The Role of the Patient-Analyst “Match” in the Outcome of Psychoanalysis

In trying to explain the nature of change in psychoanalysis, three factors are commonly stressed: the process of psychoanalysis, the role of the analyst in creating the therapeutic action, and the psychological characteristics of the patient. I believe that the “match” or “fit” between patient and analyst is a fourth critical element. This mesh of the analyst's personal qualities with those of the patient has rarely been a special focus of attention although most analysts when making referrals do consider it; few assume that equally well-trained analysts are completely interchangeable. Instead whether the referring analysts formulate their assumptions or not, most look for a match or fit between patient and analyst.

In beginning to examine the element of match, it is important to look at the factors leading to change. In order for change to occur, the analyst must be able to enter the patient's subjective world affectively, communicate an understanding of it, and yet maintain a view of the patient's affective and cognitive experience that is different from the patient's in areas of conflict and discomfort. I contend that the analyst's therapeutic effectiveness, reflected in an ability to understand and effectively communicate with a patient, is shaped not only by training and skill, but also by personal attributes. Even assuming adequate training and skill, when the personal characteristics of the analyst are too similar to those of the patient in his areas of specific conflict and/or disturbance, and especially when the analyst is not aware of this overlap as an issue, then analytic effectiveness may be