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The problem of determining the indications and contraindications for psychoanalytic treatment hinges on two separate but related issues. The first and most important question we have to answer is: Is the patient analyzable? The second and contingent question is: Will psychoanalytic treatment best serve the patient's needs? I would like to amplify this latter issue by a clinical example.
Let us assume you have a patient who desires psychotherapy and you believe he is able to work effectively and well in the analytic situation. Would you advise him to undertake psychoanalysis if you discover that he is about to be drafted into the armed forces? Psychoanalysis is a long-term treatment, ordinarily requiring three to five years of time. The total life situation must be considered in evaluating whether or not you would recommend this form of psychotherapy.
The problem of analyzability is a complex one because it depends on many different qualities and traits of the patient, both healthy and pathological. Furthermore, it is also necessary to be thoroughly familiar with the many exacting demands that the psychoanalytic process and procedure make on the patient. The brief summary of theory and technique thus far presented permits us only a preliminary view. We shall have to postpone a more definitive discussion until the later chapters.
Freud (1905a) recognized quite early that single criteria, no matter how important or clear-cut, do not permit an accurate prediction
of a patient's analyzability. One has to try to assess the total personality, and that is extremely difficult to evaluate after a few preliminary interviews . Yet it is precisely then that the therapist has to make his recommendations as to the choice of treatment. Prolonged preliminary interviews and psychological testing may help with certain patients; in the present state of our knowledge, however, even this combination of approaches does not offer reliable predictions in many cases. In addition, prolonged in