Introduction to Psychotherapy*

I wish to speak with you today about a subject which is rarely chosen as the topic for a psychoanalytic lecture, probably because of the assumption that we are entirely familiar with it by virtue of our basic training and our clinical experiences and perhaps also because we have underestimated its true significance for our therapy. As you may have imagined, I wish to discuss the situation at the beginning of the treatment and more particularly, everything which is peculiar to the first few interviews. I am concerned with this problem in reference to those patients with whom we cannot undertake formal psychoanalytic therapy and with whom we have to work as analytically trained psychiatrists. These patients always constitute the larger number of those who seek our assistance and really effective psychotherapy is certainly more difficult with them than those who come every day and lie on the couch. The problems connected with the beginning of the treatment are of special significance because the first visits often constitute a hazardous stage of the therapy. It happens more frequently than it should, for instance, that people who seem sincere in their desire to be helped, break off the treatment during this period. It is my conviction that such unfortunate occurrences frequently result from the psychiatrist's failure to recognize certain factors which have special value for the continuation and the success of the therapeutic effort.

The first visit to the psychiatrist is frequently undertaken with much difficulty by the patient who, for a variety of reasons, wishes there might be some other way of obtaining relief. For many a person the first consultation represents the final outcome of a long inner struggle as to whether he should turn to someone else about himself. For others, it is undertaken with great reluctance because of the existing attachment to the previous doctor. There are those who are so fearful about it that in the beginning they need to be accompanied by