A Model for Understanding and Treating the Impulsive Patient*

Psychoanalysis originated in the verbal study and treatment of persons suffering from a pathological excess of inhibitions. The classical psychoanalytic technique which was developed for these overcontrolled patients involved subjecting them to moderate levels of anxiety and frustration: anxiety induced by free association and by ego-oriented questions and interpretations, frustration caused by the neutrality of the analyst and by the strict limitations on the types of interactions that were permissible between patient and analyst. Patients whose egos are relatively strong, whose capacity for object transference is well developed, and in whom aggressive drives present relatively less of a threat than libidinal ones, can benefit from classical psychoanalysis.

Modern psychoanalytic theory and technique originally was formulated to deal with schizophrenic patients (Spotnitz, 1969). These patients are for the most part overcontrolled, but are subject to periods of ego breakdown resulting in a psychotic state. They cannot tolerate the anxiety induced by the ego-oriented classical technique. So-called “supportive” therapy, which aims at strengthening