Over the near century and a half of its evolution, psychoanalysis has endured much criticism: Too long. Too expensive. Too white. Too out of touch and tied to Sigmund Freud, who, if we’re being honest, was no paragon of perfection by today’s standards, what with smoking like a chimney and oversexualizing everything. And what about the future generations of women he left feeling utterly misunderstood by his punchline-of-a-term, penis envy?

Have these critiques soured potential analysts from training in it and scared away potential clients? As the field has gravitated toward shorter and shorter forms of therapy, you might have even joined the ranks of therapists wondering: Is psychoanalysis dead?

Well, it turns out that psychoanalysis is very much alive today, and a new generation of analysts is working hard to make sure this kind of depth work remains relevant and accessible to diverse clients, in diverse settings.

Listening to Anyone, Anywhere

Nate Koser, a 39-year-old Lacanian analyst in Ohio, doesn’t think his work should be relegated to some high-floor office in a cosmopolitan city. He’s integrated analysis into his work with combat vets and patients in emergency hospital settings. “A psychoanalytic perspective can add a lot in different contexts,” he says. “You might use it in a family therapy context or a school, because even if you’re working in a context that requires treatment plans and progress reports, you can still listen and intervene in an analytic way. In an emergency setting, for instance, where I’m required to pay attention to a crisis, I can still ask someone to speak about whatever’s going on in their mind.”

Even in his private practice, where he can go most in depth with clients, he’s breaking an old mold by keeping his fees reasonable and occasionally doing pro bono work. “Many Lacanians have tried to work hard against the trope that we only see wealthy clients,” he says. “For years, I offered analysis to the homeless and didn’t charge anything. But a fee has conceptual and clinical relevance within psychoanalysis, so I try to establish one that’s specific to the person. It could be anything, depending on the case.”

For clients who’ve had previous experiences with therapy, Koser then offers them something most of them find new and compelling, even if they have no idea what analysis is. “I simply begin by telling them what free association is,” he says, “because that’s the method by which we’re going to do the work. I explain that this means they can say literally anything and everything that comes to mind without censorship. Then I open it up and we go, and we keep going no matter where that takes them.

“With traumatized vets, they were able to speak in ways that they hadn’t been able to before. Or, if they had spoken about some of the things that haunt them, the space couldn’t hold it. Previous therapists might’ve focused on ‘the thing,’ and then traumatic symptomatology, and asked them to continue to talk about that stuff. Whereas free association—’what else comes to mind?’—often sheds light on what exactly was traumatic about the trauma itself.”

Still, you don’t see many clinicians advertising their ability to hold space for free association. It’s not one of the boxes you might tick in a therapist directory next to those listing your certifications in, say, CBT, EMDR, or Somatic Experiencing. And you certainly don’t see a majority of potential clients asking therapists to disclose if they’re Lacanian or Jungian. But let’s say you are Jungian. Let’s say you’ve studied and believe deeply in the healing power of myths and archetypal stories as ways to probe the collective unconscious. Is your work relegated to weekend retreats advertised on yoga studio bulletin boards or to courses designed for philosophy and psychology majors?

Not according to Jungian-trained Kwame Scruggs, founder of a much-celebrated nonprofit called Alchemy Inc., a myth-based program for inner-city youth and adults reentering society. Its accolades are impressive, including a National Arts and Humanities Youth Program Award, bestowed upon Scruggs by former first lady, Michelle Obama. Scruggs has a PhD in mythological studies with an emphasis in depth psychology.

“Years ago,” he says, “I was working at the University of Akron in the Upward Bound program, counseling students—primarily urban, Black males—to prepare them for college. Getting them to talk was like pulling teeth.” Then he came across Men and the Water of Life by Michael Meade. “The book tells and interprets myths that deal with father-son relationships, mother-son relationships, desire, sorrow, and more. It helped me understand so much about my own life, so I decided to start using it in my work. People thought I was out of my mind. But what I’ve found is that myth-based work allows you to bypass people’s natural defenses. You can talk about a myth and what’s ‘right’ or ‘wrong’ objectively. People are willing to engage with that.”

In 20 years of doing Jungian-based work, Scruggs has worked with over 2,000 kids in Ohio, and the program has now started in New York City. “In our sessions,” he says, “we might tell a portion of a myth to the beat of a drum, stop at critical points, and ask them what resonates with them. No right or wrong answers. It’s all about having them incorporate the character traits of the hero into their own lives, making sacrifices, overcoming obstacles, utilizing resources. Some of the youths I’ve worked with are fathers now, and I love to see how they’re showing up in their children’s lives—because so many of the myths are focused on father-son relationships. I’m proud their lives are mirrored through myth, and the myth is mirrored in their lives.”

Modern But Not Fast

These modern permutations of psychanalysis with diverse client populations are proliferating and heartening to hear about. But the question remains for many critics: can today’s clients engage in the work for the long haul?

Orna Guralnik, faculty at New York University’s Postdoctoral Institute for Psychoanalysis and star of the Showtime series Couples Therapy, says, “Let’s differentiate between whoever has a financial investment in short-term treatment—like managed care companies—and the consumer. These companies have done plenty of damage conveying to the consumer that we’ve got to get results fast; otherwise it doesn’t count. But when you actually start working with people, they often want more, want to go deeper.”

