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In this paper shall be presented some of the guiding theoretical and personal considerations that influence how I work. Naturally such a presentation cannot convey the variety and detail of an individual session or even more so of an entire analysis. But it may provide a reasonably informative view. The theoretical roots of my presentation lie in the broad psychoanalytic tradition, starting but not ending with the monumental work of Freud. This tradition is by now common property among analysts and indeed among the educated public.
Personal style and preference have necessarily defined the limits of my analytic experience. Thus, I have not found myself useful with severely paranoid or hypomanic characters or seriously addicted drug users. Accordingly, I do not view most of the guiding principles I put forward as having general validity. Perhaps the decisive general metaprinciple is that psychoanalytic therapy has to be individualized according to the particulars of the case.
First, some technical aspects. Generally I prefer to see patients two or three times a week; if the patient is under severe pressure, with danger of personality disintegration, an occasional fourth session may be helpful until the urgency abates. The underlying consideration here is continuity, with the opportunity for sufficient time, after initial unburdening, for associations and reflections. The use of the couch may be advisable, after getting acquainted, if the patient can tolerate the visual deprivation without decompensating and if there is a need to reduce the number of stimuli
Dr. Mendelson is Assistant Clinical Professor, Department of Psychiatry, Albert Einstein College of Medicine; Training and Supervising Analyst, William Alanson White Institute.