Freud's Free Clinics

1923–1932: THE MOST GRATIFYING YEARS
December,” Alix recorded. 32 The Poliklinik staff aimed for flexible solutions
to practical clinical dilemmas, and the duration of the clinical hour and
length of treatment were subjected to as much debate, or more, in the 1920s
as today. Daily sessions were ideal, but since so many of the patients were
working, analysis three times a week was more widespread. By 1926 the threehour
weekly treatment schedule was found generally adequate and retained
as standard practice in Berlin. Ten years later, as founder of the new Chicago
Institute for Psychoanalysis, which he modeled on his Berlin experience,
Alexander still insisted on flexibility, that treatment be adjusted to the patient
and not the other way around. Even if it meant curtailing the analytic experience,
he said, “it is advantageous at times to change the intensity of the
therapy by alternating the frequency of the interviews or by temporary interruption
of the treatment.” 33
How long should an analytic session last? If treatment is an everyday part
of life, an hour like any other work hour of the day, then maybe a thirtyminute
session is just as natural a unit of time as the full sixty-—minute
hour. Sixty minutes had been the standard length of a session until the 1920s
when Karl Abraham and the Poliklinik staff took it up as yet another controversial
debate. At first the analysts intended to “systematically and in every
case reduce the length of the analytic sitting from one hour to half-an-hour,”
Eitingon wrote, because of their patients’ crowded work and family schedules.
Instead, each patient’s session was set individually, with a total amount
of minutes ranging from forty-five to sixty minutes. The deciding factor was
the patient’s responsiveness to “discipline”—perhaps another word for motivation.
For one so accepting of mankind’s Rousseau-like natural selfregulatory
talent, Eitingon’s statement that “despite their neuroses . . . [selfdisciplined
people] are not seldom to be found in Prussian Germany
amongst civil servants and others” was sarcastic at best. Is the “discipline” a
natural internal human motivation toward health? Or is it a response to external
motivation, such as a fractionary schedule? Which would make greater
sense clinically? As their friends from the Frankfurt School would say, the answer
lay in the dialectic. An analytic interview, or session, could last from
forty-five to the full sixty minutes since, in theory at least, only a balance of
the practitioner’s clinical assessment and the patient’s discipline would lead
to an appropriate scheme. Nevertheless according to Alexander, Eitingon’s
initial experiments with half-hour interviews proved “unsatisfactory” and
what would become the standard fifty-minute analytic hour was instituted as
the official norm. Patients were seen three to four times weekly, or more,
with no time limits preestablished for ending the analysis. The Poliklinik was
180