A Tiny History of Psychoanalysis in America

I feel it is important to talk about the unique benefits of working with a psychoanalyst especially since so many today are unaware of what psychoanalysis has to offer. Many are not aware that psychoanalysis was the first and primary mode of talk therapy from the late 19th century through much of the 20th. In the United States, however, the story of the development of psychoanalysis is, sadly, a tale of power and money, coming from four directions: the medical profession, the psychology profession, the drug companies, and the insurance companies. Today, I would like to give a brief overview of these factors.

Psychoanalysis in America: The Doctor is In

Up until the 1980’s, much to the chagrin of Sigmund Freud, only psychiatrists and other medical professionals were permitted to practice psychoanalysis in the United States. In his time, Freud welcomed various professionals into the psychoanalytic community. In fact, it was common throughout Europe for psychologists, teachers, and pastors, as well as physicians to practice psychoanalysis with their patients, students, and parishioners. Here in the United States, however, medical practitioners claimed the province of psychoanalysis solely for themselves. It was during this time that Freud’s practice of treating patients with compassion often morphed into a cold, calculating, clinical treatment between the “expert” and the afflicted one. In 1985, four psychologists brought a class action lawsuit against psychoanalytic training institutes for their restriction of non-physicians as students and practitioners. Three years later, under force of law, the doors of these institutes were finally pried open and admitted psychologists and other licensed mental health providers for training.

Post WW II and the Growth of Treatment Options

Since World War II, the profession of psychology was growing rapidly in popularity in order to meet the burgeoning needs of Americans for mental health treatment. Since psychologists were forbidden to train as analysts until 1988, they were forced to think outside the box. Primarily located within universities, psychology as a science and profession grew within the academy instead of psychoanalytic institutes, which had the effect of removing psychoanalytic treatment further from the American public. It was there that these professionals fashioned alternative treatment approaches for psychological distress such as Behavioral therapies, Cognitive therapies, Cognitive-Behavioral therapies, Rational Emotional Behavioral therapies, various types of marital therapies, Imago therapy, Reality therapy, Gestalt therapy, and many more! Some of these newer approaches to therapy were necessary adjustments to a form of psychoanalysis which had become rigid, distant, authoritative, and, for many patients, arguably inhumane. As a result, many who suffered from mental anguish or emotional distress opted for one of these alternative treatments, which they viewed as more accessible and effective. Even today, most clinical psychologists-in-training will hear little of psychoanalysis and its benefits, while receiving a great deal of training in Cognitive-Behavioral types of treatment.

Easier to Pop a Pill: Prozac and Profit

A third factor that has diminished the impact of psychoanalysis in America has been the role of pharmaceuticals. The drug companies discovered medicinal solutions to ease some of the symptoms of psychological suffering. After all, why invest in psychotherapy if a pill will “cure” you? Today the vast majority of Americans either uses one of these psychotropic medications or has a friend or family member who does. Who hasn’t heard of Lexapro for depression, Xanax for anxiety, Depakote for bipolar disorder, or Adderall for ADHD? The reality is, however, that such pills do not “cure” people; they treat the symptoms and not the underlying issues. The irony is that psychiatrists, who battled to keep psychoanalysis as their sole province of treatment, rarely use it any more. Instead, many psychiatrists’ practices have become largely defined by treating mental illness with psychotropic medications. Even if psychological symptoms could be completely controlled, however, the psychological wounds and scars of having suffered with such issues still require an investment in psychotherapy.

If it’s Not Broke, Don’t Fix it: The View from an             Insurance Company

Finally, the insurance companies have served as gatekeepers for those seeking psychological help. Often, they only permit a certain number of sessions in any given year, effectively ruling out people who may be most helped by psychoanalysis. Many mental health providers eventually opt out of being on insurance panels for a host of reasons, not the least of which is the interference between patient and doctor regarding many aspects of treatment as well as the intrusion of an insurance company into the most intimate details of a person’s life. As a result, fewer patients have experienced the benefit of contemporary psychoanalysis.

Worth the Investment

So, if money and power have unwittingly conspired to disenfranchise so many mental health providers and patients from using psychoanalysis, why bother with it? If you believe, as I do, that people are incredibly complex, then psychoanalysis is worth considering. If you believe that the only way to heal from damage that you experienced in relationships is by being in a healing relationship, then psychoanalysis is worth your time. If you believe that problems which likely began in some form over the course of decades are not likely to vanish by a pill or a few sessions, then I believe your common sense may be telling you to try psychoanalysis as a more in-depth exploration of who you are, how you came to be that way, and how to make significant lifelong change.