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In therapy? In Argentina, it’s the norm

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Argentina has more psychologists per capita than anywhere else in the world

Almost half of them are in Buenos Aires

Psychoanalysis, which is not common in the United States, still flourishes in Buenos Aires

Buenos Aires CNN —  

Curled up in a fetal position, Vivi Rathbon would stare at the textured wallpaper of her analyst’s office as she spoke.

Sometimes she’d lie flat on her back with her arms dangling off the leather couch. Her therapist sat behind her in a recliner, out of her view. The door was locked for privacy.

This is how Rathbon, of Boise, Idaho, began her sessions of psychoanalysis when she lived in Buenos Aires after college. She went into therapy in 2011 because she suffered from intense depression and felt guilty about choosing to live so far from her family.

Before seeking help, she didn’t know that psychoanalysis, while viewed as somewhat obsolete by many professionals in the United States, is commonplace in Buenos Aires. When she first went to see her therapist, she had no idea what she was in for, and spent the first two weeks of sessions lying in silence.

“It was really awkward at first,” said Rathbon, 26, who moved to Argentina after graduating from college into a tough job market. “It’s very Woody Allen. You’re laying there, the analyst just says, ‘OK, talk.’ ‘Talk about what?’ ‘Anything.’ It’s free association. You just have to talk about whatever comes to your mind. And that’s actually a lot harder than you would think.”

It’s not just psychoanalysis that’s popular in Argentina. The country has the distinction of being home to more psychologists per capita than anywhere else in the world. Almost half the country’s psychologists are concentrated in the capital city of Buenos Aires.

Modesto Alonso is a psychoanalyst in Buenos Aires who keeps track of how many psychologists practice in Argentina.
elizabeth landau/cnn
Modesto Alonso is a psychoanalyst in Buenos Aires who keeps track of how many psychologists practice in Argentina.

Portenos – that’s what residents of Buenos Aires call themselves – say they don’t have the same stigma about seeking mental health treatment as Americans. Whereas mental health treatment in the United States might be seen as something to keep secret, it’s common in Buenos Aires to talk about emotional problems or what’s going on in therapy.

Going to a therapist just for a space to work through a certain issue might seem frivolous in some cultures, but it’s normal in Buenos Aires, said Daniela Frankenberg, a bilingual psychologist practicing there.

“In the expat community here, I see more and more people coming to my office who perhaps in their home country would have never done therapy,” Frankenberg said. “Here, feeling that it’s something that people do, (they) give themselves room to do that.”

Psychotherapy is a tool, “not only to cure emotional and psychological illnesses, but also tools to develop oneself as a person, with a greater quality of life,” says psychologist Modesto Alonso.

The numbers

Therapy around the world

Therapy around the world
Number of psychologists per 100,000 residents, 2011

Argentina: 202 (calculated separately); 106 reported to WHO in 2005

Austria: 79.88

Australia: 62.48

France: 47.90

Canada: 46.56

Switzerland: 40.78

Iceland: 31.89

United States: 29.03

Cyprus: 29.99

Andorra: 28.84

Monaco: 27.35

  • Source: Modesto Alonso and colleagues, World Health Organization
  • Alonso’s office is on the ninth floor on a wide avenue in the Belgrano neighborhood of Buenos Aires.

    With a gentle grandfather-like demeanor, Alonso talks about the most recent study that he and colleagues conducted on psychologists in Argentina. He emphasized that some of the figures are approximate, especially with regard to how many are in Buenos Aires, but they are the best that are out there.

    A 2005 World Health Organization study ranked Argentina as the world leader in psychologists per capita, at 106 psychologists per 100,000 people. WHO’s numbers for 2011 don’t include the country, but Austria’s 80 per 100,000 would still pale in comparison to the 202 psychologists per 100,000 that Alonso and colleagues estimated for Argentina in a 2012 study.

    Using data from 2011, his group showed that Argentina has about 81,000 practicing psychologists in the country, 46% of whom are in Buenos Aires. These numbers do not include psychiatrists.

    By comparison, according to the American Psychological Association, based on 2012 data from the Bureau of Labor Statistics, there are about 33 clinical, counseling and school psychologists per 100,000 people in the United States – in line with estimates based on licensing data.

    As expected, there are higher concentrations of psychologists in urban vs. rural areas. That also applies in Argentina; in Buenos Aires, there are 1,280 psychologists per 100,000 people, according to Alonso’s study.

    More and more students are becoming psychologists, too – about 2.6 students are entering a psychology program for each one who graduates.

    One of the soon-to-be psychology graduates is Agustina, 31, who did not want her last name used because her future patients may Google her name.

    Every member of Agustina’s family goes to some kind of therapy, but, she’s quick to add, “It’s not that we are completely crazy or something. Nobody has big issues.”

    She’s in group therapy, in which participants speak about their problems and a therapist mediates the discussion. In her circle at school, anyone who hasn’t been to therapy is seen as aberrant – it’s like “Oh my God, this person has issues,” she said.

