Treatment preparatory to psychoanalysis: a reconsideration after twenty-five years

The author's initial article on treatment preparatory to psychoanalysis (1983) challenged the long-held belief that a therapy with the same analyst would contaminate a subsequent analytic transference. The current article reconsiders the original process of transition from therapy to analysis and describes methods that can further its effectiveness. Although specific noninterpretive interventions to enhance preparation for analysis are rarely written about, they are discussed among colleagues and in supervision. Levy (1987) has described a bias against the description of strategic or tactical choices in analysis. It is increasingly clear that some patients' fear of exposing shameful defectiveness underlies their resistance to entering analysis, as does the originally described fear of an uncontrolled regression. It is useful to delay interpretation until shame sensitivity can be assessed and modulated. In the past there was pressure to keep the preparatory therapy brief so that the analyst would not become too well known to the patient. Less concern about strict anonymity allows more time for the patient's resistances to abate before the recommendation is made. Methods are described and clinical illustrations show how a deepening process can be fostered, how indications of readiness for the transition can be assessed, and when and how the recommendation can be made.