Whom is it possible to analyze? It used to be traditional for psychoanalytic institutes to have a course in analyzability. While many institutes today do not have such a course, others still do. Even in many of the institutes that do not have such a course, the question is still considered seriously, but often inadequately. The question is usually formulated in terms of there being certain patients who are analyzable and certain patients who are not analyzable. In essence, the question is whether the patient is good enough to be analyzed; that is, whether the patient has a high level of ego functioning and object relations, which will make a therapeutic alliance easy to achieve, and a full transference neurosis easy to develop, easily tolerated, and easily resolved. A great deal of thought has gone into what aspects of ego functioning are most relevant and how best to measure them. On the other hand, history shows how vain this search is.
It is the wrong question. The right question is, What needs to be done to make this person an analyzable patient?
The problem of the analyzable patient is not just a problem for institutes and training. Today we hear analysts decrying the absence of suitable patients. You cannot make a living as a psychoanalyst; there are just too many psychoanalysts and not enough psychoanalytic patients. And if, by “suitable patient,” you mean someone who does not have serious problems, has no serious ego deficits or characterological problems, makes no phone calls, has no emergencies or unexpected crises, comes in four or five times a week, and pays a large fee, indeed there may very well be few analyzable patients.
But if a suitable patient is someone who is hurting badly and is willing to work because he or she is desperate, who may have to be seen on a sliding scale, who has crises and provides challenges, then there are patients, and they are interesting, treatable patients.
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