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Accumulated clinical experience has demonstrated that a psychoanalytic structure can be of value in the treatment of relatively disturbed patients.1 Nevertheless, difficulties remain in the identification of those more disturbed patients who will benefit (Stone, 1954). Prediction of the therapeutic course in such cases is especially unreliable. Furthermore, analysts differ over the question of whether and when a psychoanalytic process has been achieved in these situations. The question of what distinguishes psychoanalysis from psychoanalytic psychotherapy has remained unresolved and continues to be the focus of controversy.
If a clinical trial is undertaken with a more disturbed patient, the outcome may range from a completed analysis (characterized by the eventual development of a fundamentally psychoanalytic process) to a failure to utilize the psychoanalytic structure, leading to termination or to conversion to some form of psychotherapy. In the middle of this spectrum are patients who, for a period of time, make good use of a psychoanalytic structure, both to achieve some therapeutic gain and to engage in some elements of a psychoanalytic process. Then, after several years of work, the analysis is either terminated prematurely or converted to psychotherapy. It is often with these patients that the difficult question arises about the essential distinctions between psychotherapy and psychoanalysis.
These controversies have implications for the selection of patients for student analyses. Often a clinical trial of a psychoanalytic structure provides the best means of assessing its potential value to the patient.