A RATIONALE FOR LONG ANALYSES--- REALIZING POTENTIAL

Victor Bloom MD

In this era of medical cost-cutting, managed care restrictions and efficient use of time and professional personnel, it would seem hard to justify long analyses, especially when the analysand is essentially 'well'. Psychoanalysis has been criticized in some circles for not only being ineffectual, but wasting efforts on the 'worried-well'.

For the purposes of this paper, long analyses will be arbitrarily defined as analyses of more than five and more than ten years, especially when the patient is relatively asymptomatic and highly functioning. In effect, there is clearly no medical necessity to continued analysis and the patient is not suffering.

In these cases the patient is intelligent and highly motivated to achieve a deep understanding of themselves and others, and realize there are many layers to the unconscious. They want to know as much as is humanly possible about their own psyche and the human condition. They pass from one phase of human development to another, from decade to decade, each posing unique challenges and opportunities.

The key element to a philosophy of optimal personal development is a concept of realizing one's potential. Many observers of the human predicament express the sentiment that we are our own worst enemy and that most of us, perhaps because of the many limitations of fallible parents and a dysfunctional family, as well as the requirements of civilization, we do not realize our full potential of creativity because of the inhibition of instincts, repression of the primary process and other maladaptive defense mechanisms. This is what Freud was talking about in his "Civilization and its Discontents".

The most common impediment to optimal human development is characterological rigidity (Wilhelm Reich), which is ego-syntonic and extraordinarily resistant to change. In these cases, the analysand is aware of impediments which detract from ultimate gratification and balance in the areas of Love and Work.

Cases are presented in which long analyses dealt persistently, patiently and empathically with longstanding character disorders limiting interpersonal effectiveness at home and in the workplace. The analysand was interested in fine-tuning his or her life and adjustment to the world. As a result, family relationships were optimized, parenting was improved, and business and artistic creativity flowered, with tangible rewards, both symbolic and financial.

Ultimately, in some cases, the cumulative income of wage earners and business and professional persons more than paid for the expense of the long analysis. These patients have declared that psychoanalysis was the best investment they ever made and do not regret one penny of the cost.

In such cases, the needs and aspirations of the individual transcend the generalized conclusions of the group and the economics of the marketplace are tangential and irrelevant.