Indications and Contraindications for Psychoanalytical Treatment1

The indications which allow the analyst to know when to prescribe psychoanalysis were studied by Freud at the time of his early discoveries. Following the usual medical procedure, patients were placed within a nosological classification enabling the doctor to determine which patients were likely to benefit from treatment—those displaying a transference neurosis, as opposed to those with a narcissistic neurosis, and in a wider sense, those displaying a character neurosis or a fate neurosis. However, the extension of analytic practice to include the latter, the possibility of treating patients with sexual perversion, the difficulties encountered in the treatment of genuine hysterical or obsessional cases as well as in the treatment of so-called "normal" cases, have compelled psychoanalysts to see the problem in another light and to wonder whether there is any way of foreseeing how the treatment is likely to develop. This is a difficult question which only a psychoanalyst can answer, and every day we see confirmation of the fact that even the best non-analytic psychiatrists, regardless of how well-read they may be in the matter, cannot recommend a psyhcoanalytical treatment without running the risk of making a serious mistake. The problem arises from the fact that a study of the superficial aspect of the symptoms leads to a classification which is of definite descriptive interest, but if the matter is taken no further, there is a danger of losing sight of the true meaning of psychiatric science.

When a doctor advises a patient to undergo psychoanalysis, he is involving him in an adventure which is not comparable with any other medical treatment and the way in which such advice is presented shows very clearly that it is no ordinary prescription. The doctor brings the patient face-to-face with his problems, pointing out to him the way in which he is involved in situations which he sometimes p