The Changing Role of Psychoanalysis in the Clinic

Often the correspondence received reflects the characteristics of the recipient as well as the sender. A letter received ten years ago, early in the career of the Karen Horney Clinic, seems to exemplify this idea. It is from Mr. R, a college teacher. He wrote, “At the suggestion of Dr. X, I am applying for therapy for my son, my wife and myself at the Karen Horney Clinic. The immediate problem centers around our relationship with our nine-year-old son, a relationship which has become more difficult and stressful. The effects on him have been nightmares, behavior problems, poor work in school, and difficulty in sleeping. My anxieties and my wife's are contributing factors to our conflicts with our son. We shall be very grateful for an opportunity to discuss our problems with you.”

This letter led to a subsequent routine screening. Both parents and child were seen by social workers, psychologists and psychiatrists. This process revealed that each family member needed help. All three received individual psychoanalytic treatment with three of our doctors for over three years, with generally good results. The discussions which took place among the three doctors during treatment were informal and related to individual treatment. But, that was ten years ago. How have we changed? At present we probably would deal with this case differently. Either family therapy by one doctor, or the utilization of social workers and a psychoanalytic-team approach would be used in our treatment program from screening through treatment. The shift of the therapeutic center of gravity from the patient to the patient-family complex might be considered. Either conjoint family psychoanalytic therapy or psychoanalytic group therapy might also be considered. The sick family requires attention as well as the sick individual.

The Karen Horney Clinic has kept up with the constructive changes now going on in our world. Psychoanalysis in clinic practice is a challenge to us. It is part of the larger chang