Discussion of Arnold Rothstein's Paper

Dr. Rothstein's paper constitutes a welcome and major challenge to psychoanalytic education. Difficult times can bring forth creative new solutions and Dr. Rothstein is undaunted by the challenge of the decline in psychoanalytic practice. He wants us to reconsider our way of thinking about patients, beginning with how we evaluate them. He contrasts the evaluative model, i.e., our “assessment of analyzability” approach with what he calls a “trusting” model. By the latter he means to encourage us, especially younger colleagues, not to go searching for elusive diagnostic factors that would rule out analysis, but rather to assume the patient wants help with his or her life, and analysis is the most powerful tool for accomplishing this beneficial change.

My own experience teaching a course in “assessment of analyzability” supports Dr. Rothstein's view. I found that students became very deft at discerning supposed ego weaknesses and developmental deficiencies that would rule out analysis as the treatment of choice. That way they didn't run the risk of starting analysis only to find it not working. Students worry about the dread criticism, “You weren't doing analysis.” Better sometimes not to start than to risk that judgment. Often a deprived or traumatic early history was taken to mean that analysis could not work. Clinical experience teaches that such a history may produce unusual strengths along with vulnerabilities.