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Alexander, F. (1950). Analysis of the Therapeutic Factors in Psychoanalytic Treatment. Psychoanal Q., 19:482-500.

(1950). Psychoanalytic Quarterly, 19:482-500

Analysis of the Therapeutic Factors in Psychoanalytic Treatment

Franz Alexander, M.D.

SUMMARY

The need for re-evaluation of the psychodynamic factors operative during treatment is emphasized. According to the view presented, the dynamic axis of psychoanalytic therapy is the corrective emotional experience which the patient obtains in the transference. The significant factor is not only that the patient relives his original conflicts in his relationship with the analyst, but that the analyst does not react as the parents did. His reactions should correct the pathogenic effects of the parental attitudes. The objective, understanding attitude of the analyst in itself is so different from that of the parents that this alone necessitates a change in the patient's original attitudes. If the analyst succeeds in reconstructing precisely the original pathogenic parental attitude, he may facilitate the occurrence of intensive corrective emotional experiences by assuming an attitude toward the patient opposite to that of the most relevant pathogenic attitude which prevailed in the past. This does not consist in artificial play acting but in creating an emotional atmosphere which is conductive to undoing the traumatic effects of early family influences. The corrective emotional experience is the most powerful factor in making the patient's original ego defenses unnecessary and thus allowing the mobilization and emergence into consciousness of repressed material. It helps the patient's ego to assume a modified attitude toward hitherto repressed or inhibited impulses. Other important technical measures serve to keep the transference on an optimal level, such as changing the frequency of interviews according to the state of the analysis,

correctly timed interruptions, and encouraging the required kind of extratherapeutic experiences.

Our experience in the Chicago Institute for Psychoanalysis is that with the consistent observance of these principles and technical measures the treatment becomes more effective and economical (8). Although the total duration of the treatment as a rule is not spectacularly shortened, the actual number of interviews can be substantially reduced in the great majority of cases. The principle which is stressed is that of flexibility in preference to routine. Briefness, in so far as the total duration of the treatment is concerned, does not characterize this approach.

Naturally the personality of the analyst and his sex are of great importance for creating the kind of emotional atmosphere and experiences in the transference which are most conducive to reversing the adverse influences in the patient's past. The selection of an analyst for each patient is an involved problem and requires special consideration.

Reasons are submitted for the urgent need for a careful reexamination of the therapeutic process.

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