Inching towards psychoanalysis

For background, I started off seeing my current therapist once a week a little over two years ago. We added a second session last year, which has been great and really useful. And we've talked on and off for the past six months about the possibility of my using the analytic couch in his office, with several intense discussions about it recently, though I still haven't tried it.

Then during my second session this week, he comes out with "I wonder if you think it would be helpful to come more often." And goes on to talk about how his patients who come three or more times a week find it makes it easier to work through things like the times I (often) have a lot of trouble talking at the beginning of the session, or the many ways I feel conflicted about therapy in general.

That made sense to me, but it was also a very odd conversation, since I wasn't expecting it and felt very caught off-guard by the suggestion. We talked about the benefits and downsides of increased session frequency for a bit before moving on to other things, and I left it at being something I'm interested in but also horrified by and need to talk about more.

Then later that day it suddenly hit me--we're now talking about using the couch and having sessions 3-4 times a week, and there's a pretty well established term for that: psychoanalysis. I don't think he's trying to be obfuscatory in any way, but I do find it interesting that he's gradually introduced the key extrinsic elements of psychoanalysis without using the label.

In some ways it makes perfect sense to talk about those elements without simultaneously invoking all of the baggage the term "psychoanalysis" evokes. And of course these are only the extrinsic elements, and my gut feeling is that the internal processes of therapy will stay essentially the same even if I do go more often and use the couch. Still, I'm curious if anyone else has experienced something similar--a slow slide of inching towards a different modality without quote realizing that's where you were headed--and what that was like for you.

Note, not looking for advice on how to discuss this with my therapist or anything along those lines. Just thought other people might find it interesting and was curious if anyone else has had a similar experience!

I inched my way into analysis. For awhile (a year?) I saw my T once a week, then went 2x/week for ~9 months, then 3x for ~9 months, then up to 4, then eventually 5. I moved to the couch a few months after bumping up to 4x/week, and it’s a little bit modified. I’ve found it extremely beneficial and I’ve grown a lot. It’s certainly not for everyone, but if you have the time, money and inclination, go for it.

Using a couch and seeing a therapist frequently doesn't make it psychoanalysis. And I find the gradual, subtle persuasion by your therapist to drastically up your sessions a bit creepy, tbh. And possibly predatory.

I go twice a week but I have switched to using the couch and I find it very helpful. It is easier to talk freely, I concentrate better, and I don't think as much about T's reactions to what I'm saying. I never thought I was very focused on how he reacted to things but it's hard not to notice changes in someone's face, even if I don't really think about it.

It seems strange that he wouldn't call it psychoanalysis straight out. I guess maybe because that would make it a more official change? Still it seems a little manipulative.

The therapy is analytic based on the Ts training, not whether a couch is used...I think the couch allows you to go deeper.

My T doesn't like to use the couch because he can't see your facial expressions etc. I've never been that interested either.

I don’t think it’s odd that he hasn’t put a label on it. It sounds like you’d be doing pretty much the same thing you are currently doing, but more frequently. I am intrigued by the couch though. I don’t use the couch, but find it both interesting and scary. I do like the idea of it being more freeing since you don’t have to worry about facial expressions, etc. I’m talking with my T about going from once to twice per week although he has mentioned that he sees others 3 or 4 times per week.

Thank you so much for sharing that--it seems like your experience is in this regard a further-down-the-road counterpart to mine, and it's extremely useful to get your insight. I've had such an immensely helpful experience in this iteration of therapy so far, in a way that makes me eager to deepen and intensify things if I can, in spite of also being conflicted about it.

How long have you been doing 5x a week? Did you suggest the schedule changes and the couch, or did your therapist bring them up first? Have you felt like the couch and session frequency changed things significantly for you in sessions, or has it been more of a smooth continuum as you've inched along?

Absolutely. As I mentioned in my original post, those are just the classic extrinsic facilitators that have a strong association with the label. And many people consider them unnecessary to psychoanalysis, though some consider them necessary but not sufficient.

