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The conversion of an initial psychotherapy into a psychoanalysis with the same therapist is an increasingly common clinical practice, or at least a more openly acknowledged one. I say “more openly acknowledged,” since I have the impression, as have others , that such conversions were regularly occurring over the years. In my own experience, three of my most successful analyses began with prior periods of psychotherapy, two beginning in the 1960s and one in the late 1970s. However, as Dr. Balter has indicated in his summary of the clinical issues involved, the increasing frequency of such transitions, and our interest in them, has been fostered by a complex mix of economic, cultural, and social factors, which have greatly diminished the number of patients willing to embark on a full psychoanalysis. This reticence may be the case if the analyst, or even the patients themselves, agree that analysis is the indicated treatment of choice. The analyst is then faced with the decision of how to proceed.
However, there are, and there always have been, a wide variety of other clinical instances where the same decisions are called for. The analyst may not feel certain at first whether the patient is analyzable or suitable for analysis, and therefore concludes that an initial period of exploratory psychotherapy would be useful to clarify these doubts. Or the therapist might feel that analysis is not the appropriate treatment of choice at that time and a prior course of psychotherapy is necessary; for example, for the bolstering of defenses or reparative work, before the patient can adequately and meaningfully participate in analytic work, if by then it seems needed and indicated.
In all of the above circumstances, there are many larger and subsidiary issues that bear on the question of conversion per se, but that