The Analyst's Role in Healing: Psychoanalysis-Plus

We argue that the original structuring of psychoanalytic treatment is based upon an unsound foundation. The questions we raise about the bases of early treatment make understandable the subsequent evolution of substantial changes, and make plausible our recommendation of still further changes. We propose that the nuanced use of techniques of explicit support, consolation, suggestion, persuasion, and advice, all used in healing across many ages and societies, be added to traditional psychoanalytic treatment. These techniques are inconsistent with the analyst's neutrality, a fundamental characteristic of the analyst's stance in the original model. The demonstration that the analyst's own values, beliefs, expectations, and theories profoundly influence all of the analyst's interventions leads us to reconsider the concept of neutrality. The possible risks associated with using these recommended explicit techniques mandate that their use requires the same discriminating judgment as is used to determine whether and when an interpretation is presented. Whether use of these additional techniques, which we have termed “psychoanalysis plus,” will enhance treatment effectiveness is an empirical, not a theoretical, question.