Discussion of Arnold Rothstein's Paper an Important Voice in the Ongoing Discussion about Psychoanalytic Practice

I have been following Dr. Rothstein's journal and book-length writings on this subject for several years and I still find his basic argument unique, refreshingly straightforward, and thought-provoking. Reading this very brief version of his basic argument for a trial of analysis for all patients, I found myself thinking about what it means to patients to have analysts or therapists recommend two, three, or four sessions per week and then, when the patient responds that they cannot or do not want to do that, have the clinician agree to a once-per-week treatment self-prescribed by the patient. Did we mean our original recommendation? If we are willing to treat the patient once weekly, why did we suggest meeting more often? I believe that some treatments never recover from an initial breakdown like this in which the clinician either agrees to a treatment he or she has implied is not the recommended one or simply accepts the patient's virtual demand to be treated once weekly.

Nonetheless, I do not proceed as Rothstein does. My attitude is more that each patient and I should be meeting as often as we can arrange to do and that the equation that determines how often that will be is an equation containing several variables, including the patient's money and schedule, my schedule and my ability (financially) to offer hours at a substantially reduced fee, the escalation or containment of anxiety that seems to occur during the initial contacts between the patient and me, and, often, as Rothstein describes, the