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In my “response to the contributors” I emphasize that I was moved to write my book in response to the question “Why are so many well-trained colleagues, young and old, having so much difficulty developing satisfying analytic practices?” To answer that question I proposed to explore my experience successfully developing and maintaining an analytic practice.
In attempting to answer the question I inadvertently stumbled upon a revolutionary (with a “small r”) answer to the problem. I discovered, in my attitudes and in my way of working in a consultation and the early phase of an analytic collaboration, a new “concrete puzzle solution” to the problem of how to help a prospective, often reluctant collaborator give analysis a “try.”
My book emphasizes my view that courses on “analyzability” and differential diagnosis are based on psychiatric rather than psychoanalytic diagnostic schema and may interfere with candidates' ability to learn how to create analytic patients.
Since I was a candidate, courses on analyzability have always seemed to me to resemble an exclusive club, deciding whom to exclude and whom to admit, rather than a procedure based on sound clinical experience. Analytic experience has demonstrated
Dr. Rothstein is Training and Supervising Analyst, the New York Psychoanalytic Institute.
that it is not possible in a consultation to predict accurately the outcome of an analysis. To make matters worse, it is probable that an analyst whose mind is focused on the task of evaluating a prospective analysand contributes to creating an environment in which certain patients are experienced as sicker than they might otherwise be.
In spite of the fact that it is not possible in a consultation to predict accurately the outcome of an analysis, many experienced “senior” analysts believe an analyst can and should be evaluative and selective. In their discussions of the subject, they focus primarily on characteristics of the patient rather than the match.
In my book I emphasize that in a consultation there are advantages in focusing on the patient's responses to the idea of engaging in a trial of analysis. The issue of the match and the particular time in their lives are significant from my perspective. The analyst's gender, age, personality, and related state of mind may be as important in effecting the outcome of a trial as any feature of the patient's mind.
My book shifts the emphasis of the focus of inquiry in a consultation from the patient to the analytic couple. It offers a different way of teaching candidates to work with prospective collaborators.