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Baker, R. (1980). The Finding 'Not Suitable' in the Selection of Supervised Cases. Int. R. Psycho-Anal., 7:353-364.
    

(1980). International Review of Psycho-Analysis, 7:353-364

The Finding 'Not Suitable' in the Selection of Supervised Cases

Ronald Baker

SUMMARY

The paper considers the scope of psychoanalysis as a treatment method from its beginnings to the present. The positions of those who adhere to 'widening' and 'narrowing' scopes are described and it is shown that the gulf between these polarized views has not diminished. The author refers to a range of studies which examine indications and criteria for selection of patients for psychoanalysis. It is pointed out that the literature reflects ambiguity and uncertainty rather than clarity. The unique and special circumstances of the supervised case and its selection is now stressed. It is suggested that the specific defences used by patients with borderline personality organization, as expounded by Kernberg in his classic paper, represent a clear demarcation line between those patients who are 'not suitable' and those who might be accepted for treatment by a candidate. The writer recommends that all patients seeking analysis at training institutes should be deemed 'not suitable' until proved otherwise in the assessment interviews, the main criterion for selection being the absence of the primitive defence mechanisms of 'splitting', 'projective identification', 'denial', 'primitive idealization', 'omnipotence' and 'devaluation'. In particular, it is proposed that those patients in whom these defences appear to operate successfully, should be regarded with caution.

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