Fortunately there's nothing creepy or predatory going on. Or drastic, for that matter. My therapist makes suggestions from time to time about ways we might consider adjusting things to make therapy more effective and comfortable for me (when possible), but they're always options that he presents without an agenda. He's also asked in the past if I thought going back to one session a week might be helpful (I didn't think it would, but we talked about it).

This last conversation about increasing sessions was spurred contextually by something I said, and though I didn't anticipate he was going to go in that direction with it, I think it's a reasonable suggestion. It's also one I've been thinking about from time to time for months, though I haven't said anything about it in therapy for a variety of reasons.

I moved from 1 to 2 to 3 over a year as we both discovered it was more effective. I also moved from the chair to the sofa. I tried laying down once to try it as an analyst's couch but didn't like it.

However I did it again organically a few times when a certain part was to the fore and that's the position she likes. But I change the way I sit or lie at will.

I've no idea what my therapist prefers. Prob the chair as that is what we started with. But if I wanted to stand in my head I'm sure she wouldn't have an issue - we would talkkkkkkkkk about it though!

That's great, and useful and interesting to hear. I do typically already look away from my therapist for most of the session, which makes part of me think the couch is unnecessary, and makes part of me think it's an obvious thing to try.

Or possibly that he wanted to keep the focus on each aspect of it individually, and not make it seem like some kind of official package deal? I don't think it was meant manipulatively, though I will start thinking it's very strange if the label doesn't make an appearance at some point as we talk about this. He did mention psychoanalysis in a previous session as a context in which the couch is commonly used, so I expect it will come up, though I'm not sure how I feel about it.

Of course, none of this would be applicable if my therapist weren't an analyst. And obviously there are differences of opinion out there about whether extrinsic facilitators like the couch and a certain session frequency are definitional or necessary to psychoanalysis, and about whether there's any bright line between analytic therapy and psychoanalysis vs them being the same thing or existing on a continuum together.

I'm intrigued that you see the couch as allowing people to go deeper but that you and your therapist aren't interested. The possible loss of facial expressions is a big deal to me too, but I'm beginning to think the tradeoff would be worth it if it made it easier to speak and listen.

I have nothing to share regarding your original question because I jumped right in from the beginning. But I wanted to comment on the trouble of talking at the beginning of the session.

This has always been very difficult for me and I don't think the couch made any difference here. Of course, I couldn't even imagine how it would have been with less frequent sessions. Maybe it would have seemed "easier" because I would have held my mask on for much longer and not gone into this deep empty place where starting the session felt impossible? I don't know.

Obviously you have your own reasons why starting the sessions are difficult but my experience just says that frequent sessions are not necessarily a remedy against that issue. But they most certainly would enable you to go far deeper than is possible with 1 or even with 2 sessions per week because there just will be time to zoom in into tiny things that on surface look irrelevant but after zooming in end up being significant.

Thanks for this. Yes, part of me finds it comforting to remind myself that it's all the same thing, just more of it. Increasing to two sessions did feel very different in some ways, though. That said, I do highly recommend it if you're able to give it a try.

As for the couch, I feel very similarly--intrigued, but every time I think I'm going to try it there's an intense fear that wins out.

You wouldn't necessarily have to talk more. Any analyst loves a good long silence. Gives them a bit of time to do their shopping list

I'm intrigued by the couch. My T and I are so tuned in to each other's body language during session that not being able to see him would invoke some serious anxiety. I find it fascinating for those of you who can do it tho! (My last T had a couch, but I always sat on the floor...just found it better...I'd sit on the floor now, but his office is too small).