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    Why so many?

    Gabriel Rolon, a prominent psychoanalyst who has written several best-selling books – the new Argentine TV series “Historias de divan” is based on his writings – said he sees the proliferation of psychologists in Argentina as good news.

    Gabriel Rolon is a psychoanalyst and best-selling author in Buenos Aires.
    elizabeth landau/cnn
    Gabriel Rolon is a psychoanalyst and best-selling author in Buenos Aires.

    While in other countries there may be a clearer division between physical and mental sickness, “in Argentina a very important battle was won, which was giving space to emotional health,” he said, and acknowledging that a person who suffers emotionally needs professional help, “just like when he has pain in his knee or another physical symptom.”

    In his spacious white-and-wood home office, there is a particular sensitivity and poetry in the way that Rolon speaks about why the culture has evolved this way: That the people who created Argentina fled from war, hunger, ideological or religious persecution. Everyone had left something behind – relatives, friends, language, land – and so they brought with them a certain sadness and nostalgia.

    “We became listeners interested in the pain of others, because we also needed people to be interested in our pain,” he said.

    This theory, he admits, may be more poetic than real, but it’s true that modern Argentina has had a lot of influence from European immigration, particularly from independence in the 19th century until the 1950s, when immigration restrictions tightened during the country’s military dictatorships.

    The United States also had European immigration during this time, and psychoanalysis was also “the thing to do” in America in the 1940s, ‘50s and ‘60s, said Albert Brok, a psychologist who practices in New York but grew up in Argentina. But this form of therapy faded as a fad, conflicting with ideas about pragmatism, will and work ethic that are dominant in American culture.

    Many Argentines I spoke with agreed that their culture is one in which people talk about their personal issues more openly than in the United States.

    “In other countries, people are more closed off about their problems,” Frankenberg said. “There’s much more of a push for people to resolve their issues elsewhere, like throwing themselves into work.”

    People in Argentina commonly kiss one another on the cheek in saying hello and goodbye, expressing a warm feeling even between a dentist office receptionist and patient. They talk about their feelings. They sit in cafes without a sense of urgency, drinking café con leche with a small glass of soda water and eating small cookies.

    Brok said the United States tends to have a culture more oriented toward shame and individualism, and an ethic of finding solutions to particular problems.

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    Argentina, he says, is more into introspection. The Argentine tango, too, invokes nostalgia and self-exploration, Frankenberg said.

    The slowness of psychoanalysis in particular may make it unattractive in other cultures, Rolon said. No analyst can guarantee a result in six months, and therapy goes as long as it continues to feel right to the patient and analyst. Rolon has himself been going to psychoanalytic therapy for 25 years.

    “Maybe a patient comes because of a problem. And when that problem is resolved, he realizes that he wants to continue working on other problems. In analysis, that is permitted,” he said. “In other kinds of therapy, when a problem is resolved, it’s over.”

    Fundamentals of psychoanalysis

    The area around Plaza Guemes is nicknamed “Villa Freud” because of the concentration of psychologists’ offices there. Frankenberg says it makes sense for many professionals to have offices there because it’s “very safe and beautiful and commercial,” with easy access.

    In the display window of Libreria Legenda, a bookstore on a side street near Plaza Guemes, three books were lined up together among a smorgasbord of historical and philosophical titles: Writings of Jacques Lacan, a book about famous cases of psychosis and readings on the psychoanalysis of Freud and Lacan.

    You’ve probably heard of Freud, perhaps best known for his beliefs that behaviors could be traced to several stages of psychosexual development, and that the human psyche has components called id, ego and superego. He argued that the unconscious has a critical role in the formation of our concept of self.

    Lacan is more obscure in America, but he has been influential in the European thinking about the psyche that made its way down to Argentina.

    Among Lacan’s contributions is the “mirror stage,” the idea that when infants see themselves in a mirror, that leads them eventually to produce a sense of self or “I.” But this “self” image is also somewhat false – it is symmetrically inverted, and disconnected from the baby’s actual body, notes Joel Dor in “Introduction to the Reading of Lacan:: The Unconscious Structured Like a Language.”

    If our sense of self is based on an illusion, then, that’s very different from the American ideal of individualism.

    “Psychoanalysis is not only about understanding the will, but unconscious experience,” Brok said.

    The fundamentals of psychoanalytic theory are still important in Rolon’s view. Sexuality is important in the structure of the psyche. There is an unconscious. There is also what Freud called a “death drive,” a self-destructive force that Rolon describes as relating to why people always make the same mistakes. Childhood is important – personality develops, Rolon says, within the first six or seven years of life – but that’s not the main thing that patients discuss.

    “You’re going to tell about how is your job, are you in a relationship, what worries you, why did you come, why are you sad or preoccupied,” he said. “We’re going to speak about today.”

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