The real difference between psychotherapy and psychoanalysis is how often we meet. Conventionally, being in psychoanalysis means having sessions four or five times a week, and being in psychotherapy means coming less often. Once-a-week treatment does run the risk of becoming the “news of the week in review.” By meeting more frequently, we can move beyond surface concerns and work at the underlying problems which interfere with connecting, loving, working, being expressive and creative, feeling better. It becomes safer to reveal yourself when you know that we can pick up the conversation tomorrow.

There’s a popular notion that more frequent treatment is for those who are more disturbed, that coming often must mean you’re “really sick.” But it’s actually the other way around. It takes a measure of personal strength to engage in a substantial treatment. Most of the people I’ve seen in psychoanalysis have been students or professionals with fully engaged personal lives. For stubborn inner problems, which have been years or decades in the fashioning, it may be that nothing less than an intensive treatment will make a difference. A maladaptive way of negotiating the world fashioned over a lifetime can’t be shifted quickly or easily.

“So am I signing on to do this for the next ten years?” I might be asked at this point. “Am I surrendering my life? Am I another perpetual patient like Woody Allen?” might be the private thought. (My first thought is: But think of all the great movies he made during those years of treatment.) What I’d say is this: You’re not signing on for life, you’re going to give it a try. If it doesn’t seem useful you’ll move on and try something else. And if it does feel helpful, it folds into your life like other useful activities which take time (working out at the gym, practicing at the piano, participating at the church, and so forth). Analysis makes heavy demands in time and money, and you’ll only stay with it if you sense that it’s become worth doing.