But whether you are submitting yourself to psychodynamic counselling, or to cognitive behavioural therapy, or to reversal theory, or to curative hypnosis, the question of when, if ever, the process is complete can hover in the background. For some, the whole point of it is that it is never- ending. For others, the onset of dependency is the cue to get out. And then there are those for whom a conclusion seems to be reached quite naturally.
But whatever the circumstances, if the decision to start seeing a therapist is a big one, the decision to stop can be even more momentous. Which is why the news that Woody Allen, the world's most famous neurotic, has finally, after 40 years, stopped seeing his analyst, will reverberate around consulting rooms from the Upper East Side to the most-angst ridden corners of Hampstead.
It is an issue that therapists themselves are increasingly concerned about. Sensitive to accusations that their motives in seeing people are purely commercial, professional symposiums repeatedly address the question of how to find "resolution" without being interventionist.
"When to stop is a huge theme in the field," says Paul Gordon, a north London psychotherapist. "I have never actually suggested it to a patient myself, but patients do decide for themselves when the moment is right." Mr Gordon, who is the author of Face to Face: Therapy as Ethics, to be published later this month by Constable, says that he can only ever imagine terminating treatment himself if he really felt it was going nowhere. "The trouble is that treatments do seem to have got longer and longer. In Freud's day they were actually quite short."
The lengthening of the shrinking process is partly due, he believes, to the obvious conflict of interest between the parties involved. Therapists aren't in the business of stopping people coming to see them, and among the more venal members of the profession, the patient's needs are hardly paramount. "I hope it is more true in the States than here," he said. "And that may be why there is generally more criticism of the profession over there."
Money is bound to be an issue for private practitioners, whichever side of the Atlantic they are on, and Mr Gordon recalls the predicament of an analyst friend working in London. "Two of her three-times a week patients quit at the same time and it had a big effect on her income."
Analysis typically costs around pounds 35 an hour. But what about those who are parting with the money on a weekly basis, year after year?
"I was so attached to my different therapists over years of attending a few times a week that it was almost as if they were part of my own head," remembers one young woman who gave up therapy two years ago. "I know - and I really think this still - that therapy made me face up to a lot of things, but it was so hard to know when we had reached the bottom and it was finally time to come up again."
Woody Allen decided that, while a good practitioner might perhaps exorcise some minor guilts and improve daily life a little, the patient's fundamental problems are always too deeply-seated to reach. He is not the first writer to have rejected analysis. Joseph Heller displays similar disenchantment in his recent autobiography. "My theory now about psychoanalytical theory," he writes, "is that corrective therapy demands unwavering concentration by a patient of intelligence with a clear and untroubled head who is not in need of it."
Anne Murray, a psychotherapist working privately in Dublin, counters that the defeatist line taken by both Allen and Heller may be fashionable, but it is wrong. "I still think that a person can change quite dramatically at any stage," she said. "It is all about an increasing awareness of your own needs and about not simply saying that you can't change." Miss Murray agrees, however, that the analyst/patient roles can become unhealthily entrenched over time unless the patient learns to take responsibility for their actions.
WHETHER Allen's renunciation is the sign of a general move away from analysis, or whether he is just in "denial" is hard to determine. Certainly the shrinks have taken a variety of beatings during the 1990s. Post-1987, for instance, the impact of Prozac has taken its toll on them. In 1997, New York magazine ran a piece heralding a crisis among the city's analysts. They had reputedly suffered an 11,000-hour drop in "patient therapy hours". In 1985, the article continued, the average practitioner was seeing three patients three times a week; in 1997, the average analyst had only one such reliable customer.
Citing the case of Alvy Singer, Woody Allen's alter ego in the film Annie Hall, the magazine worked out that his total bill for 15 years of therapy would have been the equivalent of pounds 93,000. The calculation gives added bite to the moment in the film in which Alvy promises: "I'm going to give it one more year, and then I'm going to Lourdes."
For some, this sort of opposition between the curative powers of religion and those of therapy is a lot more than a joke. Patients with even a residual faith in God can often feel treacherous about ever having resorted to "science". They are then looking for escape routes. Patients without any faith at all have their problems too. Paul Gordon gives credence to the idea that in an atheist milieu people tend to seek out a neutral observer- figure, someone who will give their life "a bit of narrative shape."
Where religion has been discounted, philosophy has increasingly been asked to fit the bill. At least, in Manhattan it has. A philosopher called Lou Marinoff is at the forefront of a movement designed for "refugees from psychology". Paying upwards of $100 (pounds 60) an hour, clients are offered philosophical bons mots to chew on. "Psychology has failed!" Marinoff is apparently fond of declaring as he banks the cheques.
But if all this contempt for therapy merely represents fear, as analysts have suggested, how can the punters ever win? How can they ever be allowed to criticise their therapist without labelling themselves as still sick?
Anne Murray believes the only way to defuse this kind of antipathy is to help the patient towards a less solipsistic outlook. "People should gradually be encouraged to think about others and not so much about their own reactions to the therapist."
Paul Gordon thinks so too. "Although none of my patients have ever been self-obsessed in that way, I am sure it can happen and that some therapists go on to exploit it. I do wonder sometimes what is going on when a patient has been seeing someone for very many years and nothing seems to be changing, yet alone resolving."
Yet, when the paid hour runs out and the patient is put out on to the street again, Woody Allen's passionate contention is that events are likely to take the same course as they would have done anyway. Maybe it is a rejection of his years of analysis, or perhaps it is his own form of "resolution". He may even have learned the anarchic wisdom of the old story he tells as Alvy Singer at the close of Annie Hall. It is about a man who visits the psychiatrist complaining that his brother thinks he is a chicken. Asked why he does not simply disabuse his brother of the whole idea, the man replies: "Because we need the eggs."Reuse content