The Shortage of Psychoanalytic Patients: An Inquiry into Its Causes and Consequences

This paper explores a number of reasons for the shortage of patients available for psychoanalysis in recent years. A particular focus is on the possible connection of “hard times” for psychoanalytic practice with the flowering theoretical diversity in our field over the past 30 years in the United States. While there is undoubted enrichment from this theoretical ferment, the author questions the benefit of its influence on technique and outcome in full-scale psychoanalysis. The distinctions between psychoanalysis and psychotherapy are increasingly blurred. The argument is made that theoretical diversity as a concurrent phenomenon with the shortage of patients for full psychoanalysis fits in with the homogenization of psychoanalysis and psychoanalytic psychotherapy as a practical response to the crisis. A section of the paper also deals with the author's view of the impact of patient shortage and theoretical diversity on the policies and standards of psychoanalytic training institutes in the United States. Theoretical diversity and multidisciplinary inclusionism are consistent with contemporary culture but may also lead to a homogenization and egalitarianism in both psychoanalytic treatment and training, which

have a mixed effect on the nature of psychoanalysis as a discipline and on its future.