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An Interview with Fern Cohen, Ph.D. on whether Psychoanalysis is Dead

David Van Nuys, Ph.D. Updated: Aug 18th 2008

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Fern Cohen, Ph.D.In this episode of the Wise Counsel Podcast, Dr. Van Nuys speaks with Psychologist and Psychoanalyst Fern Cohen, Ph.D. on the provocative theme, "Is Psychoanalysis Dead?". In this context, Psychoanalysis refers to the version of psychoanalysis developed by Dr. Freud (e.g., the one with the couch) and not to modern psychodynamic versions related to that original therapy. Not surprisingly, Dr. Cohen doesn't think that psychoanalysis is dead at all. While acknowledging that this form of therapy is on the decline in terms of practitioners, she points out various ways that it continues to be vital and important.

Dr. Cohen suggests that various cultural forces have come together to influence the decline in psychoanalysis' popularity. These influences include the increasing desire for a quick fix for mental health issues, the wide availability of psychiatric medications, and alterations in how the American health insurance system will reimburse for therapy treatment. The heyday of American psychoanalysis was during the 1950s and 60s, prior to the development of modern psychiatric medications and before the advent of managed care.

Dr. Cohen talks about the development of her interest in psychoanalysis; a journey very much influenced by her own personal experiences as a patient (or "analysand" as patients are called in psychoanalysis). She had three major engagements of psychoanalysis in her life, first as a college student, then as a young mother, and then later while training to be a psychoanalyst herself. Though a variety of problems urged her into therapy each time, a consistent theme emerged with the therapy becoming in most cases a way to work on a core issue of feeling deprived of enough attention from her father. At various times in her life this issue was showing up in a variety of ways in her life and causing problems; for instance, it negatively affected her choice of relationship partners, and influenced her to become a "workaholic". Over much therapy involving her transference to her analyst who became for a time a father-like figure to her on which she felt dependent, she was able to work through this unresolved longing so that she felt better and had less of a need to act out her issues because those issues were identified and more resolved. She has written about this process in her book, " From Both Sides of the Couch: Reflections of a Psychoanalyst, Daughter Tennis Player and Other Selves ".

Drs. Van Nuys and Cohen talk about the professions involved in traditional psychoanalysis. Though Freud originally did not intend psychoanalysis to be the exclusive domain of medical doctors, that is how the profession evolved in America, with only Medical Doctors being admitted to the first accredited psychoanalytic training institutions. Ultimately, a lawsuit was filed and won which forced these training institutions to admit qualified psychologists and social workers, and since that time, the field has become populated with more psychologists and social workers than medical doctors who are increasingly oriented towards medication treatments.

Though it still uses a couch in many cases, traditional psychoanalysis has not remained a static therapy but instead has evolved over time. The development of the object relational school of therapy is one major development, but in Dr. Cohen's opinion, the most significant development is that analysts are not the silent distant figures they once were, but instead are more inclined to answer questions and engage directly with the analysand. In addition to being more willing to talk with analysands, modern Freudian psychoanalysts are also taking a less authoritative stand, seeing themselves as co-journeyers as opposed to authorities. Another big change is that the field has updated its understanding of female psychology; something which Freud originally got very wrong.

Psychoanalysis is a time intensive therapy requiring two or more sessions each week. It is not covered by insurance, and it lasts for years at a time. This makes the therapy a luxury item affordable only by the wealthy, as a general rule. It is possible to get a discounted analysis by going to a training institution, however, but for the most part this is not an option. The expense of psychoanalysis, both in terms of money and time, has contributed to its decline.

