Office Treatment of Patients Other Than Psychoneurotics by Psychoanalysts

In many of Freud's writings he specified that the technique of psychoanalysis was applicable only to the psychoneuroses and not to other psychiatric illnesses such as schizophrenia, psychopathic personality, involutional psychosis and manic depressive psychosis. In recent years there has been a good deal of work done on applying psychoanalytic principles to the treatment of these other disease entities. Always this has required a considerable modification of the standard technique. There are some analysts who have become very proficient in treating these other illnesses and who specialize in treating patients other than psychoneurotics. I think that psychiatry owes a great debt of gratitude to these pioneers, and my comments are not directed toward them. Rather I question the advisability of analysts, who do not have special qualifications in treating these patients and the bulk of whose practice is made up of psychoneurotics, taking on a few of these other patients. I wish to state at the outset that I think that, as far as the psychotic or psychopathic patient is concerned, he is most fortunate in obtaining a therapist with analytic training. All other things being equal, it appears quite likely that he will receive better treatment than he would from a non-analytically trained physician.

I question, however, whether this will work out better in the long run from the analyst's point of view. Non-psychoneurotic patients present some problems that an analyst whose main effort is with psychoneurotics may not be too willing or too eager to face. First of all, these patients often have crises that require extra time and effort from the analyst—frequent phone calls, extra sessions, prolongation of regular sessions, home and hospital visits and visits or telephone communication with relatives. These may serve as disruptive elements in the necessary order and routine of the analyst's schedule and personal life. He will often have to give time and attention to one or two ps