1) an analyst sees an analysand. The analysand pays cash for the analysts time.
2) it's per hour
3) I guess the provider actually believes that the service is worth what they charge.
4) no idea how it works out financially for the median practitioner.
5) insurance does not cover psychoanalysis.
6) no idea
7) no idea
8) the details are likely very different than most medical and psychological practices. Highly dependent on prestige, location, etc. I went to a big name person for a while who charged around $400/hr and required 3x a week.
Wow... I can definetly understand the impulse to treat pharmacologically from a Medicare perspective.
This is not true. Medicare covers psychoanalysis and some of the better insurances do too. This is probably geographically dependent, but there are in some locales psychiatrists out there who take medicare (because they work at a hospital as well for example and thus can't opt out, or because they also want to provide access in addition to more affluent pts). My psychoanalytic supervisors during residency both took insurance, and most of the analysts who provided therapy to residents (it was a requirement in our program to have our own therapy) took insurance. I'm sure that doesn't happen in NYC but it does happen in some places. My insurance at the time did cover psychoanalysis.
In general psychoanalytic psychiatrists have always made less than their non-analyst counterparts but there are obviously some exceptions. For example in the APsA survey, some analysts said they charged $600/hr (in NYC). Many operate a sliding scale. The same survey found the lowest fee was $5. Usually analysts offer patients who want psychoanalysis proper will offer significant reductions in price, compared to patients they are seeing for weekly or twice-weekly treatment.
btw lymphocyte - there are psychoanalytic fellowships but they exist to make up for the deficiencies in residency training (since they no longer provide the same psychodynamic focus they did in the past), but they will not make you a psychoanalyst. Only analytic training will do that. You can begin that typically as a 3rd or 4th year residents, though some residency programs may let their residents begin as early as 2nd year. Typically the taught component is 4 years. You will typically need to treat 2 patients in psychoanalysis, have supervision and have your own personal psychoanalysis with a training analyst in addition to attending classes and case conference. Having one's own analysis can be very costly and lengthy and in the past could go on for 10+ years if you were very personally disordered (or gay - they wouldn't let people graduate until their homosexuality had been cured but those days are thankfully in the past). The most successful analytic institute (William Alanson White) actually defines analysis as 3 times a week, so watering it down might be the way for analysis to survive. I flirted with the idea but too many of these analysts are overly smug and impressed with their fatuous interpretations which I found very offputting. Also, I believe only new york state licenses psychoanalysis so you can say you are a psychoanalyst in any other state if you so wish
Super helpful. Thank you.
I thought
@RomanticScience's distinction between "descriptive" and "dynamic" psychiatry was
powerful. It's a distinction I've actually never heard before (yes, I'm that much of a neophyte), but it captures something very essential about two different approaches in psychiatry. I previously thought of these approaches as "biological" and "nonbiological," but that never really made sense to me: surely,
all of psychiatry is biological. But I suppose we can
engage that biology in a descriptive or dynamic fashion, with clear implications for diagnosis, therapy, and research. (This distinction may be porous at the level of therapy or diagnosis, but seems pretty sharp when it comes to research and training philosophies.) Very powerful conceptualisation.
In Australia, at least in NSW, the training places a
heavy emphasis on
psychodynamic formulation; it forms the backbone of our initial assessment. From this perspective, the DSM "axis" system is thoroughly strange; an odd gesture toward "mathiness" that isn't nearly as helpful as a cohesive narrative of the patient’s inner world,
contextualising biopsychosocial factors rather than listing them on arbitrary axes as if a principal component analysis were being conducted before our very eyes. I suppose diagnosis and formulation are different things, but the two often seemed conflated where I did my US Sub-I--there was sadly a more "checklist" approach centred on the DSM. I did not enjoy that experience. But I suppose emphasis on formulation is institutionally dependent in the US.
My inclination at the moment is actually toward psychosomatic medicine or public psychiatry, but I find "smugness" just as often in self-proclaimed "biological" psychiatrists as in the psychoanalysts. I just want
balance--a balance that respects
different modes of gathering and assessing evidence (like you see in intensive care, where there's a healthy and unselfconscious tension between empiricism and theoretical models).
That's why I have such tremendous respect for The Last Psychiatrist; some essays deconstruct psychopharmacology, and other essays deconstruct media, society, politics, relationships--in all cases, with vivid clarity that uses the
totality of psychiatry in
all its richness, history, and insight into human experience.
Anywho, keep the suggestions coming!!
