On the Couch

Veronique Caillat

Imagine a therapy where you spend ten hours at a time on the couch, which pores over your family photographs, and you end up paying £100,000 for 500 hours of treatment..... this is micropsychoanalysis, the most intensive, expensive form of therapy, hailed by some as the ultimate cure - criticised by others as manipulative and damaging.... report by Alix Kirsta.

Photo: Veronique Caillat at her desk, with a picture of herself and the therapy's founder, Silvio Fanti.

One can't help wondering what Freud would have made of it: psychoanalytical sessions lasting three or more hours, conducted every day including weekends; every session tape recorded and eventually played back to the patients; analysts and their patients meeting for dinner or going to the movies after therapy. Above all, what importance would he have attached to the clutter of old photos, personal letters, drawings and other memorabilia which, according to French psychoanalyst Veronique Caillat, hold the key to a person’s neuroses and unhappiness? Would Freud dismiss such departures from his classical technique as foolish tinkering — or welcome them as a breakthrough in promoting deeper understanding of the human psyche?

At first glance, the dozens of photographs scattered on Veronique Caillat’s desk in her Left Bank apartment in Paris seem unremarkable. The quality of the pictures is poor, the content dull and repetitive, showing several generations of French women, all relatives of one of Caillat’s patients, let’s call her Chloe, a 30-year-old publisher. Some snapshots, dating back to the early 1900s, are either so small or faded that details of the people in them are almost invisible to the naked eye. Certain groups are blurred or too far away to be dearly distinguishable — until Veronique Caillat enlarges each image with a magnifying glass.

Eventually, in picture after picture, tiny details and astonishingly similar patterns begin to emerge, indicating tension and coldness between certain family members. The main giveaways are subtle nuances of the women’s body language, which appear, uncannily, to have been passed from generation to generation. As Caillat points out, Chloe’s mother and before her, her grandmother and great-grandmother, although smiling and apparently relaxed, all stand or sit somewhat stiffly, their bodies turned away from their husbands, avoiding physical contact. Even more striking is how each of these women holds her child. Chloe’s mother, grandmother and great-grandmother all keep their faces slightly averted from their babies. “If you look really closely, you can see that they aren’t embracing the child at all,” says Caillat, handing me the magnifying glass.

She is right. Each mother holds her infant a fraction away from her upper body with a rigid arm, claw-like fingers digging aggressively, yet possessively, into the child’s flesh. You can almost sense the women recoiling from intimacy Caillat passes me the last photo, a colour Polaroid: it shows Chloe, aged six, clutching her doll in an identical grip. “The pattern of behaviour, avoidance of physical warmth and affection was already being repeated in her childhood, but Chloe did not know it until now,” says Caillat. Only after lengthy examination of these photos, a key feature of micropsychoanalysis, a relatively unknown psychotherapy, did Chloe realise the extent of her parents’ coldness towards one another. It brought back an old childhood dread of her mother’s criticism and indifference.

Intense Reactions

For most of Caillat’s patients, such “photo study sessions” lead to similar, intense reactions, including the realisation of how many forgotten childhood experiences lie behind existing emotional problems — in Chloe’s case, an avoidance of intimate relationships. “We all think we’ve noticed every detail in a photo, when we haven’t. We are sure we remember how our parents behaved and how they treated us in our childhood, but do we?” muses Caillat. Passing me other pictures of a pretty 12-year-old girl standing next to various male relatives and friends, she points out the girl’s provocative, almost sexual pose and expression. “As an adult, Anne now claims that every man she’s known only wanted to seduce and discard her. It wasn’t until she examined ten pictures all showing the same thing, that she began to realise it was she who wanted to seduce, not the other way round. Having visible proof of this can produce very powerful memories and experiences. A single snapshot can develop into a film of your whole life.”

For Chloe and Anne, as for most of Caillat’s patients, the scrutiny of old, long-forgotten family photos has helped them to achieve rapid progress in their analysis, accompanied by insights which could take years if they were undergoing classical Freudian analysis. Although underpinned by Freudian theory and such conventions as free association and the interpretation of dreams, this is one of its most radical and controversial offshoots gradually gaining ground in parts of Europe. Unlike orthodox psychoanalytic techniques, micropsychoanalysis — so called because of its almost forensic examination of the small print of a person’s past from photos and other personal documents — is relatively brief yet extraordinarily intensive. In contrast to the notoriously lengthy process of classical analysis, consisting of 45 or 50 minute sessions, micropsychoanalysis, lasting three or more hours at a stretch (and occasionally up to ten hours in one sitting) undertaken almost every day, including weekends, resembles a marathon.

It may be over within a year or less. Brevity and intensity are its most radical features. The relentless detective work applied to objects connected with a patient’s early life is also what sets it apart from all other psychotherapies, and has led to charges from orthodox practitioners that it represents more of a potentially damaging assault course than a lasting cure.

