Psychotherapy as the Initial Phase of a Psychoanalysis

Although it is an increasingly common practice for psychoanalysts to select analysands from their own psychotherapy case loads, the analytic literature is surprisingly silent on this subject. Through the presentation of an extensive case report, I have attempted to document that cases of successful conversion do exist and to illustrate the impact on the therapeutic relationship and treatment process of the decision to enter psychoanalysis. In attempting to understand the relationship between the psychotherapy and the subsequent psychoanalysis, I have examined issues of technical neutrality, the impact of reality factors on the transference and the relationship between psychoanalytic and psychotherapeutic technique in the opening phases of treatment. While reasons for beginning with a less intensive treatment may vary, my overall conclusion holds that given a patient for whom analysis is appropriate and an analyst who maintains a position of technical neutrality through the psychotherapy phase, successful conversion from psychotherapy to psychoanalysis is indeed possible. Under such circumstances, the condition of a prior psychotherapy with the treating analyst should not be considered a major modification of analytic technique. Rather, it is more usefully conceptualized as an alternative pathway to psychoanalysis or a variant of the opening phase. For patients such as the one presented here, an introductory psychotherapy phase may even be a necessary prequisite if an anlysis is to occur.