Psychologist and a psychoanalyst Jonathan Shedler, a former researcher and author of The Efficacy of Psychodynamic Psychotherapy, says that for 30-plus years now, “psychoanalysis has been the foil and the whipping boy of every other therapy approach. People deliberately promote century-old stereotypes, caricatures, and falsehoods about what psychodynamic therapy is. The public’s perception of it isn’t formed by psychodynamic practitioners. It’s formed by people with an agenda to promote other therapies.”

Historically, patients tended to stay in analysis for years and in some cases even for decades. But psychoanalytic treatment is not defined by length, and most psychoanalytic therapists today would simply say that treatment takes as long as it takes—it continues as long as the patient desires to continue and so long as they benefit.

The essence of this work, Shedler says, is for clients to come to know themselves, and that requires a relationship. “We’re all living out ingrained patterns all the time. It’s not pathology; it’s the way we’re constructed as humans. And we bring our patterns into relationships, all relationships, including the therapeutic one. That’s what we want, so that we can start to recognize the patterns, understand them, talk about them, and hopefully rework them.” And all this takes time.

“Research has shown that meaningful change only begins around the six-month mark,” Shedler reminds us. So why the push for shorter treatments? Take depression, the most common diagnosis in the mental healthcare system, and the most often studied. “Suddenly,” Shedler explains, “you see treatments for depression being promoted as evidence-based. What that means is they’ve been studied in a randomized control trial, like a drug, and the treatments are conducted in a standardized way according to an instruction manual—that’s what gets them called evidence-based, not the benefits to the patients. “Evidence-based” is about how the research is done. Seven out of 10 people who get evidence-based treatments for depression either don’t improve or relapse quickly. And yet we still have academic researchers and insurance marketing executives telling people that these are the gold standard.”

His hope for psychoanalysis is that one day researchers will stop the “sleight of hand being perpetrated on the public, and say, ‘Okay, when we study therapy, we’re going to study therapy of 6 to 24 months duration because we know that’s how long it takes for change to begin.’”

Relationship and Culture

It may be a while before Shedler’s vision comes to fruition, but in the meantime, Stephen Seligman, Clinical Professor of Psychiatry at the University of California, San Francisco and the New York University Postdoctoral Program in Psychoanalysis, says the academic side of psychodynamic therapy is laser-focused on addressing the issues of affordability and accessibility in psychoanalysis, and working knowledgably with diverse clients. Recently, in fact, Seligman facilitated a discussion group at American Psychoanalytic Association meetings in which he asked participants to consider the following: “‘What if you were to give social, cultural, and historical factors as much weight as you give family of origin? What if you used cultural factors as your tools of interpretation to understand the relationship, not the usual analytic factors?”

While psychoanalytic training is now less taken up with dream interpretation and studies of Freud, and more with contemporary psychological literature, Seligman notes, “There are those of us who feel that we’ve got to make sure that the new people really get the idea of the unconscious and primary process while bringing things up to date.” He’s watched the field evolve over decades and says, “The biggest overall switch in recent years is that across the board, psychoanalysts are much more interested in the relationship between the analyst and the patient than in the old idea that we’re going to interpret to the deep sex and aggression drive. It’s no longer standard practice that you abstain from saying anything. New generations of analysts are actively trying to be helpful, and being human is basic and important.”

Guralnik sees the effects of some of the academic and sociocultural changes in her contemporaries, students, and clients. “The analyst and their own unconscious and subjectivity are now implicated in the treatment. There’s no longer the fantasy that we’re operating from some privileged position of knowledge. Candidates enter with the expectation that psychoanalysis comes with an awareness of sociopolitical issues and power dynamics. My colleagues and I have been working in that direction for many years, but younger cohorts are expecting that of psychoanalysis. Plus, different initiatives are attempting to make psychoanalytic work available to larger swaths of the community. Psychoanalytic institutions are even developing programs where the options for candidates’ training cases are not just individual patients, but entire communities.”

It’s interesting to note that despite the cartoons and the images we all carry around in our own unconscious about psychoanalysis, the focus on community and cost was baked into psychoanalysis from the start. Freud and his contemporaries created low-fee clinics and saw the social-justice benefits of analysis from its inception. In many ways, today’s innovators would’ve made great contemporaries of Freud’s. All of them share in the notion that really hearing someone out for as long as is necessary shouldn’t be considered a radical act. It’s just what it takes for therapy to work.



Lauren Dockett

Lauren Dockett, MS, is the senior writer at Psychotherapy Networker. A longtime journalist, journalism lecturer, and book and magazine editor, she’s also a former caseworker taken with the complexity of mental health, who finds the ongoing evolution of the therapy field and its broadening reach an engrossing story. Prior to the Networker, she contributed to many outlets, including The Washington Post, NPR, and Salon. Her books include Facing 30, Sex Talk, and The Deepest Blue. Visit her website at laurendockett.com.