Chapter 6. From the Initial Interview to Therapy

Introduction

This chapter focuses on the all-important step from the initial interview to therapy, complementing the corresponding chapter in Vol. 1. This step can be demonstrated particularly clearly with regard to those patients who are often considered unsuit-ed for psychoanalysis or analytic therapy. Experience shows that social class, de-linquincy, and adolescence are factors posing special problems, at least in the initial phase (see Sect. 6.2). The manner in which the analyst deals with the patient's family is another of the factors that can influence therapy one way or another (see Sect. 6.3). In this chapter we extend the detailed description of the problems associated with third-party payment, given in Vol. 1, by referring to a concrete example (Sect. 6.4). We also devote a separate section (Sect. 6.5) to the consequences that peer reports within the German health insurance system can have on transference.

An Initial Interview

The initial interview was preceded by a brief telephone conversation. A psychiatrist, after having conducted numerous diagnostic examinations, had recommended that Ludwig Y undergo analytic therapy and given him the addresses of several psychotherapists in private practice. In the following months Ludwig Y had not succeeded in arranging an appointment with any of these therapists. I had several reasons for offering him an initial interview at short notice. The polite and modest way in which he posed his question, which seemed to be completely devoid of emotional involvement, led me to ask myself if this might have contributed to the fact that he had been turned down or referred to other therapists. During our telephone conversation I began to assume that he needed help much more urgently than he was able to express.

Ludwig Y arrived right on time. He was about 30 years old, tall, very slender, and looked miserable. For months he had been vainly undergoing examinations because of his diverse psychoso