Quality Control, Condensed Analysis and Ethics

A doctor who once had an exciting and fruitful analysis with a ‘master’ of the time decides for personal reasons to embark upon another treatment many years later. This second analysis profoundly disappoints him. The quality of the exchanges seems to him to fall far short of what he had experienced before. The analyst appears absent-minded and bored as he listens, and his interventions are off the point. Nothing happens and the patient decides to break off the analysis after three years of regular sessions. He then goes to a third analyst, whose way of practising analysis is very different from that of the second. Substantial and fruitful psychic work is accomplished. Now the practice of the second analyst has proved incorrect in terms both of his behaviour in the sessions and of his interventions. In any other medical speciality, this negligence or incompetence would be common knowledge and would result in a loss of reputation or even a sanction. So the patient wonders what approach psychoanalytic organisations have towards monitoring the quality of the care provided by practitioners trained at their institutes and claiming adherence to the methods espoused in their soceties.

This issue of the quality of care cannot be evaded for much longer. It is the patients themselves (the ‘consumers’) who are concerned about it, anticipated or followed by government and, more generally, by public opinion as a whole.

The insistence on the need for evaluation and quality control of psychoanalytic treatment is relatively recent (Chodoff, 1996). In the post-war period of rapid expansion of psychoanalysis in Western countries, the idea of evaluating its results by objective empirical procedures barely existed. From the beginnings of psychoanalysis to the mid-1950s, the position had scarcely changed. That is not to say that there were no ethical concerns about the utility of psychoanalysis. As long ago as in 1910, Freud ended his paper ‘The future prospects