Therapist Anonymity in Rural Areas

The therapist as a neutral and basically anonymous person to the patient seems to be a basic stance or even role in the development of individual psychoanalytic psychology. Approaching anonymity seems to be useful both in understanding the patient's previous relationship with important early figures as they are expressed in the transference with the therapist and in helping the therapist with the countertransference struggle to gratify the needs of the patient.

The large cities, such as Vienna and New York, where much of the major work on psychoanalytic psychotherapy has been developed, may have permitted such techniques to flourish by allowing an isolated patient-therapist contact. In an environment, however, where extratherapeutic social contact between patient and therapist may be virtually unavoidable or at least quite likely, possible influences on the usual psychotherapeutic relationship must be recognized.

Such an environment is that of the small community in rural areas. Although the effect of the rural environment on other areas of service delivery has been studied, the size and nature of the surrounding community as a relevant variable in psychotherapy has been virtually neglected. Concerns of and ideas for this paper relate to being one of the only therapists conducting psychoanalytic psychotherapy in both a small town of about 30,000 people and its nearby military community of less than 10,000 in rural Alabama.

One consequence of the small town is the marked increase of inadvertent social contacts between therapist and patient. This necessitates a significant change in the type and frequency of unplanned self-exposure of the therapist. Repercussions of this frequent loss of anonymity with typical patients from the rural community are indicated in the following cases.

Case 1. A young woman who was a middle-level army officer came in for treatment after being rejected by a man, when after a close relationship