Letters to the Editors

To the Editors:

I read with interest your “Guidelines for Identifying Therapeutic Modalities” (Vol. 41, No. 3, 1981) and found them to be generally a clear and useful addition to the literature on the subject. I would like to add a few comments. The distinction between psychoanalysis and psychoanalytic psychotherapy may be in reality more blurred than as noted in your Guidelines. For example, a particularly insightful patient in twice-a-week psychotherapy may use the couch, may not have a diagnosable mental disorder, and may achieve significant self-realization, comparable to, or better than, that achieved by a less insightful patient seen more frequently. Similarly, patients who have been in psychoanalysis may reduce frequency to once or twice a week as they near termination and yet still do major psychoanalytic work. Also, supportive therapy may be done at less than weekly intervals, particularly in the later phases of therapy.

So I would like to clarify whether you are making frequency of treatment an absolute criterion for distinguishing between therapies.

To the Editors:

The scope and detailed analysis of the “Guidelines for Identifying Therapeutic Modalities” (Vol. 41, No. 3, 1981) is a very organized one which to my knowledge has not been done before. In my comments I shall try to keep in mind that Dr. Ingram and his committee sought to achieve a closer amalgamation between psychoanalytic points of view and those of DSM III. This is truly a heroic task. The Guidelines show that much thought and care has been put into defining the dimensions of the psychotherapeutic processes. They will not satisfy everyone. We therapists work with language. The Guidelines work with words too, which are symbols. The possibilities for interpretation and misinterpretation cannot be overestimated.

As to the title, the four modalities discussed do not exhaust the therapies. A more accurate title would be “Guidelines for Identifying Verbal, One-to-One Therapies,” since group, family, co