in therapy far too long with doctors who aren’t helping them. Alpert maintains that these therapists typically listen, nod and offer little or no advice. As he wrote in his Times article, “I have come to a sobering conclusion over the years: ineffective therapy is disturbingly common.” 

I hear you. For many years I went to a therapist who didn't just nod — she nodded off during our sessions. And I don’t blame her: After a few months we ran out of things to talk about. A friend of mine recently told me that her therapist often nods off too. “Sometimes I have to wake her up by clapping my hands,” my friend said. “I already see her once a week, and she wants me to come twice.”

By no means is Alpert saying that long-term therapy isn’t helpful. For those who have truly serious mental disorders, like schizophrenia, it may be the only kind of therapy, he wrote. But for your run-of-the-mill neurotics like me, the long-term approach can be excessive. In my experience, it’s the first few months of treatment that matter most — that's when I identify the problem and take steps to fix it. When the therapy continues, and continues, there’s not a lot left in the subconscious to dredge up. The silences between patient and doctor become deafening.

Therapy, as everyone knows, doesn't come cheap — and that naturally creates an incentive for the therapist. Patients, after all, are clients, and no business wants to send customers away, especially when they’re paying $200 or more an hour. Anyone who’s been in long-term therapy knows what it’s like to be in shrink debt. You’re in a perpetual state of anxiety and depression about all the money you’re spending to get over your anxiety and depression.

After so many “see you next weeks,” you begin to wonder: Is my analyst really trying to help me get better? Or does he simply want my money to help pay for the new Nendo chairs in the waiting room? Or for that villa he rents every August in the South of France?

When I was in my late 20s and living in San Francisco, I went to an Austrian psychiatrist whose office was in the library of his house in Pacific Heights. An older man, he looked just like Alfred Hitchcock, right down to the extended stomach and high-waisted trousers. I'd ring his doorbell, and he’d buzz me in. “Gud afternoon,” he’d say in his Germanic accent, standing in profile at the top of his stairs. Believe me, nothing says “Snap out of it!” faster than having a shrink who's a dead ringer for the man who directed "Psycho." I used to tremble as I walked up those steps.

I didn't continue with him for long. After a few sessions, he cut to the chase. “Your problem is you need to leave California,” he told me. “Go and live in New York. You’ll be happier being away from your family.” I took his advice, and he proved to be right. “Separate Coasts” should be its own chapter in every psychology textbook.

Before I moved on, a friend of mine was seeing him too. One night Suzy called me, hysterical. “I’ve been fired,” she said. “By your boss?” I asked. “No, by our shrink. He told me that my fiancé, Eddie, was a swamp and that he was dragging me under. He told me that as long as I stayed with Eddie, my coming to therapy was useless. So he fired me. He told me to never come back.”

Now there’s a therapist that Alpert could respect!

“In my experience, most people seek therapeutic help for discreet, treatable issues: they are stuck in unfulfilling jobs or relationships, they can’t reach their goals, are fearful of change and depressed as a result,” Alpert wrote in the Times. “It doesn’t take years of therapy to get to the bottom of those kinds of problems. For some of my patients, it doesn’t even take a whole session.”

If Alpert hasn’t already been torn apart by an angry mob of Upper East Side analysts, I’m going to book an appointment with him right away. I’ll be in New York next Tuesday. Depending on crosstown traffic, I should have some free time between 3 and 3:45 p.m. I look forward to being cured.