Most training programs do not teach psychoanalytic therapy anymore, instead opting for training students in cognitive therapy and variations thereof. Dr. Cohen sees this development as a training disaster in that cognitive therapy is in her (and in Dr. Van Nuys' opinion too) relatively superficial in nature, and content to ignore patient's past history. Dr. Van Nuys points out that he has heard stories of cognitively trained therapists who have subsequently trained as analysts after practicing CT and CBT for a number of years so as to be able to provide a more in-depth therapy to their patients. Though not discussed in this interview, other CT trained therapists have incorporated psychodynamic ideas into cognitive therapy resulting in innovative forms of CT such as Dr. Jeffrey Young's Schema Therapy.

In Dr. Cohen's opinion, the most significant difference between traditional psychoanalytic psychotherapy (with the couch) and the more relaxed child of that therapy, commonly called psychodynamic psychotherapy today, is the amount of time that the analyst and analysand spend together. Psychoanalysis occurs multiple times per week, while psychodynamic therapy occurs once a week. The expanded time together that occurs in psychoanalysis fosters a more intensive transference relationship between therapist and patient, which makes the therapy a deeper, more fundamental change process than what is possible with less frequency of sessions.

Dr. Van Nuys closes the interview by asking Dr. Cohen to speculate about the future of traditional psychoanalytic therapy. She believes it will continue to exist in some form despite its dwindling therapist base, and despite the fact that the object relational approach has become dominant over the original Freudian version of the therapy.

Links Relevant To This Podcast:

About Fern Cohen, Ph.D.

Fern Cohen, Ph.D.Fern W. Cohen, PhD is a psychoanalyst and psychotherapist in private practice in New York City, and has long been committed to conveying in everyday language what the psychoanalytic process is about and how it works. She is the author of the 2007 book, From Both Sides of The Couch: Reflections of A Psychoanalyst, Daughter, Tennis Player, and Other Selves… A graduate of Radcliffe College, Dr. Cohen earned her Ph.D. in School Psychology from New York University and completed her analytic training at the NYU Postdoctoral Program in Psychotherapy and Psychoanalysis as well as the Institute for Psychoanalytic Training and Research (IPTAR) of which she is a member. When she is not playing tennis, hanging out with her grandchildren or mastering music for two pianos, she is practicing psychoanalysis in New York City.

    Reader Comments
    Discuss this issue below or in our forums.

    Great program - - Jun 11th 2009

    Dr. Dave,

    This was a great program. As someone who attends therapy three times a week, it was wonderful to hear someone discuss how much work is really involved in getting to the bottom of one's problems, which of course really means getting to know oneself more completely, and accepting who you are. This is an arduous and often maddeningly painstaking process that also often seems unending, tedious and just plain god-awful. Not to mention that it can take years to really figure out what's going on.

    Dr. Cohen's description of our culture's quick-fix approach to everything, including deep-seated emotional issues, was spot on. Would I love to be "cured" in 6-10 sessions of CBT, spinning around in a chair to mimic my anxiety symptoms? Of course I would, and I guess some people are. But the truth - at least for me - is that my problems require a lot of digging, a lot of analysis, and a lot of work. I think this was the bottom line of Dr. Cohen's ideas. 

    I would love to hear another program about this kind of psychotherapy. I would also love to hear a program on the use of dream analysis to reveal the workings of the unconcious.

    Keep up the great work!

    - R

    Clarification about frequency vis a vis psychotherapy - fern cohen - Jan 26th 2009
    For the sake of clarification in a somewhat muddied field, psychodynamic psychotherapy does not only occur once a week; in fact, the optimal conditions for psychodynamic therapy are a minimum of twice a week.  The minimal frequency for psychoanalysis (according to most trained practitioners, but not all) is three times a week, and for some schools (as in contemporary Freudian), four or even five.  It is the greater frequency that usually fosters a more intense transference, which is the "medium" through which much of the process unfolds. Although the therapist might be more active in psychotherapy (ie., talk more), the basic tools are much the same: silence to create a space for free association and process, interpretation of transference, pointing out patterns that are presumably related to an  but most of all, helping a individual recognize his or her unconscious processes and learning about how unconscious mind works - for better, but often for worse if undetected.

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