The Relationship Between Formal Operations Cognition and Suitability for Psychoanalytic Treatment

Psychoanalysts have long noted the importance of thinking as an important factor in analyzability. Hartmann (1939/1958) viewed psychoanalysis as “the highest form of thinking directed toward the inner life, in that it revises and regulates adaptation and fitting together” (pp. 64-65). Schlessinger and Robbins (1974, p. 556) took note of a patient's “cognitive grasp” of the therapeutic experience and briefly wrote of the importance of her ability to selfobserve and think about past sessions. Bellak and Meyers (1975) stressed the importance of syllogistic reasoning as a capacity necessary for psychoanalysis and noted the interrelatedness of thinking with many other ego functions. Basch (1981) argued that Freud's metapsychology is actually a theory of cognition and he views clinical interpretations as precipitators of cognitive transformations. Paolino (1981) argued that a patient's capacity to understand psychoanalysis cognitively as well as emotionally is the very essence of the definition of analyzability. In their review of the literature on analyzability, Bachrach and Leaff (1978) identified 4 references out of 24 surveyed in which the authors believed that “adequacy of thinking” was correlated with a favorable psychoanalytic prognosis. Diatkine suggested that the capacity for imaginative and secondary-process thinking makes for a more favorable prognosis. In an early article on the Psychotherapy Research Project, Wallerstein and Robbins (1956) discussed the concepts that they intended to use in studying the evaluation process for prescribing psychotherapy and, although not explicitly referred to as cognition, this function would seem to fall within the category they designated as “capacities factors,” which include (1) intelligence, (2) psychological mindedness, (3) constitutionally