Over time, psychoanalysts have felt forced to introduce changes to the analytic structure in an effort to accommodate large numbers of patients and respond to pressure to reduce the expense of time and money resulting in what is known as psychoanalytic psychotherapy. The principal differences are that the patient usually sits up and is seen twice a week. The advantages of such an arrangement are clear: psychotherapy is more available and less expensive, the patient may retain a greater sense of autonomy while feeling somewhat similarly relieved.

For some patients such contact can be insufficient to produce dramatic and effective results There are individuals whose repetitive self-destructive behaviors and low self-esteem have deep roots which simply cannot be changed by any psychotherapy. We know that mental conflict arises in the crucial relationships of early life and, despite the pain it has caused, caused, often it finds its way into new editions in current life. The revelations uncovered in psychoanalytic work are unparalleled in fully demonstrating these unconscious sources and their problematic expressions in the present. These conflicts often emerge in the relationship with the analyst and it is through that encounter that the patient comes to confront the past and then becomes capable of really creating satisfying new relationships and a new future for himself.

I advocate, when possible, psychoanalysis because it provides enormous support while the patient faces current issues and their nagging sources, often previously never addressed, in a painful past. The experience of one session following directly on another allows the patient to most fully engage in and explore his hopes and dreams for his life. We live only once and, cumbersome or no, psychoanalysis offers definitive relief from neurotic misery and sadness that simply cannot be obtained elsewhere.