Analysis of Patients with Acute Symptoms*

Most patients who enter psychoanalytic treatment are able to talk with a fair amount of freedom and adequate emotionality about relevant experiences. The analyst has considerable latitude as to when and what effective interpretation he may offer to the patient Also, the customary arrangements about lying on the couch, the analyst being outside of the patient'svision, and about the length of the interview present no special difficulties.

Some patients, however, do not conform to this picture e.g. the psychotics (1, 2, 3, 4), the borderline ambulatory schizophrenics, and patients who remain silent or markedly detached (5) for long periods of time. A variety of technical devices have been evolved to deal with such patients: to ask the patient which of his productions are reality, which fantasy (1, 2) to have him sit up and face the analyst (6) to be particularly supportive in handling the patient and focus attention on transference reactions (3, 4, 7, 8).

Horney (9, 10) described the analysis of two patients who presented acute problems. One exposed herself in front of the analyst and threatened to ruin his reputation. The other became highly emotional in a hostile manner soon after the beginning of the analysis. The condition of these patients cleared up as a result of the analysis of the transference situations in terms of immediate unconscious needs.

Greenacre (11), in an extensive study of patients with acute symptoms, emphasizes the necessity in the early stages to have the understanding cooperation of the people who are close to the patient during most of the day. The work in the early stages of the analysis is to increase the immediate reality hold of the patient first through the attitude of the analyst then through the relentless defining or clarifying of the immediate conscious attitudes and problems of the patient, and finally through the interruption of special self-perpetuating autoerotic tension states.