Tracking down clues

Micropsychoanalysis is to psychotherapy what Berlitz Total Immersion courses are to foreign language schools. Audio-recorded sessions are played back to the patient towards the end of their analysis to provide further insights into behaviour and reinforce self-help skills. The goal is for patients ultimately to become their own analysts. However, the emphasis on tracking down clues to early trauma by scrutinising home videos, photos, letters, school, health and genealogical records, and the assertion that memories of distressing domestic events eventually surface when patients sketch the layout of homes in which they grew up, is dismissed by some orthodox analysts as little more than gimmickry. Yet micropsychoanalysts claim these techniques can help patients with “normal neuroses”, rather than serious mental illness, overcome their problems in a fraction of the time of conventional analysis, usually with more profound, far-reaching effects.

For example, Daniel Lysek, a Swiss practitioner, has found that his clients achieve sudden insights while examining forgotten letters and documents. “One man I treated had a very hostile relationship with his father, whom he saw as rigid and unloving. After finding letters his father wrote to him at boarding school, he read them out to me and was surprised to discover the amount of affection expressed in them. He saw that the love was there, not in gestures but in written words. He had just forgotten it,” says Lysek.

At a time when Freudian analysis is under fire for being too slow, doctrinaire and often unproductive, this penetrating approach is claimed to work especially well in the treatment of disorders like depression, anxiety, phobias, panic attacks, obsessive compulsive behaviour, including drug or alcohol addiction and eating disorders. Nevertheless, 50 years after it was pioneered by the late Swiss psychoanalyst Dr Silvio Fanti, micropsychoanalysis remains controversial, partly because of its unorthodox approach, but also because of its exclusivity — and expense. Due to the intensity, length and cost of the training there are so far only 50 or so qualified practitioners in the world. The demanding schedule means they can only treat a few patients at one time and their hourly rate averages between £100 - £200. New patients must commit themselves in advance to a minimum of 100 hours’ therapy, usually within several weeks or months — the obligatory first stage of a “complete” 500-hour analysis. This makes it currently the most expensive analytic technique in the world. The first 100 hours may cost upwards of £15,000 — often more depending on the analyst’s rate — and a full 500-hour micro, as it is dubbed by practitioners, could set you back as much as £75,000 - £l00,000.

Europe embraces the therapy

Yet despite the expense, time and effort needed to embark on micropsychoanalysis, its appeal is growing, mostly in France, Switzerland and Italy, largely among high-earning professionals and it has, oddly, become especially popular among Russians living abroad. According to Zurich practitioner Dr Pierre Evard, who speaks French, German and English, many of his growing Russian clientele must first learn one of these languages before they begin analysis, while he himself has mastered basic Russian in order to establish greater rapport with his patients.

Why micropsychoanalysis should be largely confined to Europe while remaining unknown in America, where no practitioner exists, is not as baffling as it at first seems, given the background of its maverick pioneer. Dr Fanti’s new technique regularly attracted gossip and rumour until his death at 78 in 1997. Some observers even suggested it was more a cult, led by a charismatic guru figure, than a serious form of psychotherapy There was talk of patients, often with their relatives, moving into Fanti’s palatial home in the small Alpine town of Couvet for extended periods, living as a commune, and often staying on to train as analysts after completing their treatment. While today’s practitioners are discreet, the same could not be said of Silvio Fanti, a showman who revelled in his role as shrink to the rich and powerful and, above all, relished the intrigue that came with the territory.

Fanti, who trained to become a priest before taking up medicine, first made headlines in France and Switzerland with a series of controversial books; in these he condemned marriage as “the most unnatural and immoral institution that exists on earth”, warned that romantic attachments, with their inevitable break-ups, were “the worst of all atrocities, reopening the wound of a child’s first abandonment by its parent”, and claimed incestuous attraction and infantile sexuality to be commonplace. Like R.D. Laing, Fanti was dismissed by some psychologists as an irresponsible self-promoter who talked tosh, yet others hailed him as a brilliant iconoclast, courageous enough to confront taboos sidestepped by other professionals.

Between the Sixties and mid-Nineties micropsychoanalysis and its larger-than-life creator were rarely out of the European press. One of the ironies of micropsychoanalysis is that it could just as easily have taken off in America rather than Europe. In 1947, Fanti, then a 28-year-old psychiatrist, trained as a Freudian analyst in New York, and practised in the US until l953.Achance meeting at a dinner party with a White House aide led to an invitation to Washington to analyse a senior White House adviser. Asked later to analyse the politician’s wife, he became a close friend and confidant of the family Soon Fanti’s reputation took off. His social circle — as well as those waiting to lie on his couch - soon included, reportedly Guggenheims and Rockefellers as well as international statesmen, diplomats, film stars and industrialists.

