Why American psychoanalysts are an endangered species

Drugs, yoga, CBT and busy lives are occupying the space once reserved for the shrink’s couch

25 April 2015

9:00 AM

25 April 2015

9:00 AM


 New York City

Nothing says New York like a psychoanalyst’s couch. Think Woody Allen or those New Yorker cartoons. It fits our perception of east-coast Americans as all neurotic and self-obsessed. But that mental picture needs updating, because traditional psychoanalysis is in dramatic decline in its traditional heartland.

Across the urban US, in fact, the profession is dying out or having to change drastically. New figures from the American Psychoanalytic Association reveal that the average age of its 3,109 members is 66, up four years in a decade. More seriously, the average numbers of patients each therapist sees has fallen to 2.75. Some shrinks now never meet patients, dealing with them only via the phone, Skype or email. In the 1950s and 1960s, therapists could see between eight or ten patients a day. Now they’re lucky to see one.

So why are Americans shrinking from the shrinks? Packed modern lives must produce more therapist fodder than ever. But that’s part of the reason — a dwindling number of people now have the time or patience for the classic Freudian treatment of three to five weekly sessions — each lasting 45 to 50 minutes and costing up to $500.

The real change, however, seems to be in the American psyche. America — at least elite America — took psychoanalysis to heart in the post-war years. It helped that many Jewish analysts had fled Europe to New York, but it was also a by-product of tremendous affluence. Many Americans had little to worry about except their mental health. There was a name for such patients: the worried well.

Even then there was a sense that psychotherapy was scientifically wishy-washy, but such anxiety if anything helped the industry: if you can’t be cured, you have to keep coming back. Since the 1980s, however, medical insurance companies have been increasingly loath to pay for more than a single visit to the shrink a week, if that. The same decade saw the rise of biological alternatives in the form of psychotropic drugs. Products like Prozac could quickly treat depression, anxiety and panic attacks.

Other forms of treatment have also put the squeeze on psychoanalysis. Chief among these is cognitive behavioural therapy, which teaches people to bypass unhelpful thoughts. ‘It focuses more on the here and now [than psychoanalysis], and the changes in how people think, rather than talking about childhood all the time, about the unconscious or Oedipal complex and so forth,’ says New York psychiatrist Sebastian Zimmermann.

Yoga and meditation are also drawing away people who would once have seen a shrink, say analysts. Purists still insist on the old Freudian ways but many analysts spice up their treatment with breathing exercises and other techniques.

They’re also watering down the rules of engagement set out by the great man. Freud thought that lying down made it easier for a patient to ‘free associate’, to speak about anything coming to mind without censoring it. If he can make eye contact with the analyst, the patient tries to read the reaction he is producing and perhaps tailor what he says to suit. He’s probably going to feel less comfortable ‘regressing’ to early childhood.

But the couches are largely for show now. If a patient only comes in once a week, you have to cut to the chase. He or she can sit on the couch and talk directly to the shrink. ‘I do have patients who want to lie down and then we talk about why they want to lie down,’ a Manhattan analyst told me.

Some say that today’s digital narcissism has replaced the need for a talking cure. Who needs an analyst when every inane tweet or Facebook post will get a response from someone? Yet studies show that the longer we spend on social media, the more isolated and depressed we feel. ‘Nothing can replace human face-to-face contact,’ said an analyst.

Dr Zimmermann, a photographer on the side, has just published Fifty Shrinks, a book of portraits of Manhattan therapists in their offices. He partly did it to preserve what he fears is a vanishing piece of medical history.

But all is not lost. There’s a growing interest in China. ‘It’s a dictatorship, of course, and the Chinese haven’t really looked into their traumatic revolutionary past,’ an Upper West Side analyst told me. ‘Rich Chinese are turning to New York shrinks and getting their sessions on Skype.’ Psychotherapy is moving with the money. Or maybe the citizens of a new superpower just need to talk to someone.

Got something to add? Join the discussion and comment below.

Tom Leonard is a US correspondent for the Daily Mail.

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Show comments
  • Diggery Whiggery

    People are just finding other ways of filling the emptiness.

  • Michael Donner

    There are so many distortions and stereotypes in this article. Psychoanalysis has changed, as it should. Saying psychoanalysis is dead because it adapted and doesn’t use the couch is like saying medicine is dead because it no longer uses leeches.

    Many of the fundamental principles of psychoanalysis (the unconscious, the importance of early relationships) are fundamental to most treatment, including CBT

    The reports of the death of psychoanalysis have been greatly exaggerated.

