Howard Stern, the ubiquitous satellite radio talk-show host, is a big proponent of psychotherapy. He has noted how he’s been in psychotherapy three times a week for the past few decades, much like Woody Allen. But what kind of psychotherapy is Howard Stern in? And why does it seem endless?
This type of intensive, long-term psychotherapy is almost always psychoanalysis — a specific type of psychotherapy that focuses on how a person’s unconscious conflicts impact a person’s everyday functioning. People who undergo psychoanalysis almost always meet with their analyst 2 to 3 times a week, every week, for years on end. Howard Stern has said he sees his analyst 3 times a week, but sometimes feels like he would like to cut down to twice a week.
Psychoanalysis is considered a specific form of psychodynamically-oriented psychotherapy and is far more popular in European countries than the U.S. And it’s no wonder — it’s the form of treatment invented by Sigmund Freud himself. Contrary to popular belief, there’s been a fair amount of empirical research conducted on psychodynamic therapy demonstrating its general effectiveness (see, for example, Shedler, 2010). Psychoanalysis is indeed a valid, effective form of therapy.
But at three times (or more) a week, who can afford such intensive therapy (other than celebrities like Howard Stern or Woody Allen)? And why would you bother if other forms of less intensive psychotherapy can be just as effective?
Psychoanalysis is conducted by specially trained professionals called psychoanalysts, who are typically a special kind of medical doctor — a psychiatrist. Psychiatrists complete medical school, and then typically spend another 4 to 5 years gaining expertise in psychiatry in residency.
Psychoanalysts go one step further, however. They also spend another 4 to 5 years training in psychoanalysis (at the same time, undergoing their own personal psychoanalysis, which they are encouraged to keep up for their entire professional career). So a typical psychoanalyst may have an additional 12 years or more of post-college education and training. Somebody has to pay for all of that.
Who can afford psychoanalysis in the U.S.? In general, rich people. Insurance companies don’t reimburse for 3-times-a-week or more therapy. Not when there are other more cost-effective forms of treatment available. Most people who are in psychoanalysis pay the fees of their analyst — which can begin at $250/hour and go up to over $1,000/hour — from their own pocket. So Howard Stern could be spending upwards of $1,000/week (minimum) for his treatment. That’s over $50,000 per year!
So why would a person bother with psychoanalysis if it’s so expensive and time-consuming?
In studies conducted about characteristics of people who undergo psychoanalysis, no clear patient picture emerges. They often suffer from similar and severely debilitating mental disorders like depression or anxiety, but have chosen the psychoanalytic route for treatment. Some research has suggested that perhaps people who enter psychoanalysis have fewer interpersonal problems, but in general, research has demonstrated that psychoanalysis is suitable for virtually any disorder of any severity.
The key to good outcomes in psychoanalysis appears to be, not surprisingly, directly related to how good the therapist-patient match is. This is a finding consistently reproduced amongst many types of psychotherapy.
Folks like Howard Stern — who constantly talks on his radio show about how insecure, paranoid and neurotic he can be — may understand some of the unique benefits of intensive psychotherapy. The analyst is always there as a constant, reliable sounding board in his life, allowing him to focus more of his personal time on his career and other pursuits. It may help people like him keep his personal insecurities at bay better than traditional, once-a-week cognitive behavioral psychotherapy.
Howard Stern is a surprisingly vocal and positive supporter of the benefits of psychotherapy in general, and recommends it regularly to his listeners. While you may not find much benefit to pursuing psychoanalysis like Stern, you may be surprised at the beneficial effects that can be realized when you find a good therapist to work with. Whether it’s a psychiatrist, psychologist or some other mental health professional (the research suggests it doesn’t much matter which you choose), the key is to get help when you most need it in your life — don’t be afraid to ask for help.
Is endless psychotherapy of the type that Stern appears to be engaged in ultimately healthy? In most cases, probably not, as it creates a co-dependent relationship that instead of emphasizing and supporting a patient’s independence, fosters a continuing dependence upon the analyst. In my opinion, good psychotherapy should be time-limited and goal-focused — you enter therapy with a specific goal (or set of goals in mind), and when you’ve reached them, it’s time to leave.
