As I mulled it over for Dr. D., I noticed that I was speaking with greater detachment and less gusto than I usually brought to the occasion. Perhaps this was a response to Dr. D.’s own removed demeanor, which made me in turn wonder if patients eventually began to sound like their therapists, much in the way husbands and wives of long standing are said to resemble each other. And then there was my feeling that I better not get in too deep. I was wary by this point of the alacrity with which I attached to shrinks, each and every one of them, as if I suspended my usual vigilant powers of critical judgment in their presence merely because they wore the badge of their profession. The truth of the matter was that in more than 40 years of therapy (the only person I knew who may have been at it longer than me was Woody Allen, who once offered me his own analyst), I never developed a set of criteria by which to assess the skill of a given therapist, the way you would assess a dentist or a plumber. Other than a presentable degree of intelligence and an office that didn’t set off aesthetic alarms — I tended to prefer genteelly shabby interiors to overly well-appointed ones, although I was wary of therapists who exhibited a Collyer Brothers-like inability to throw anything away — I wasn’t sure what made for a good one. I never felt entitled to look at them as members of a service profession, which is what, underneath all the crisscrossing of need and wishfulness, they essentially were. The sense of urgency that generally took me into a new shrink’s office was more conducive to seeing myself as the one being evaluated rather than the evaluator. Was I a good-enough patient? Would this latest psychiatrist (I saw mostly M.D.’s) like me and want to take me on? Or would he/she write me off as impossibly disturbed under my cloak of normalcy?

Image Credit... Laurie Simmons for The New York Times

I knew I wasn’t the most promising candidate — I was, in fact, a prime example of what is referred to within the profession as a “difficult” patient, what with my clamorous ways, disregard for boundaries and serial treatments — but perhaps this time, after so many disappointments, I would get lucky. Somewhere out there, sitting in a smaller or larger office on Central Park West or the Upper East Side, tucked behind a waiting area furnished with a suitably arty poster or two, a couple of chairs and old copies of The New Yorker and National Geographic Traveler, was a practitioner who would not only understand my lifelong sorrow and anger in an empathic (but not unduly soppy) fashion but also be able to relieve me of them. Just as some people believe in the idea of soul mates, I held fast to the conviction that my perfect therapeutic match was out there. If only I looked hard enough I would find this person, and then the demons that haunted me — my love/hate relationship with my difficult mother (who has been dead now for four years), my self-torturing and intransigently avoidant attitude toward my work, my abiding sense of aloneness and seeming inability to sustain a romantic relationship and, above all, my lapses into severe depression — would become, with my therapist’s help, easier to manage.

Therapy, as Freud himself made clear, is never about finding a cure for what ails you. Its aim, despite the lyrical moniker it is known by (“the talking cure” was not actually Freud’s phrase but rather that of Dr. Josef Breuer’s patient Bertha Pappenheim, whom Freud wrote about as Anna O.), was always more modest. Freud described it as an effort to convert “hysterical misery” into “common unhappiness,” which suggests a rather minimalist framework against which to judge progress. There is no absolute goal, no lifetime guarantee, no telling how much therapy is enough therapy, no foolproof way of knowing when you’ve gotten everything out of it that you can and would be better off spending your valuable time and hard-earned money on other pursuits.

All of which raises the question: What exactly is the point? How can you be expected to know when being in therapy is the right choice, to know which treatments are actually helpful and which serve merely to give the false sense of reassurance that comes with being proactive, with doing all that we can? Does anyone, for example, really know what “character change” looks like? That, after all, is what contemporary therapy that is more than chitchat for the so-called worried well aims to promote. More pressing, who can be trusted to answer these questions? Looked at a certain way, the entire enterprise seems geared toward the needs of the therapist rather than the patient to a degree that can feel, after a certain amount of time, undemocratic, if not outright exploitative. With no endpoint in sight, it’s possible to stay in therapy forever without much real progress; at the same time, the weight of responsibility is borne almost entirely by the patient, whose “resistance” or lack of effort-making is often blamed for any stagnancy in treatment before the possibility of a therapist’s shortcomings is even acknowledged. As the psychiatrist Robert Michels observed in his aptly titled essay “Psychoanalysis and Its Discontents,” for patients, “it often seems as if psychoanalysis isn’t even designed to help them. Patients want answers, whereas psychoanalysts ask questions. Patients want advice, but psychoanalysts are trained not to give advice. Patients want support and love. Psychoanalysts offer interpretations and insight. Patients want to feel better; analysts talk about character change.”

