A Reply

The Guidelines originated from the perceived need within the Horney group to ask: What do we mean when we use the terms psychoanalysis, analytic psychotherapy, supportive psychotherapy, and counseling? How

much agreement can we achieve before further efforts at detailing our views lead into divergence? Can we formulate a chart of how, generally, we tend to distinguish treatment modalities? We sought an approximation, a compromise with which each of us might find some reasonable objection without, however, needing to discard the final product. We sought to offer “guidelines,” for example, rather than “criteria” or “standards.” In this connection, the Guidelines are not intended to be somehow larger and more legitimate than any single clinician's effort at the same task.

Much of Dr. Crowley's letter concerns emphasis in theory and areas where the logical coherence of the Guidelines may be murky. The elaborations and clarifications that he offers could be incorporated into a next version of the Guidelines, I believe, without raising major problems. That we cared less than Dr. Crowley about certain issues and more about others is no surprise. Clearly, the spirit of his comments and the spirit of the Guidelines are compatible.

The Medical Board is seeking to stimulate a pluralism of views, not to presumptiously hand down a finally correct interpretation. That is, to the extent that the Guidelines prompt clinicians to ask how each distinguishes these therapies, the Guidelines succeed. For those who do not wish to address this question or articulate an answer, the Guidelines offer a default position. Nevertheless, a few critical thinkers may opt to embrace the Guidelines with little or no alteration.

This issue is amply illustrated in Dr. Shrier's letter. Dr. Shrier wants to know if “frequency of treatment is an absolute criterion for distinguishing between therapies.” She apparently regards the insightfulness of a patient in treatment as a very major indicator, even the de