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“It is worth reconsidering the practice of being choosy.” So states the author in presenting his thesis that a reluctant person may require a six- to twenty-four-month period of “modified analysis” (p. 16) to realize that analysis is “the best form of psychotherapy for most adults” (p. 42) who consult an analyst. With this blanket conviction,
Rothstein sweeps away the selection process, including such distinctions as indications, suitability, and analyzability.1
Patients are categorized as “(1) inhibited, (2) enactment prone,” or “(3) too disturbed and disturbing for me” (pp. 59, 44). Inhibited patients are the easiest with whom to “collaborate.” Those suffering from “enactment resistances” (p. 4) are frequently unwilling to accept the recommendation for analysis, or to pay for it, until the resistances are analyzed. Yet, so long as there has been agreement that there is resistance and that the intent of the analyst/patient dyad is to work toward establishing a usual analysis, Rothstein considers that a patient is in a “modified analysis” rather than psychotherapy, even if the patient has only agreed to once or twice a week face-to-face sessions. This iconoclastic conceptualization of “modified” or “trial” analysis replaces the concepts of preparatory psychotherapy and of conversion of psychotherapy to psychoanalysis. Ultimate failure of this trial or modified analysis may be attributed to “both timing and the match” (p. 56).
In this reviewer's opinion, to begin consultations with the presumption that analysis is the treatment of choice bypasses the stance of suspended judgment and the ability to be surprised by what comes forth from the patient. Interpretation of all reluctance as resistance is the antithesis of a neutral stance. Although analysis has become an even more “impossible profession” in these days of managed care and expectations of medication management, and much as we might wish to create an abundance of financially solvent patients, it does not follow