Treatment preparatory to psychoanalysis

Many potentially analyzable adult patients with unimpaired egos require a period of preparatory treatment before entering psychoanalysis. There has been some concern that such face-to-face treatment, if done with the same analyst, would influence the subsequent analysis by stimulating inaccessible unconscious fantasies, gratifying infantile wishes, or making the analyst too "real." This would necessitate a change to another analyst after the preparatory treatment, in order that the analysis be unmodified and have the most profound and definitive effects. Increasingly, however, many analysts practicing in the classical tradition have found preparatory treatment compatible with progression to psychoanalysis with the same analyst. But neither this process nor the concerns about it have been described to any extent in the literature. This may be, in part, because of historical conceptions that the effects of psychotherapy rest mainly on suggestion, lack of a full theoretical framework for psychotherapy compared with psychoanalysis, and disagreement as to whether these procedures are dichotomous or on a continuum. In order to discuss most clearly the basic issues involved in preparatory treatment that progresses to analysis with the same analyst, a case is presented in which complex variables were at a minimum; the transition could be anticipated, so that interventions, which might complicate the analysis, could be avoided; and the preparatory treatment was necessary to attenuate specific resistances to the meaning of analysis. The patient described here resisted analysis as it represented the facilitator of a feared regression and the reactivator of warded-off libidinal and aggressive impulses and wishes which the patient experienced as more controllable in psychotherapy. The meanings and effects of the prior treatment and the transition on the analytic transference neurosis, resistances, countertransferences, as well as possible effects on analytic technique, are described. Although some effects on the analytic process were apparent, limitations were not observed. Also considered are advantages and disadvantages of this extension of analytic technique and why many patients, despite our best efforts, persist in avoiding analysis.