The Assessment of Analysability: A Major Hazard in Selection for Psychoanalysis

This paper is based on the author's observations derived from his work as an evaluator of applicants for psychoanalytic training and as a consultant with the responsibility of selecting patients for psychoanalysis to be treated either privately or by students in training. Selection under such different conditions and for such a variety of purposes is made more difficult by the lack of well-defined criteria of indications and contra-indications for psychoanalysis. In the course of a week's work a psychoanalytical consultant may be called upon to evaluate the chances of breakdown, severe enough to require hospitalization, in a patient who has been recommended for psychoanalysis. Such event, if foreseeable, is no bar in the case of private treatment, but it would certainly be a contra-indication for a supervised analysis, although the reasons for depriving a student of the opportunity to gain experience in a special aspect of his future work are not altogether clear. More understandably in the case of an applicant for training the expectation of a psychotic breakdown inevitably leads to rejection. In these examples, rationalization plays a part in decision-making. But the situation becomes rather confusing when we consider specific symptoms such as the sexual perversions. Although most psychoanalysts do not hesitate to undertake their treatment in their private practices, sexual perversions are generally regarded as being unsuitable for supervised analyses, whilst they are the basis for automatic disqualification in the case of applicants for training in some countries at least. This wide range of outlook in relation to a symptom or the possible course of an analysis can only be accounted for by the variability of our assessing capacity and predicting ability, together with the possible over- or under-estimation of analytical skills. This is a puzzling state of affairs, considering that we are dealing with a systematic form of psychotherapy, which has stood th