Variations in the Dynamics of the Analytic Relationship in the Clinic and in Private Practice

For More than twenty years I have practiced analytic psychotherapy. Approximately half of this time I have been in full-time private practice; the other half I have devoted full-time to clinics. Periods of private practice of two to five years have alternated with clinic practice of two to four years’ duration. I have been engaged in both clinic and private practice in several localities: large urban centers, medium-sized cities, and small towns in various parts of the country—Philadelphia, Washington, D. C., Salt Lake City, and Salem, Oregon, among others. Except for three clinics in which I worked on a part-time basis as a member of a teaching faculty, every clinic position has meant full-time paid employment. The clinics have been under the auspices of colleges, cities, states, the Veterans Administration, and a Community Chest. With this diversified experience I may perhaps look at clinic relationships with a somewhat broader viewpoint than if I had been continuously located in one area or with one type of sponsorship.

Because in the clinic the patient load is too heavy and the waiting lists are too long, there is rarely time for long-term, intensive psychoanalysis. I shall therefore assume that the term “analytic relationship” refers to the doctor-patient relationship whenever the doctor is involved in practicing analytic psychotherapy, irrespective of the time factor, and this type of therapy will be the basis of comparisons I shall make.

There are several possible sources of variations in the analytic relationship in clinics and private practice. One source of difference might relate to techniques employed; a second might derive from the environmental factor; a third might have its source in the patient, and a fourth factor could be the therapist.

In many clinics it is routine procedure to have the patient initially interviewed by a psychiatric social worker to determine one or more of the following items: 1. suitability of the patient's problems for clinic serv