Alexander begins by tracing the development of psychiatry from its beginnings
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as a common-sense, intuitive art to its present position as a science based upon knowledge of human illness. 'Psychiatry is not only ready but eager to assimilate in an undiluted form the teachings of Freud … it became our responsibility to guide and facilitate this process of incorporation.' The logic of psychoanalysis will lead to 'the absorption of psychoanalytic theory and practice into psychiatry and medicine in the not too distant future'. Alexander divides psychotherapy into two categories, the supportive and the uncovering procedures. All uncovering procedures are aimed at increasing the ability of the ego to meet unconsciousconflict, while supportive procedures are aimed at meeting acute stress. He enumerates five supportive measures: gratifying dependency needs; abreaction; objectively reviewing the stress, thus assisting the patient's temporarily impaired judgment; strengthening the neurotic defenses; and manipulation of the patient's situation. From the beginning of treatment the formation of a regressive dependent transference must be controlled by keeping the patient aware of his wishes for dependency by frustration of them. This cannot be achieved by interpretation alone. These procedures make it possible to treat many patients who would otherwise fall into the category of 'interminable cases'. It is emphasized that the use of such measures requires as much technical and theoretical preparation as psychoanalysis. The classical psychoanalytic method is differentiated from other uncovering procedures mainly in 'quantitative respects',—that is, the criterion is whether the procedural method is primarily supportive or uncovering. The method should be selected to fit the patient, not the patient to fit the method. 'Psychoanalytic' should be used to identify all procedures using the same concepts, observations, and technical principles as psychoanalysis, while 'psychoanalysis' is to be retained as the trademark for the classical procedure.
Flexible use of psychoanalytic principles requires more knowledge than the use of the classical procedure. The recommendations by the Chicago Institute for Psychoanalysis for reducing the dependency in transference to workable levels is opposed, Alexander believes, not because of theoretical considerations but rather because reduction in frequency would abolish the barrier between psychotherapy and psychoanalysis.
Alexander's views on the present readiness of psychiatry to embrace the whole of psychoanalytic theory and practice may well be seriously questioned by both analysts and psychiatrists. This paper, moreover, contains an interesting and seemingly important change in his views as to when the dependency needs of the patient should be frustrated. In Some Quantitative Aspects of Psychoanalytic Technique, abstracted above, he states clearly that neutrality should be preserved until the transference neurosis develops, while here he suggests frustrations of the dependency needs from the very beginning of treatment.
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Richter, P. (1958). Journal of the American Psychoanalytic Association. II, 1954. Psychoanal. Q., 27:284-285