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Freud, the father of modern psychotherapy, was the first to emphasize the central psychotherapeutic significance of the doctor-patient relationship. In the meantime much has been published on this subject. This afternoon, we heard one paper on this
topic by Semrad, Menzer and Mann of the Boston State Hospital, discussed by Mary Julian White of Chestnut Lodge. Let me remind the participants of this panel and the audience of other authors who have concerned themselves with this subject: Balint, Berman, Eisler, Federn, Ferenczi, Lorand, Reich, Rosen, Sullivan, recently Bychowski, Steinfeld and the writer.
There is agreement among all of these authors about some basic requirements which a psychiatrist must fulfill in order to build a valid therapeutic relationship with his patients, with the goal of contributing constructively to the solution of the patient's difficulties in living. First, the psychiatrist should have his own problems in living reasonably well solved, or he should at least be sufficiently aware of them so that they do not interfere with his ability to listen constructively to patients. If that is accomplished, the previous or present problems of the psychiatrist may serve as a useful adjuvant in an experiential personal frame of reference in his work with the patients—so long as he guards against using them for wayward over-identification.
Second, the psychiatrist should be able to handle impacts upon his own narcissism and on his personal and professional vanity without uncalled-for, unconstructive counter-reactions. This includes his ability to handle frustrations in the therapeutic process, patients’ hostile outbursts against him, and the eavesdropping of sensitive patients upon expressions of the hidden peculiarities of his personality.
Let me illustrate this by the report of a boardwalk consultation which I had this afternoon with several younger colleagues. One of them spoke of a psychotic patient who had done remarkably well in treatment for severa