Discussion of Arnold Rothstein's Paper

Rothstein has written a cogent, wise paper. Essentially, it is a critique of what Rothstein calls the “evaluative model.” But his choice of terms could easily be misunderstood. By no means is Rothstein opposed to evaluation. He is opposed to a method of evaluation that exempts the analyst from accountability and blames the patient for treatment difficulties. We are trained, Rothstein points out, to ask the question: “Is this patient analyzable?” whereas, as he has stated elsewhere, the only relevant question, the only valid question a psychoanalyst can ask, is: “Is this patient analyzable by me?” Otherwise, we force potential patients into a Procrustean bed, a bed into which the majority of them are unlikely to fit. Furthermore, Rothstein suggests, the question of whether a given patient can be analyzed by a given analyst can usually be answered only by a trial effort, conducted open-mindedly.

Here Rothstein extends his critique to include the tendency toward misguided pathologizing that has tended to characterize traditional psychoanalytic conceptions of diagnosis and treatment. It is reasonable to assume, Rothstein says, that the patients who come seeking our help really do want our help. One would think this assumption is self evident; but Rothstein is right to emphasize it, inasmuch as longstanding, prevalent psychoanalytic principles (e.g., the concept of resistance) do direct the analyst to assume that patients, despite their ostensible interest in getting better, secretly prefer to remain ill. Therefore, Rothstein goes out of his way to advocate for what he terms a “trusting model,” i.e., an approach in which the