My abiding faith in the possibility of self-transformation propelled me from one therapist to the next, ever on the lookout for something that seemed tormentingly out of reach, some scenario that would allow me to live more comfortably in my own skin. For all my doubts about specific tenets and individual psychoanalysts, I believed in the surpassing value of insight and the curative potential of treatment — and that may have been the problem to begin with. I failed to grasp that there was no magic to be had, that a therapist’s insights weren’t worth anything unless you made them your own and that nothing that had happened to me already could be undone, no matter how many times I went over it.

And yet it seems to me that the process itself, in its very commitment to interiority — its attempt to ferret out prime causes and pivotal events from the psychic rubble of the past and the unwieldy conflicts of the present — can be intriguing enough to stand in as its own reward. In the course of growing up, we all learn to repress our unruly fantasies and to keep our more anarchic thoughts mostly to ourselves. As for our dreams and what they might signify — their “latent content,” that is, as opposed to their “manifest content” — who can be expected to be interested in them except a close friend or tolerant spouse, both of whom are assuredly only half listening? Therapy offers us a particular kind of chaste intimacy, one that in its ideal (if not always actual) form is free of the burden of desirous expectations. Or as Adam Phillips, the writer and psychoanalyst, puts it with characteristic brio: “Psychoanalysis is about what two people can say to each other if they agree not to have sex.” It is a place to say out loud all that we have grown accustomed to keeping silent, in the hope that we might better understand ourselves and our missteps, come to terms with disowned desires and perhaps even find a more direct route to an effectively examined life. It provides an opportunity unlike any other to sort through the contents of your own mind — an often painfully circuitous operation — in the presence of someone who is trained to make order out of mental chaos. Although it is possible to view the whole exercise as an expensive self-indulgence — or, as its many detractors insist in one way or another, as the disease for which it purports to be the cure — psychoanalysis is the only game in town in which you are free to look and sound your worst the better to live up to your full potential.

FREUDIAN PSYCHOANALYSIS reached its high-water mark in the 1950s, having become something of a secular religion; it offered, as Dan Wakefield observes in his book “New York in the Fifties,” a “dream of wholeness” — and, no less important, “the cure for what ailed you sexually.” All of the so-called New York Intellectuals, like Delmore Schwartz and Mary McCarthy, dipped into analytic treatment at one time or another; and James Baldwin, in a 1959 essay, noted of “the citizens of this time and place” that “when they talk, they talk to the psychiatrist; on the theory, presumably, that the truth about them is ultimately unspeakable.” In the mid-60s, psychoanalysis was still very much in vogue, having not yet become the reviled and increasingly discredited discipline it came to be in the 1980s and 1990s, when anti-Freudians like Frederick Crews and Peter Swales did their dismantling work and the psychopharmaceutical industry flourished. (My favorite line from Donald Barthelme’s 1972 short story “The Sandman” is, to my mind, more predictive than descriptive: “The prestige of analysis,” the protagonist writes to his girlfriend’s shrink, in defense of her decision to give up analysis and use the money saved to buy a grand piano, “is now at a nadir.”) Popular magazines like Redbook and McCall’s familiarized Middle America with basic Freudian concepts, the better to understand phenomena like marital discord and sibling rivalry, and references to therapy abounded in theater and film. In their book “Psychiatry and the Cinema,” Glen O. Gabbard and Krin Gabbard refer to the period from the late 1950s to the early 1960s as the “Golden Age” of psychiatry in the movies: “For a half-dozen years . . . films reflected — however imperfectly — a growing conviction in American culture that psychiatrists were authoritative voices of reason, adjustment and well-being.” In 1969, Alexander Portnoy unburdened the content of his carnal character on the silent Dr. Spielvogel and made his creator, Philip Roth, a household name.