FREQUENCY

Freud initially started out with very brief analyses, mostly aimed at relief of ego alien symptoms. The assumption was that the patient had a coherent ego to fall back on. As he began working with the transference and resistance, his analyses got longer and longer. They went from weeks, to months, to years, and finally, became “interminable”. The symptom analysis became a “character analysis.”

Contemporary analysts have widened the scope of analysis to include conditions Freud thought were untreatable. We have come to recognize the transferences that exist in narcissistic conditions, and to work with them. We call the treatment we do analysis because of its focus on transference, resistance, and the unconscious.

Freud throughout his career, was interested in tension arousal and reduction. He saw any increase of tension as leading to unpleasure, and any perceived reduction of it as pleasurable. Spotnitz(1969) had the idea of using Freud’s ideas about tension regulation in his work with seriously disturbed analysands. He tried putting them in charge of the amount of stimulation they would get in the sessions through the use of several techniques. One was what he called the “contact function” which meant that the analyst’s interventions were timed to some contact made by the patient—usually a question. He further experimented with frequency of sessions. He usually started with a once a week session and increased the number only if the patient requested more time and showed an ability to make use of it. If the patient frequently cancelled, was late, missed sessions or gave other signs that increasing the frequency would likely be detrimental to the treatment, he did not offer more sessions and explored requests made by the patient.

He originally developed his techniques to work more productively with narcissistic patients.

Later he discovered that the practice of starting with one session seemed to work with everyone, neurotics as well as more severely disturbed patients.

Part of the rationale for reduced frequency is the length of the treatment. We realize there is a temporal factor at work
in all learning. Think of how long it takes a baby to become fluent in his native language after he possesses the physical maturation to utter the first word at about a year. Another year and a half to two years will pass, and the baby is at the peak of his learning curve. How much longer for an adult to progress to the stage where “the best possible psychological conditions for the functions of ego” (Freud 1937) have been achieved.

Reducing the frequency allows patients to slowly metabolize what they have heard themselves or their analysts say. They can “go on being” (Winnicott, 19–) without having to react to the analyst. Self growth goes on between sessions. The ability to engage in self analysis, which ought to be a goal in every analysis is nurtured by this method.

The classic patient seems to have been rich and leisured. Our patients work constantly and never have enough money or time. Frequency is certainly an issue for them—so it seems reasonable to modify our treatment if alternatives work better with the patients we have.

June Bernstein, PhD