What Would Sigmund Freud Think of Therapy Apps?

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Therapy apps are popping up like daffodils these days. Given how much of our lives has been digitized in some way, this may not be a shock. A therapy app allows someone with a mobile device and an internet connection to complete exercises to address depression, anxiety, negative thoughts, stress, or issues related to self-worth. They also are used to set goals, break habits, track moods, and promote mindfulness, taking one on what is sometimes called a “guided user journey.”

While they apparently offer value given their popularity, especially among the more digitally fluent, one might wonder what Sigmund Freud, the founder of psychoanalysis, would think of therapy apps if he was around today. In my book Shrink: A cultural history of psychoanalysis in America, I discussed how that original form of therapy was a demanding, exhaustive, and usually lengthy process.

Despite its demands, psychoanalysis (the psychological theory and method developed by Freud based on the ideas that mental life functions on both conscious and unconscious levels and that childhood events have a powerful influence throughout life) often didn’t work. (The one-third “cured,” one-third “improved,” one-third “failures” rule was probably about right.) When it did work, however, it was said to work wonders, with only an intensive course of therapy believed to be able to resolve deep-seated neuroses buried in the unconscious.

Although there have been many schools of psychoanalysis over the last century plus, classic Freudian analysis was and remains the best-known and most controversial theory and treatment. Through a long and intense “conversation,” the patient (while yes, often lying on a couch) says whatever comes into his or her mind, with thoughts and feelings considered unacceptable in normal settings encouraged. Thoughts and feelings of an aggressive or sexual nature are viewed as having their roots in childhood, as British psychotherapist Philip Chandler explained in Psychology Review in 2008. That time in our lives was considered crucial as it was then that we defined the boundaries between ourselves and others and determined how to express emotions.

Learning how to tolerate frustration, finding a proper balance between “I” and “we,” understanding the impact of one’s parents as an adult, dealing with depression and anger, and figuring out why one is attracted to the “wrong” person were and remain common themes in Freudian-based analysis. These issues are probably not much different from those that regularly surface in other, newer forms of therapy. While today it represents just a small piece of the therapeutic pie, there is no doubt that psychoanalysis heavily informed the development of both psychiatry and psychology over the past century.

What was different about psychoanalysis in years past was the deep commitment required for both the treated and treater. Sessions were typically one hour long, three to six days a week, with the whole process lasting maybe eight or nine months. Patients were advised not to make any important decisions during treatment, including to get married, get divorced, or start a new career. Even in the mid-1920s, the “talking cure” was not cheap, with analysts charging anywhere from $7 to $30 an hour (about $100 to $500 in today’s money). At about two hundred total hours, patients would thus usually fork over a small fortune—this was before health insurance, after all.

Even dearer than the financial costs were the emotional costs associated with psychoanalysis, as the process was frequently a painful ordeal. Making admissions and giving up illusions about oneself as well as taking responsibility for one’s actions were not easy things for patients to do, especially when friends and family were not particularly sympathetic to the process. Not only was success not guaranteed but there was a widespread belief that analysis could and did lead to insanity and suicide, making one wonder why anyone would put herself through this thing imported from Europe.

Needless to say, therapy apps do not make such financial and emotional demands, as they cost very little, and, with games and quizzes, can even be rather fun. But what would Sigmund Freud think of the evolution of what he developed in Vienna in the late 19th century? We can’t know for sure, of course, but we could conjecture that he’d say that the journey to good mental health requires more effort than that to be found on any smartphone, no matter how smart it is.