Sure, it would be nice to have that kind of professional helping you with life’s ups and downs your entire life. But it’s certainly not necessary for most of us. We can still enjoy a fulfilling, positive and happy life without such constant therapeutic intervention.
Reference
Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2), 98-109.
For further information
Read our overview of psychodynamic therapy, which includes psychoanalysis, and Sandy Naiman’s Random Thoughts On Psychoanalysis vs. Psychotherapy.
15 comments
I realize there are some people for whom a dozen therapy appts. a month for decades is helpful, but I believe the rest of us should strive to enter and then LEAVE therapy. Therapists in general should be helping a person deal with the past and the current, then teach the client to deal with the future on their own. I’ve long thought of someone like Woody Allen as co-dependant and his analyst is laughing all the way to the bank.
I was surprised by the assertion that most psychoanalysts are psychiatrists. In my experience most analysts are MSWs and psychiatrists do not seem to pursure analytic training.
Well, it seems to me that the author of this article is not completely aware what a psychoanalytical cure is, when he write that it make the client dependent (?!). This is a common, normal fantasy about the therapeutical situation, but also a cliche that can be analyzed too.
The dependence is in fact one that the client bring in therapy, and a good therapy try to deal with it. It last for a week, a month, a year, a decade or a life – as for Howard Stern and Woody Allen. The long life support is, of course, important too, for these two clients and many others.
I guess that one of your gains in therapy is that you can see, having to chose between two or more explanations, not the “or-or” choice, but more often the “and-and” one. I think that it is also the case here.
“but in general, research has demonstrated that psychoanalysis is suitable for virtually any disorder of any severity.”
John, my understanding is that people with borderline personality disorder whether in the neurotic, borderline or psychotic range are totally unsuited to psychoanalytic psychotherapy proper where the analyst sits behind the “lying on the couch” patient, because this type of situation can trigger off paranoia or psychosis both in the short and long term.
Sonia
Therapy Unplugged
And Sonia is very right. Psychoanalysis is not recommended for those with Borderline Personality Disorder. It has been empirically proven that psychoanalysis can be more damaging to those with BPD. Suggested treatment for BPD is DBT or CBT.
Dante – I don’t agree with the assertion that dependence is a “fantasy” about the therapeutic situation that a client brings into the relationship. That’s hogwash — it sounds like a complete rationalization for the normal feelings of dependence that are bound to come up for nearly anyone who sees a professional this intensively for years on end.
Howard Stern is dependent on his analyst? Probably also his business manager, his personal assistant, his housekeeper, his personal trainer…. so what? Is the concern that he’s setting a bad example for potential therapy clients, going “too often” and endlessly?
He and his analyst are breaking some rule?
You place value on this: “good psychotherapy should be time-limited and goal-focused — you enter therapy with a specific goal (or set of goals in mind), and when you’ve reached them, it’s time to leave.”
Perhaps for most people this is best, and for most people it is what they can afford or get insurance to cover. So be it.
That’s crazy! I only saw my therapist 3 times a week for about a month when I was going through a bona fid crisis and I was endanger of being hospitalized. During that time my life was basically about therapy and getting well. Money aside, I can’t imagine putting all that energy into therapy each week. Where is your life? I’ve also noticed that when I see or talk to my therapist a lot, my relationship with others like my spouse and parents becomes more distant because I’m just relying on my therapist for emotional support. That isn’t healthy. That’s why I decided take a break from therapy, and I’ve become much closer to my family because I’ve ditched my therapist.
It’s ok to have a longterm relationship with a therapist, but you shouldn’t see them frequently when you are emotionally healthy. You should be able to help yourself or look to others in your life for support. That should be the goal of therapy.
Long-term psychoanalysis seems to be a ploy to get rich people to pay $$$ to the therapist.
