The Future of Psychoanalysis

Ominous predictions about the future of psychoanalysis are not a new phenomenon, but they have recently taken on new coloration due to third-party payments, threats concerned with malpractice insurance, the pressure to develop more short-term therapies, lack of funds for psychiatric hospitals, etc. These problems enhanced the tendency to invest more time and money seeking chemical or organic answers for problems of mental illness such as the new modification of electro-shock therapy. Obviously any improvements that can be made in terms of more refined and effective drug treatment are all to the good, especially if drugs can be found that involve less danger, and will not create irreversible damage, to the central nervous system. Mechanical methods of treatment are important for chronic, irreversible, severe mental illness as well as for many forms of acute psychotic and depressive reactions. There is a grave danger, however, of our falling into the trap of thinking these will solve our increasing needs for personal, psychoanalytically oriented psychotherapy. The latter, for instance, is often necessary to maintain and enhance initial improvement started by the use of drugs. It decreases the percentage of relapse.

There will be increased need for psychotherapy not only as a result of population increases, but also due to increased social stress and economic insecurity. Lawrence Kolb has pointed out that admission rates have correlated historically with fluctuations in the economy. In addition to this, there is bound to be an increase in anxiety and depression, and many character disorders that might hold up in normal conditions will now require more help.

I think that psychoanalysis has an important role to play in facing these problems of the future. Psychoanalytically trained people are more apt to have good clinical judgment in terms of diagnosis and prognosis, and can be of help in selecting what type of treatment is most apt to be helpful. They are also more able