Treatment Modality: Plans and Changes

The original intent of PRP was to follow the treatment careers of a typical sample of Menninger Foundation patients in psychoanalysis and in long-term expressive and supportive psychoanalytically based psychotherapy, in order to learn more about the changes that can (empirically) be expected to take place and the basis for those changes. Though we planned on an equal number in psychoanalysis proper and in psychoanalytic psychotherapy, the intent was never to compare psychoanalysis with psychotherapy. Patients presumed comparable were not randomly assigned to these two major treatment modes in order to try to see which mode did better, and in what ways, with which kinds of patients.

Rather, in keeping with the naturalistic spirit and naturalistic design of PRP, each modality had assigned to it those patients for whom it was deemed the specifically appropriate treatment method (in terms of the clinical knowledge and the clinical practice of the 1950s); therefore, different kinds of patients (in terms of illness structure) were recommended for psychoanalysis and psychotherapy. Comparisons were then made internally: Each planned treatment and predicted outcome was compared with itself, in terms of reaching, falling short of, or exceeding the expectations for it.

For reasons already stated in detail, the total sample size accumulated over a 4-year period of doing Initial Studies was 42. Inadvertently it worked out that 22 patients (10 men and 12 women) were designated for psychoanalysis and 20 (11 men and 9 women) were designated for psychotherapy.

Classical Analysis with Minimal Modifications

Of the 22 who started in psychoanalysis, with 10 (4 men and 6 women) the analyst adhered throughout, as much as possible, to an effort at classical analysis. There were, even with these, some departures from the classical procedure—“minimal” within the context of that group of quite sick patients within that setting, though obviously they would be seen as more consequenti