I've actually made a post similar to this a few months ago. When I started seeing my T, we started off with 1x week sessions that quickly became 2. At that time I had a separate EMDR therapist that I was seeing 1x week. That became conflicting having separate Ts, so I switched to just the one. That was in October and since then I've been going 3x a week. Maybe once or twice we've added in an extra session if I've been really struggling. But he's been very clear to me from the start that this is how he practices. When I feel guilty for coming so often, he's told me that he sees some clients 5x a week, and that everyone needs different things.
He also has a couch and discussed plenty of times using it. I struggle with making eye contact and being open, so he's suggested that as a way to help. He's also said I can turn my chair away from him if I wanted. All of these I haven't tried because my own anxiety but have been interested in trying and discussed it.

I agree with those saying that multiple sessions a week and the couch are just some classic tools (actually a few analysts follow them strictly these days). The actual analysis is more looking at your current feelings/behavior and how those relate to and potentially derive from early life experiences. They also use transference heavily and like to work with aspects of the interactions between client and analyst.

I had a stint with psychoanalysis in the past but unfortunately the T turned out pretty incompetent and actually very manipulative, some might consider it even abusive. I know a few analysts from other sources that look much more decent. When I started mine, I was specifically looking for psychoanalysis, mostly out of curiosity (I did not have significant problems at the time but generally like to analyze myself and see how elements of my personality, behavior, experiences etc are connected). The T I was seeing does one session per week with most clients and has a coach but apparently uses it only with a few few clients. I never had problems talking in therapy but tried the coach once because I was curious - I personally really did not like it, it inhibited me (while normally I had no inhibitions) because it just felt so unnatural to interact that way. I like eye contact with anyone and normal conversations.

I did that therapy for ~a year and the progression in it that was becoming more analysis-like was the transference dissections. I liked it initially but then figured the T was extremely limited and actually distorted, so I stopped.

I don't know if going multiple times a week can help with opening up more... I guess it can if the client gets more comfortable and relaxed, trusts the T and the therapy more etc. What I've read on this forum more is that it helps some people who struggle between weekly sessions with obsessions, attachment, not having access to the T etc. I think it can also exacerbate obsessions for some. I would consider carefully before committing to many times a week - maybe try for a month or so. I think many Ts use that argument as a business strategy to make more out of clients and make it more secure for them (they know the same client will bring more money each week).

Interesting! Did you find the shift from 1 to 2 similar to the shift from 2 to 3?

Reading this makes me wish it were possible to try the couch in a more organic way. That sounds really intriguing. In my case, my therapist's couch isn't really meant for sitting on--it's a rather firm looking chaise, so sitting on it would be more like a bench than a sofa, and the only reason for me to make the move from chair to couch would be to lie down.

I love the image of you standing on your head in therapy and having to talk about why! Whenever we talk about the couch, my therapist mentions that there's no wrong way to arrange myself on it, that I can switch back and forth from sitting to lying down to whatever else as much as I want "as long as it doesn't make you dizzy."

Thanks for responding, this is very interesting to hear. I'm sure you're right that the couch and more sessions won't automatically make that aspect of things easier on their own, and that's an important insight.

My experience of going from one to two sessions was that it did change the character of the issues I was having with talking, even though it didn't erase them, so I'm very curious what would gappen with another increase in frequency. I simplified it a bit in my post, but on the session frequency side of things, it's more about needing/wanting more time and space to examine and work through the internal conflict and possible transferential stuff that seems to be contributing to that difficulty right now.

There is also the fact that both my therapist and I have noticed a decrease in how much difficulty I have when my sessions end up closer together because of a scheduling issue, though that could also be connected to the fact of the schedule change itself rather than an inherent impact of the time between sessions.

Yes, I think I remember seeing that post! Thanks for weighing in. How did the switch from 2x to 3x compare to the switch from 1x to 2x for you?

I felt a little ridiculous writing this post and realizing my therapist and I first started talking about the couch over 6 months ago. But it's complicated, for all the reasons you mentioned. The prospect of using it just brings up so much stuff.

1:2 unfortunately my memory of this period is a bit shakey. It was after maybe 6-8 weeks she was like let's have 2 cause crisis. I do struggle to start again each time in a session and found 2 helped in that respect as I was already 'open' for the second session - which is the next day due to scheduling issues.

