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Wallerstein, R.S. Adler, M.H. (1970). Panel on 'Psychoanalysis and Psychotherapy'. Int. J. Psycho-Anal., 51:219-231.
(1970). International Journal of Psycho-Analysis, 51:219-231
Panel on 'Psychoanalysis and Psychotherapy'
Robert S. Wallerstein and Morris H. Adler
Dr Rangell: There was a cluster of interest and papers around 1954, all of which resulted in the publication of 12 or 15 papers in a whole issue of the Journal of the American Psychoanalytic Association, in an attempt to clarify the grey area of theory and technique of dynamicpsychotherapy. There was then a lull in interest and I am glad to see that it has been revived. In my own paper on that subject I tried to delineate precisely the area which is the focus of this panel—the similarities and differences between the two areas. What is necessary is an equal kind of conceptualization, if that is possible, between a much more amorphous area of psychotherapy in comparison with the more structured and definable area of psychoanalysis. People are working towards that end, and we need further study. We need the raw clinical data of this area of psychotherapy. Many people are studying it and have studied it for many years: Dr Wallerstein himself and his team at the Menninger Clinic; Dr Zetzel in Boston; and another team at Mount Sinai in Los Angeles. This is not a completely empty field. Attempts at conceptualization have been made and good ones. I refer to Dr Sidney Tarachow's book on psychotherapy. There is a small, clear, excellent book by Dr Tedesco on very brief psychotherapy: and the vast literature on borderline patients who come for treatment contained various attempts at conceptualization in the techniques of this field.
It would appear that there are a variety of treatment facilities serving different kinds of patients. Psychoanalysts in these settings have developed experience and skills for dealing successfully with most of the crises and maladjustments encountered. Those patients who are
not helped by these circumscribed goal therapies require extensive care.
This can involve management of the patient at his level of adjustment or an attempt can be made to alter the course of his illness through changes in his personality. Psychoanalysis is one form of such care for the chronic patient and is being applied to a certain portion of this group. A much larger number require another form of psychotherapy. These patients are important because over the years they tend to clog up every therapy facility built. They are the ones who shake us out of our complacency and indicate there is more for us to learn.
Some feel that appropriate care for these patients is so complex and sophisticated that it can be provided only by psychoanalysts themselves. Yet this is a highly unpractical solution, since the case load is huge and the number of analysts is a small fraction of the total number of psychiatrists, and other professionals in the field.
In our role as teachers, it is incumbent upon us to teach others to help share the burden.
In order to teach psychotherapeutic theories and their applied skills with assurance, clarity and effectiveness, it is necessary for these theories to be more thoroughly and precisely formulated.
Some differences in opinion expressed at this panel may be more apparent than real. However, they do indicate the need for further study and explanation. Dr Wallerstein has favoured us by preparing, in effect, a blueprint for such studies. Some of the speakers have indicated how we should contrast and compare the differences between the various therapies of the different patients in different settings. We must endeavour to do this; otherwise we will continue to run into the paradox of hearing one therapist urge that suggestion never be used, or that transference never be dealt with; whereas another therapist urges us to do quite the contrary.
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