  • tomgreaves

    Classical psychoanalysis has long been eclipsed by a huge number of treatment methods and modalities that preserve its fundamental principles; and yet most deny they do so. It is popular to sneer at Freud, but his analytical treatment pioneered talk therapies that have successfully treated millions. Importantly, neuroscience has been greatly enlightened by psychoanalytic theory, which employs many insights delivered by Freud in his early work on the project to make psychology a science. And, just to say that CBT is a very limited treatment modality; but it suits the consumer age where people trust the market to deliver them instant remedies. It also suits governments and health authorities pursuing economic efficiency, who peddle the idea that cognitive behaviour can mould and shape the mind, moods and the personality. This is not only an absurd idea but an immoral one.

    • cartimandua

      Certainly over here it means a doctor has “done something” and a box is ticked.

    • Hippograd

      treatment methods and modalities

      I wish it were popular to sneer people who use words like “modalities”.

      • Verbatim

        Modalities? These are a kind of German verb: Ich mussen, Ich will etc. etc.

        • post_x_it

          “Ich mussen”? I don’t know what language that is, but it’s not German.

    • ClausewitzTheMunificent

      It might also be the fact that Freud’s theories make people uncomfortable at first glance – hence they like most “offensive” things these days are brushed under the carpet.

    • Freud was fraudulent. There’s no getting around it.

      • Precambrian

        Not completely. Laing did more damage really, with his full-on self-obsession manifesto. Freud made some good points on how close the beast is to the surface in so many people (which is how Bernays made so much money on the back of it).

        • Freud, apart from fudging this and that, had two fundamentally self-sourced unevidenced wrongheaded views of humanity. Firstly, he believed in ‘the unconscious’, as if it were a counterpart to and indeed a driver of consciousness. It isn’t. (I often think that people that make claims for their ‘unconscious’ are really trying to evade responsibility — and self-consciousness.) Secondly, he thought that the most important (and so interesting) parts of a human were those you cannot see, and that we as desirous beings are essentially formed and sealed-off in infancy. Ludicrously untrue and unhelpful, and shows that the man had no idea how to grapple with actual grownups as he found them.

          • Astvatz_Troov

            “Firstly, he believed in ‘the unconscious’, as if it were a counterpart to and indeed a driver of consciousness. It isn’t. ”

            With all due respect, you don’t know what you’re talking about when you make statements like that. I’m not coming at this from a theoretical position but from the context of a working system. I’m well acquainted with the unconscious and the very narrow limits within which we work on the level of consciousness… limits not just self-created or due to social conditioning, but due to many factors… including evolutionary and cosmological factors.

            The unconscious is indeed the larger part of the iceberg we can’t see, and is very much a “driver” – especially in those whose behaviour is more automatic and instinctual. But Freud was about settling, engineering and labeling what is essentially our birthright… that about us which is most vital and most primal. We need to take repossession on an entirely different set of terms once Freud has been evicted along with his fellow poachers. The unconscious is the key… not only to personal transformation but to health, integration and community cohesion. The problem is after WW2 we became afraid of the power of the unconscious and went toward empty secular humanism… the arid existentialism that was in certain key respects an exercise in futility.

            Freud was a trespasser on terrain that cannot be codified along these lines… or at least should not be. But needless to say with his limited tools (he and his) – they were always hopelessly out of their depth and the chickens have finally come home to roost… as many of us always knew they would.

      • Astvatz_Troov

        Time to coin a neologism… “freudulent”.

        Indeed he was, a massive con. He and others of his “tribe” have cleverly used the mind as a pathway to control, and not just on the psychiatrist’s couch… also in relation to mass culture and politics.The psyche game and its wider ramifications were apparent long ago… but unfortunately it has taken the sleeping masses a while to catch up. Even then, although the psyche trend may have fallen off, real understanding hasn’t necessarily followed… the real reason why.

        Unfortunately the post-war overreaction to Nazi excesses swung the pendulum too far in the other direction… laying us open to a form of mass neutering and the PC’ification of society that followed from that. These psyche vampires feed on passivity. To the extent that true individualism, true independence was undermined… psychoanalysis and its accompanying agenda took hold. I’m not a Scientologist… but when it comes to an assessment of psychiatry and its poisonous effect on society, Hubbard was absolutely correct.

  • cartimandua

    Psychoanalysis and CBT light up different parts of the brain. The trouble with CBT is it is very limited. The symptom merely shifts and the patient revolves through the door.
    Nor can it “deal with” anything but mild depression.

    • And mild depression isn’t worth ‘dealing’ with, and without drugs, on an ongoing basis? I’d say that’s a success that you’re spinning as failure.

      • cartimandua

        I am saying what highly trained CBT therapists will say. What they can offer works well for some conditions and some people. It is not a quick fix panacea and it doesn’t work for all conditions and every person.
        Governments and health insurance companies want quick fixes so they have been pushing the idea that a bit of CBT will fix everything and it is just not so.

  • RavenRandom

    There’s also the fact. not mentioned in the article, that traditional Freudian psychoanalysis has a dubious success record at best, and has been largely superseded.