Suicide of a Politician

However, in 1953, a politician he was treating committed suicide after nine 50-minute sessions of conventional analysis. Distraught, Fanti returned to Switzerland determined either to give up analysis or revolutionise a practice he believed was too superficial and slow. Shortly afterwards, a German banker told him he had considered undergoing analysis, but had only five available weeks before leaving Europe. Fanti took him on for up to eight or ten hours a day, insisted they spent their spare time socialising together, and asked him to bring along all personal childhood mementos which might prompt memories of his upbringing. From 1953 on, Fanti continued developing his method, treating super-rich clients, often from overseas, who would usually stay at his home. In between, he often travelled abroad, sometimes as far away as Australia and the Far East, treating statesmen and tycoons, even high-ranking church members, who were too busy to come to him, accompanied by his retinue of assistants and any clients currently in analysis.

Fanti’s eccentric working methods — which included analysing patients while on his annual slimming cure at the spa town of Evian — soon became legend. Not surprisingly, it was the extramural activities, which Fanti saw as integral to the success of micropsychoanalysis, which sparked the most controversy, and probably tainted its image among many psychologists, even though his rationale made a certain sense. “Too many psychiatrists in the past have played at being gods and gurus. I insist that we analysts should not be looked up to,” Fanti told me when I met him in the late Eighties. “When my patients spend time eating meals, drinking, chatting and relaxing with me, they see I have faults and weaknesses like any ordinary human being.” Fanti believed that, in contrast to classical analysis, this weakens the process of transference and patients are then less likely to idealise the parent figure represented by the analyst. It sounded like a refreshing take on his profession, a recognition of its power and tendency to manipulate. But was Fanti really so averse to being a guru?

Meeting Silvio Fanti

My first meeting with Silvio Fanti was on a winter afternoon when I arrived in the middle of a lunch party of around 20 guests at his villa in Couvet. A haze of cigarette smoke enveloped the chattering crowd; the table was cluttered with the remnants of a lavish meal and wine was still being passed around the refectory table. Fanti, a jovial mountain of a man in a black polo-neck, held court, puffing on a cigar, telling jokes and anecdotes. What seemed at first to be a weekend house party turned out to be a routine gathering of patients undergoing analysis with Fanti and his two young male assistants. Everybody stayed either at the villa or at nearby hotels. As the afternoon wore on, several patients and analysts disappeared for a late analysis session. By 8pm the group reassembled for drinks in the drawing room, before sitting down to a copious dinner, followed by music, card games and Scrabble, or more conversation. During the evening several women retreated to the kitchen to confide in Fanti’s cook-housekeeper Antonietta, the only member of the household who had never been psychoanalysed; her sympathy and understanding, I later learnt, was a lifeline for many anxious or depressed residents.

What Fanti had created was essentially an elite community. devoted in equal parts to psychoanalysis and the pursuit of good living. However, despite the wealth of many “inmates” as some called themselves, there were no visible signs of ostentation, no designer clothes or flashy accessories. Unlike most converts to any therapy, these patients explained the benefits of micropsychoanalysis in no-nonsense jargon-free terms. “It doesn’t actually change your personality You just learn how to recognise repetitive behaviour. You see the problems and conflicts coming. You repeat previous mistakes, but you know you are doing it, therefore you are never as helpless as before” said Katya, who was halfway through her analysis. Alex, a scriptwriter, told me she had stopped caring about her fillings and what people thought of hem; “even though I’m still no better at doing certain things, like being assertive with employers”. Those who had previously tried orthodox analysis emphasised how much deeper this went. Most agreed with Fanti’s frequent comment that “two hours studying a photo is equivalent to a day on the couch”.

Another unique feature was the luxury of unlimited time, which Fanti insisted he had reclaimed from Freud: “When Freud first began treating people he never looked at his watch, he carried on for hours. It was only later that sessions were limited to 50 minutes. Because the first hour is usually a warm-up, patients feel frustrated when they have to stop abruptly, just as memories begin to surface. We must respect the patient’s right to silence, to talk unprompted, only when ready. The analyst has no business to interrupt or implant ideas in a patient. Many of us talk too much when we should be listening.”

Hedonist craving attention

But how much did Fanti really practise what he preached? It didn’t take long, even for a casual visitor, to spot that this unashamed hedonist who craved attention had established his “therapy commune” largely to satisfy personal needs. Despite the mantra that dependence on the analyst must be avoided, some ex-patients remember being subtly manipulated by Finn to ensure they remained in the fold. Alex, who spent her entire capital, a £150,000 inheritance from her father, on analysis and training as a practitioner, today admits: “Although everybody there was always tremendously nice to me, micropsychoanalysis was the worst mistake of my life”. Having previously believed that ceasing to care about other people’s opinions of her meant the end of old anxieties and inhibitions, she now sees that far from reflecting confidence and self-esteem, indifference simply became another defence mechanism. This truth only dawned on her several years ago during a period of harassment at work, which led to a nervous breakdown. “Even though I always stood up to Fanti, I realise now I was bullied into training.

