When the Patient is a Therapist: Special Challenges in the Psychoanalysis of Mental Health Professionalsy*

As the therapeutic options available to the distressed consumer continue to expand in all directions, many psychoanalysts find that an increasing number of their patients come from the ranks of their colleagues in the mental health professions. Perhaps because of their sophistication regarding the relative merits of alternative treatments vis-à-vis analysis, therapists are less inclined to succumb to the siren song of quick-fix approaches that promise lasting cure in return for minimal investment of time and money.

It is surprising in this context to discover that discussions of the special challenges facing the analyst who undertakes the psychoanalytic treatment of mental health professionals are virtually absent from the literature. At first blush, this omission may seem perfectly understandable in light of the unique problems of confidentiality associated with the psychoanalysis of psychotherapists. With occasional exceptions (Elmhirst, 1982-1983; Fleming, 1973), most of us find the publication of case material stemming from the treatment of colleagues an unacceptable practice. Therapists who have inadvertently discovered themselves in a publication written by their analyst have felt violated, wounded, and “raped” (Grunebaum, 1986; Person, 1983). Not only are patients likely to recognize themselves in such reports (despite careful efforts at disguise), but it is highly probable that other colleagues may well recognize the patient. The close-knit nature of mental health communities is such that who