    • ClausewitzTheMunificent

      Sure with mind altering psycho-drugs which supposedly treat symptoms and have horrible side effects.

  • jim

    No loss.Americans have been on the couch for decades and are more wrecked in the head than ever.Psychoanalysis has done more damage to the US than hard drugs. Once it got a grip on Hollywood the infection was bound to spread.These people are not doctors.It is not a science. If it’s on the way out then hopefully it will take all that annoying Oprah style psychobabble with it.People who should have been taking an interest in the direction their country was taking instead began to obsess about themselves.We can see the results of this self absorbtion all around us.

  • Ambientereal

    I never believed in Psychological treatments and never saw the Psyc. as a science, because it is grounded more in opinions than in facts. Its influence in education has been very negative and although some claim that it has healed or helped millions, I think it made the living worse for even more people.

    • mikewaller

      The only sensible route into human psychology is via evolutionary theory. Ironically, in my view at least that now gives support to one of Freud’s most controversial proposals: that idea that the humans drives directed at survival and reproduction are accompanied by a propensity for self-destruction, it too fine tuned by natural selection.

  • James

    Psychiatry is a swindle industry when folks will pay higher costs per hour than solicitors week in week out when they could just change their environment for a short while and get perspective.

    • Farage’s Fried Chicken

      Still not believing what you write?

      • Verbatim

        That’s because you haven’t taken your tablets.

    • Jackthesmilingblack

      And a few weeks on the back-packer trail is a sure-fire way to get rid of writer’s block.

  • Farage’s Fried Chicken

    Most shrinks need help themselves.
    Why many are refusing self-analysis/a regular chit chat with colleagues is beyond me.

    • Verbatim

      And, of course, you speak from vast experience. That much is obvious.

    • Damaris Tighe

      Most people who study any of the branches of psychology have ‘issues’. That’s why they’re attracted to it. They’re wounded healers. But psychoanalysts (unlike psychiatrists & clinical psychologists) are required to have a full analysis themselves as part of their training. They’re also required to have regular supervision which analyses their relationship with their clients.

      I once worked in an acute psychiatric hospital. I was appalled by the psychiatrists’ lack of people skills – their lack of insight into the emotional impact they were having on their patients. They made mistakes that the most basically trained counsellor, let alone a psychoanalyst, would have avoided.

  • goodsoldier

    They are so busy giving SSRI medications to children so that they can be under supervision for life. How come the press never report on the SSRI medications taken by young people who suddenly break out in violence? I think they approve of mass medication to the masses to keep them supine until they burst into a violent frenzy. The NHS pushes drugs on teenagers rather than spending 15 minutes in frank and open discussion. No wonder the suicide rate is so high. These SSRI medications are are killers if used more than 2 months.

  • Verbatim

    They’re an ‘endangered species’ because they are fraudulent, like Dr. Phil – that master of Pop Psychology. Americans need to get their heads out of their rears.

  • Jackthesmilingblack

    The US needs more shrinks not less. Face it, the US is wall-to-wall nutter.

  • James Hamilton

    The entire “profession” is absolute bunkum. These charlatans deserve to go the way of phrenologists.

  • Terence Hale

    “Why American psychoanalysts are an endangered species”. My assessment of psychoanalysts on the European continent is reimbursement from medical insurances and the trend to medication as an alternative.

  • Matt

    This is a poorly written article by an individual who clearly has not read much of the psychotherapy outcomes literature. Using The American Psychoanalytic Association for data on trends in American psychoanalysis would indeed paint this picture – however they are but one organization among many. And their data cited speaks more about their organization than psychoanalysis as a discipline. This is not a good example of science journalism. For recent data on the efficacy of psychodynamic psychotherapy: https://www.apa.org/pubs/journals/releases/amp-65-2-98.pdf

  • Fraser Bailey

    Wow! Some good news.

  • PaD

    I think the real reason for its decline is other than some efficacious talk therapy put out by Freud….it;s all bullshit…was then …still is now in its myriad forms

  • Cymrugel

    Good thing too.

    Psychoanalysis should only be used sparingly for real, major problems. Most issues can be resolved with self help and meditation, plus some moral support from loved ones, as is now finally happening.

    This can only be beneficial. After all, how many people can afford analysis?
    Come to that how effective is it on the industrial scale?

    Look at Woody Allan ; decades of analysis, yet he is too self absorbed to understand why his girlfriend of 10 years would be angry that he is having sex with her adopted daughter.

    Whether its legal ort not is immaterial. A person with basic self awareness would surely realise that his behaviour is questionable at best. But no – he is completely perplexed that she could be angry.

    I think Woody is entitled to a refund.

  • Davedeparis

    The best line about pyschoanalysis I’ve heard is that, “it is the disease which pretends to be the cure”.