Back To The Couch With Freud.

Joseph Bernstein, New York Times, March 26, 2023

This article is an attempt to suggest that Freudian psychoanalysis may be making a comeback in the U.S. I am not wholly persuaded. Bernstein has written a fine journalistic summary of the current state of various psychotherapeutic approaches. It is mostly focused on New York based psychoanalysis, though the article sets the proposed recent growth of psychoanalytic patients within the broader context of a waning interest in particular psychiatric drugs and a move away from cognitive behavioral therapy (CBT) as the dominant treatment approach for all mental health issues.


I agree with Bernstein’s comment that “Freud never totally disappeared. Some of his concepts,like denial and libido, are so deeply imbedded in popular culture that we no longer think of them as Freudian.” I would add just a few of his other concepts, such as ego, id, superego, free association, Oedipal complex, oral and anal phases, which are part of our cultural discourse. I believe psychotherapy in general has become progressively more imbedded in our U.S. culture over the last several decades, though this may not necessarily indicate a growth in people seeking psychoanalytic treatment. Classical Freudian psychoanalytic practice has evolved into a variety of approaches, with varying theoretical distinctions from Freud’s central propositions and varying practice parameters, such as fewer sessions per week and more empathetic engagement with patients. Any type of psychoanalytic treatment is still very expensive and usually longer term than many other types of psychotherapy. So called “efficacy” evaluations are misplaced when comparing something like cognitive behavioral therapy and psychoanalysis. CBT is often very short term and focused on treating phobias and anxiety issues. Psychoanalysis is generally longer term and deals with a fundamental transformation of one’s essential self and life meanings. It is not typically symptom treatment focused.

Bernstein mentions several film and television representations of psychotherapy/psychoanalysis, such as a forthcoming film, “Freud’s Last Session” with Anthony Hopkins, and “Couples Therapy” a Showtime series, featuring psychoanalyst Orna Guralnik, as well as the 2011 film, “A Dangerous Method”, about Freud, Jung and Sabina Speilrein. I have written about various media representations of psychotherapy/psychoanalysis in previous posts and one trend I have noted is that depictions of therapy in various media have become progressively more realistic and authentic. From Hitchkock’s “Spellbound”, through Tony Soprano and Dr Malfi, and “Dead Poet’s Society” to “In Treatment”, with Gabriel Berne as the therapist, film and TV representations have hewn closer to the “real thing”. But the first documentary representation to become widely available and impactful is “Couples Therapy”. I have used “In Treatment” in seminars to discuss the process of psychotherapy and the types of problems which arise and ways in which the therapist and his supervisor choose to deal with their patients/clients. This series was fictional and while it raised some important issues, such as the necessary ethical boundaries of the therapist, the audience knew it was not a documentary.

In a time when TV audiences have become entertained by a variety of “reality” shows, perhaps we have become trained to find interpersonal conflicts entertaining? Or are we identifying with characters and situations to the point of having these representations of therapy be somewhat therapeutic for ourselves. “Couples Therapy” offers us a psychoanalytic psychotherapy approach to resolving relationship conflicts, while teaching us about the kinds of conflicts many couples deal with and the possible ways a therapeutic guidance or intervention may help restore what likely was once a loving and healthy relationship. I would like to have data which would indicate how many couples may be seeking therapy as a result of watching “Couples Therapy”.

Bernstein includes the obligatory journalist’s mention of one of Freud’s critics, Frederick Crews, who I have referred to in my post about “Freud Bashing”. Crews’s criticisms notwithstanding, his impact is virtually nil, while Freud’s influence continues. Also mentioned is a quote from Orna Guralnik which underscores what I had written earlier in my posts on various biographies of Freud. She said, “I originally read Freud as a teenager and thought This is amazing. Then I came into all sorts of deep feminist critiques and started thinking This is a whole bunch of patriarchical garbage. But having read a lot more and having come to realize that you have to see Freud in the context of his time, I came out on the other side. There are all kinds of Freuds. And you kind of pick and choose what Freud you want to have.” I titled one of my posts, ” Who’s Freud, or Whose Freud?” I do think we need to think with and beyond Freud, however, when evaluating the current impact of psychoanalysis in the U.S. If we broaden our lens to consider what may be happening with a general increased involvement with all approaches in psychotherapy, a possible uptick in psychoanalytic sessions may be just part of a larger trend. After a few years of the Covid 19 sequestering, there is likely a pent up need for help with individual emotional problems and interpersonal conflicts, and while many therapists were forced to offer remote therapy sessions, people now have even more need for in-person visits to a therapist’s office. And most therapists are overbooked, which makes wait times longer. Psychoanalysis will likely remain a boutique therapy, appealing to people who can afford the time and cost and who are desirous of some kind of essential transformation of self.

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