Meetings of the New York Psychoanalytic Society

DISCUSSION: Dr. Rudolph Loewenstein stated that the tool devised for evaluating results is one of great precision and yet of great flexibility. He stressed the usefulness of follow-up study as compared with reanalysis for purposes of evaluation. In the former the emphasis is on improvement and areas of conflict-free functioning; in the latter on pathology. In reanalysis the patient would tend to regress to early forms of transference much more markedly than in the follow-up study; also it is very difficult to determine what was accomplished in the previous analysis because most patients tend either to overidealize the first analyst or to turn against him with resentment. Dr. Charles Fisher pointed out that prior to the present project practically all studies in the literature dealing with the outcome of psychotherapy have utilized adaptive and behavioral indices as the only evidence of intrapsychic change, and have overstressed the factor of social adaptation as an indicator of improvement or cure. Evaluation of therapeutic change in terms of intrapsychic structure and functioning within a psychoanalytic framework has hardly ever been attempted. He stated that a particularly valuable contribution in Dr. Pfeffer's paper is the potential value of the residual transference as a means of evaluating the results of analysis. Dr. Harry Weinstock thought that it is doubtful at present whether we will be able to answer the question of how effective psychoanalysis is. One reason is our very unsatisfactory psychiatric nosology. The University of Minnesota is studying the language of psychiatry and the problem of diagnosis. The Menninger Clinic has abandoned diagnosis altogether and now operates only with the concept psychological illness. A careful study of diagnostically similar cases should go a long way toward evaluating results. One theoretically possible approach to the problem would be follow-up studies of psychoanalytic candidates. Dr. Victor Rosen comment