Which patients should avoid psychoanalysis, and which professionals should avoid psychoanalytic training?: A critical evaluation

This paper discusses contraindications to psychoanalysis and psychoanalytic training. From Freud onwards, there has been a clear understanding that not all patients are helped by psychoanalysis, but there has been considerable controversy as to who might benefit from treatment, and whether this depends on the diagnosis, the personality or the rather vague concept of “analysability”. Increasing emphasis has been placed on the analyst-patient relationship and its characteristics, without this clearly solving the dilemma. Moreover, while psychoanalysis was previously perceived rather uniformly in its classical version, treating mainly neurotics, increasing differentiation between psychoanalytic schools has appeared in the last fifty years, which would seem to give grounds for a widening of indications. This development has increased the need for rational criteria for indications and contraindications. In this article, research findings relating to outcome and process and the therapeutic relationship will be examined in parallel with clinical experience. As the therapeutic relationship is probably decisive for the outcome of the treatment, scrutiny of who is suited to be a psychoanalyst should have been an important focus of research. This has not been the case. Available research on this issue and the experiences of practitioners in the evaluation of candidates will be discussed in the following.