If Howard Stern is dependent on his analyst, then he’s likely also dependent on his personal assistant, business manager, trainer and housekeeper. Busy and successful people rely on others as a norm.
I don’t understand the value judgment on how he and his therapist are working.
Do you think it sets a bad example for others, the fact that he goes so often or for so many years?
Good therapy should have a time limit? It is what you state: good psychotherapy should be time-limited and goal-focused
I’m not a fan of this guy, but maybe this is the most effective way for him to have a happy life? You say “it would be nice to have that kind of professional helping you with life’s ups and downs your entire life” – so his approach is good too?
A lifetime of therapy, good or not good? A luxury for the rich?
“In my opinion, good psychotherapy should be time-limited and goal-focused — you enter therapy with a specific goal (or set of goals in mind), and when you’ve reached them, it’s time to leave.”
My experience of psychotherapy has been different. The problem I entered therapy with turned out to be a superficial one. We found bigger fish to fry as we worked on the initial problem. These took time (1 yr of weekly sessions, then 2 yrs of every other week). I guess I could have worked for 12 weeks on the original presenting problem and then gone my own way with some superficial symptom relief. But my therapist and I chose to work on these deeper issues, and obtain greater healing for me rather than just symptom relief. Wonder of wonders, when you work on those core issues, some of your superficial problems (that cause difficulty in life and initially bring you to therapy) get “fixed”. I am really glad my therapist was not the kind who makes you stay “on task” and work for a short time only on the presenting problem.
Most psychoanalysis are not psychiatrists. Most are a LMSW. Many have gone past the MSW training and also gone to a psychoanalytic training Institute. These are 2 to 4 year intensive programs. However, in many states you can become a licensed psychoanalytic therapist if you attend one of these institutes in lieu of a masters degree. They are that intense. Most psychiatrists prefer to remain doctors, although some do provide therapy. But that’s why many people have a psychiatrist AND a therapist. Psychiatrists often don’t provide talk therapy. I’m really surprised at this author for not acknowledging all the types of psychoanalytic therapists, those with a LMSW /LCSW, LMFT, LPC, LMHC and also those who onthe attend the psychoanalytic Institute. I really hope the author changes this article to reflect the truth
I meant that most are LCSW, although many are LMSW.
We have a similar relationship with our Irish bartenders in South Buffalo, NY. A few times a month you go in and tell the barman your problems. He usually says something like, “that ain’t nothing…Jimmy got his leg off from the sugar.†Or, “Timmy’s got stage 4 cancer and one foot in the grave.†And after a few pints you walk out feeling like your problems are pretty small. If you don’t drink there is always Confession. Both methods are a lot cheaper than a shrink.
I’ve had training in psychoanalysis and disagree with your statements. First, psychoanalytic institutes have opened their doors to many other professionals such as social workers and professional counselors, not just psychiatrist and psychologist. We undertake psychoanalysis ourselves so that we can better understand our own unconscious, freeing us up to work with other people’s unconscious mind. Next, psychoanalysis is not a life long therapy. Even in our own treatment, psychoanalysis is not recommended throughout our professional career. Psychoanalysis can take anywhere from 3-12 years, sometimes more and sometimes less, depending on the individual. It’s important to develop a close relationship with our patients, working through their desire for closeness and also fears of closeness. To depend on another is normal and healthy, this is not dependence. We want our patients to have an individual sense of self and to have healthy relationships with others. To work in this type of intense treatment, the person sees what gets in the way of having the relationships they desire, what keeps them from expressing their true self, and will better be able to understand the motives to their behaviors. To be able to love, work, and play more freely. It’s not just insight intellectually but also insight emotionally and experientially. As we develop a close relationship, the patient typically replays their relationship dynamics with me and this gives us deeper understanding of them and them in relationship so this is part of the reason why it takes so long. Lastly, psychoanalysis is often a developmental process which means that termination is important, like the adolescent graduating high school and going off to college. The termination phase is very important and crucial for the individual. It seems your knowledge of psychoanalysis is limited, outdated, and biased.
Short term therapy short term gains.
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