CONTRAINDICATIONS TO PSYCHOANALYSIS:
presenter: Herbert J. Schlesinger, Ph.D.
ARE THERE PERSONS WE SHOULD NOT TAKE INTO PSYCHOANALYSIS?
discussant: Frederick M. Lane, M.D.
Summary and Learning Objectives:
There is a class of persons who apply and seem entirely suitable for psychoanalysis. They have the requisite intelligence and psychological mindedness, had some success in life, but believe they could accomplish much more if not burdened by what appear to be neurotic inhibitions and symptoms.The neurotic impediments yield to analyzing, but the patient is now impatient to stop. Problems with unresolved narcissism, which have become evident to the analyst, do not seem to be of concern to the patient. To the analyst’s dismay, the patient ruthlessly goes about achieving the life his inhibitions had previously forestalled. The analyst ruefully considers that the neurotic symptoms he helped the patient to overcome may well have kept this unbridled narcissism in check and been the main civilizing influence in his life.
What evidence would allow us to anticipate such developments? How might we conduct treatment so as to give the best chance at analyzing? Problems in terminating (not just ending) treatment with such patients will be discussed, as will the question of how to assess the likelihood of terminability, not just analyzability, in deciding whether to recommend psychoanalytic treatment.
For CME purposes:
Attendees should be able to recognize the presence of specific narcissistic features that presage special difficulties in conducting psychoanalysis or psychodynamic psychotherapy and should understand better how to keep these features in focus. They should appreciate the importance of terminability as well as analyzability when evaluating prospective patients for such treatment.
Schlesinger full text
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Lane discusssion soon to follow!