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director of the American Psychoanalytic Association, ruefully admitted that “almost no one”—she was speaking of medical psychoanalysts—“is now in the full-time practice of psychoanalysis.” As for psychologists, by 1990 the American Psychological Association reported that only 2.5 percent of its clinical members considered themselves primarily psychoanalysts. Some psychotherapists, both medical and nonmedical, were still using analysis with certain patients—those who could afford it—for whom major character change, reaching deep into the unconscious, was the goal, but psychoanalysis was no longer the model and ideal of therapy, nor was it at the frontier of therapeutic knowledge and research.33

But as noted in the earlier discussion of Freud’s life and work, the ranks of psychoanalysts, though still very small, have swelled somewhat in the past half dozen years, and psychoanalysis, gleefully pronounced dead many times in recent decades by its enemies, has regained some of its éclat, particularly because most of its practitioners have greatly modified their procedures.

True, a few hard-liners such as Glen Gabbard, who is now professor of psychiatry and director of the Baylor Psychiatry Clinic at the Baylor College of Medicine, still define psychoanalysis as “an intense treatment, four to five times per week for 45–50 minutes, generally lasting between three to eight years, [in which] the patient generally lies on the couch and free associates—that is, says whatever comes to mind—facing the ceiling, and not the therapist.”34 But even Dr. Gabbard says that Freud wouldn’t recognize psychoanalysis today: “Freud believed that just recalling repressed memories would be curative, but now we understand that recollection alone is not sufficient. Also, Freud conceived of the unconscious as a sort of reservoir of sexual and aggressive impulses.

Now, thanks in part to modern neuroscience, we think of unconscious mental processes as, at least in part, procedural memory, also known as habit memory or muscle memory. The way we relate to people in early life gets internalized and repeated, in much the same, automatic way our fingers ‘remember’ how to play the piano. The analyst will point out these patterns of behavior—an approach quite different from Freud’s notion that repressed memories will simply pop over the repression barrier.”35

Most present-day medical psychoanalysts and the small percentage of psychologists who do psychoanalysis operate very differently from the way their predecessors in the profession did. Their practice, though the core psychoanalytic conception of the human personality and of neurotic disorders lives on in it, takes other forms that are less expensive, easier, and briefer. In one important group of variations, known as psychoanalytic, psychoanalytically oriented, or dynamic psychotherapy, typically the therapist sees the patient only once or twice a week (and sometimes less often); the patient sits and faces the therapist (Freud, you recall, could not tolerate that); and the therapist becomes a real person to the patient, discussing, querying, advising, sharing experience and knowledge, and in general being as much an educator as an elicitor and interpreter of unconscious material.

(In addition, many M.D. psychoanalysts now supplement therapy with medication and many non-M.D. psychoanalysts refer their patients to an M.D. for medication. In fact, a number of psychiatrists now practice psychopharmacology, all but laying aside psychotherapy except for enough patient-physician talk to establish diagnosis.)

The bottom line of all this is that for many of the psychologists who practice various forms of nonanalytic psychotherapy, it remains the case that psychodynamic concepts prevail and are the heart of the treatment process. Transference, for instance, can exist and be used even in weekly face-to-face therapy, though differently from the way it is in classical analysis, as in this description by the clinical mental health counselor Bernice Hunt of her relationship to a young woman she treated several years