Psychoanalytic Therapy in the Light of Follow-Up

In the course of years we have learned a lot about the theoretical aspects of psychoanalytic therapy. This knowledge should enable us in each individual case to judge when an analysis is finished, and whether the therapeutic result is in agreement with our theoretical demands. Certain doubts had always accompanied our overvaluation of analytic therapy, but not until Freud's "Analysis Terminable and Interminable" was published (1937) were we able to set definite criteria regarding the limitations of psychoanalysis as a therapeutic method.

There are two ways in which to evaluate the therapeutic successes in analysis: (i) the statistical reports as submitted by Alexander (1), Knight (7), Jones (6) and others, and (ii) individual observation. In my efforts to arrive at statistical data on the basis of my personal experience with 250 to 300 analyzed patients plus a great number of control cases, I came to the conclusion that it is very difficult to speak of therapeutic results in general terms. From what point of view should the analyst classify his success? By the loss of the symptom? By the ability to adapt to reality? Or by the degree of harmony achieved in the patient's personality (ego)?

I consider the method of individual observation the more reliable of the two. The analytic literature is rich in case histories, in reports of failures and successes and in theoretical interpretations. There is, however, an evident lack of information about the postanalytic psychic state of patients whose treatment has been successfully terminated. At this point the method of direct observation is no longer available. We have learned certain general facts, such as that the patient will for a time continue the analytic process by self-analysis, and that the remnants of incompletely resolved transference may reappear and cause difficulties, etc.