2:3 I asked for this cause I wanted to get the damm therapy over with. Was obvs still in my yeah this is a quick fix period! What we found is that it fit a story arc better. I had time to ease into the opening, e.g. update on week, drop the closing time bomb. Then in the second session I was more relaxed with diving deep as I knew the next session was in 24 hrs so I didn't have to live v long with whatever crap I unearthed.

So I was a lot more willing to be open. Then the last one gave time for dealing with the inevitable overnight questions and thoughts and wrapping up and getting back to normal. Without that safety net of an easy session if needed again I don't thibk I would be as willing to go so deep.

Aside from the arc, 3 sessions let us deal a lot faster e.g. there's always the inevitable reaction due to a break, or some mini rupture, that needs to be discussed that is that work but not if you get what I mean.

I'm a lot more stable outside sessions with 3 than 2, also less outside contact as like it's only 4 days between sessions.

It's certainly a financial and time commitment but I prefer the greater effectiveness for me. Progress is more visible. But I view it as a time of transition. I think if and when I'm ready for the next stage e.g. maintenance I'll drop back down.

Yes, definitely. As I mentioned in the OP and several replies, I'm aware of the distinction between the classic extrinsic factors and the internal processes of analysis. Still, you'd be hard pressed to find someone who sees patients 3 to 5 times a week on the couch who wasn't intending to practice psychoanalytically. The link is there, even if those extrinsic factors alone aren't sufficient for something to be "truly" psychoanalysis, and even if analysts aren't typically as rigid about them anymore.

Ugh, a terrible psychoanalyst can do so much damage, and I'm sorry you went through that. I've seen a couple of therapists in the past whose clumsy attempts to work with transference were very harmful and manipulative, so I can definitely relate.

It's not about attachment or obsessiveness in my case, though I know it can be for people. More about having more time to look at some difficult things that are getting in the way, and also possibly thinking that more frequent sessions might give me less time to resolidify my defenses as strongly between sessions.

Fortunately, I doubt that the business strategy aspect is factoring in here. My therapist isn't taking new patients right now, so it would probably take some time to find another session in his schedule if I opt to go that route. He's a psychiatrist, so if he were very focused on money he'd be much better off taking on more medication-only patients than offering therapy patients additional sessions!

Also the sofa is a hybrid chaise and sofa - some modern design. It is firmer than the chair but lots of pillows. The first time I moved she 'told' me to lie down as if It was a chaise. So I think that's what it is used for usually - lying down.

She's fairly self reflective, so after the first time when I moved there and she showed me how to lie down, the next session she was like I think I almost manuvoured you into lying down in a certain way, how would you have done it. So that opened the conversation of, at that time how I'd prefer to sit cross legged on it. Then we talked about the child nature of that pose for like ages.

Wow, all of that sounds amazing. I've experienced much greater continuity with 2x compared to 1x (weekly felt like continuously starting over, in some ways) so what you're describing sounds ideal to me. Thanks, that's really very helpful to hear.

My therapist recommended moving to 3x/week over the summer of 2015, but it took me months to agree, so we made the switch in January 2016. I think I asked for a 4th session (fall 2016), so then I was going M-W-Th-F, but we found that the Tuesday gap was a large roadblock. My T didn’t have time on Tuesdays at that point, but eventually her schedule opened up a bit, so I added the 5th session in fall 2017. I needed the continuity given the depth of the work we were doing. Each change in frequency was a big deal and had immediate effects.

The couch was a slower development, probably over 9 months, and my situation is modified - rather than sitting behind me out of sight, my therapist sits across from the couch so she’s just in my peripheral (it happens to be where she sits when people sit up). I find the out of sight business completely intolerable. I never actually look at her while I’m on the couch (I barely look at her during greetings), so it’s almost the same re:freedom, just without the specific trigger of not being able to see her.