Unlike many patients who couldn’t wait to become analysts, I wanted to leave that environment because it seemed obvious that if you want to rejoin the real world, then your analysis has worked. Most ex-clients loved the training and were unable to leave the cocoon. When I said I didn’t want to be an analyst, Fanti said, ‘But what else can you do?’ I told him my plans, but he succeeded in undermining all my existing skills and wherewithal. Finally I looked on it as a challenge and started training — which meant paying out a lot more money. Disenchanted, Alex gave up halfway through her training, and tried half-heartedly to resume her writing career while taking menial jobs to earn a basic living. She continued battling with depression and lack of self-confidence, unable to form close relationships with friends or lovers until beginning cognitive behavioural therapy two years ago.

Although micropsychoanalysis has been hailed as non-invasive, Alex believes that there are subtle, insidious influences which may damage very insecure patients — such as Fanti’s insistence that all relationships based on dependency, including marriage, are doomed to failure. Some found the emphasis on emotional detachment hard to take. “I was shocked at how manipulative and abusive Fanti could be towards people, in public,” remembers Alex: “The rule was that people’s analysis shouldn’t be discussed, but it often was. People often left the dinner table in floods of tears. Other therapists were abused in front of their patients. The response was always that he must be doing this for some specific reason. But Fanti was just a bully, and many took it all as gospel because they revered him as a genius — he could do no wrong. Even when he bragged about his drinking binges with friends like Picasso. Apart from overeating and getting drunk, he’d encourage us to overindulge! No one really noticed that the person psychoanalysing us had big problems.”

More popular than ever

Contrary to expectation that interest in his method might vanish after Fanti’s death, micropsychoanalysis is now more popular, even outside Europe. and also attracting interest within medical circles. In the past four years, micropsychoanalysts have been invited to participate at ten psychoanalytic congresses around the world; new institutes were recently founded in Canada, Brazil, Germany and Spain. The technique also appears to be edging slowly towards the mainstream. “There has been a steady expansion in micropsychoanalysis, and some modification in the way it is practised,” says Veronique Caillat, Fanti’s partner and assistant from 1987 until his death, and now President of the International Society of Micropsychoanalysis, which he founded in 1973. “Some of the features which were considered extreme, like very long daily sessions of six, eight hours or more, or insisting that clients pay full fees for 100 hours in advance, rarely happens these days.” Less common, too, is the trend for patients and analysts to share a social life. Professor Nicola Peluffo, director of the Italian Institute of Micropsychoanalysis at the University of Turin, which has about 30 qualified members, says that most Italian practitioners prefer not to mix socially with clients. “I believe it is better to maintain a professional relationship in its traditional form — it is less invasive for the client and his family”.

While no longer the spectacular moneyspinner it was when Couvet became a Mecca for troubled millionaires, micropsychoanalysis still seems almost absurdly financially demanding. Although Daniel Lysek stresses that many practitioners now charge less, because there are more of them (he says the rate among his own colleagues is between £50 and £100 an hour), Caillat emphasises: “Money is rarely a problem for someone who genuinely wants to embark on analysis,” she declares airily. “Many of our clients aren’t rich; they save, borrow from relatives, or take out loans. And if you have insufficient money for it, that could be exactly why you need it, to Fanti out if something is holding you back from fulfilling your potential earning power.”

Expense aside, finding concentrated periods of time and energy to undergo 100, let alone 500, hours of analysis must surely prove daunting, especially if no practitioner exists nearby? Again, Caillat and Lysek refuse to concede that any of this might present a problem for the average person; on the contrary, they insist that undergoing analysis abroad, far from one’s home environment, ideally during an extended holiday, reinforces its benefits. Location and language can ultimately determine where analysis takes place, and some analysts, following Fanti’s footsteps, may visit clients. An Italian-speaking colleague of Caillat’s, based in France, has just left for China to analyse an Italian businesswoman, temporarily based in Beijing — becoming in effect her “personal shrink”.

This month, a congress in Paris celebrated the thirtieth anniversary of the foundation of the International Society for Micro-psychoanalysis — and the fiftieth birthday of the technique. Among the many tributes to Silvio Fanti was the famous claim that his technique goes “further than Freud”. Maybe it does. But at such financial cost, one wonders how many can ever benefit.

Some names in this article have been changed

This article in its entirety is copyright © 2003 Alix Kirsta.
First published in the Times magazine, 15 March 2003

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