Psychoanalytic Inquiry

ISSN: 0735-1690 (Print) 1940-9133 (Online) Journal homepage: http://www.tandfonline.com/loi/hpsi20

Notes on Psychoanalysis, Psychotherapy and

Methodology

Dr. Henry M. Bachrach Ph.D.

To cite this article: Dr. Henry M. Bachrach Ph.D. (2000) Notes on Psychoanalysis,
Psychotherapy and Methodology, Psychoanalytic Inquiry, 20:4, 541-555, DOI:
10.1080/07351692009348906

To link to this article: http://dx.doi.org/10.1080/07351692009348906

Published online: 01 Jul 2008.

Submit your article to this journal

Article views: 35

View related articles

Full Terms & Conditions of access and use can be found at

http://www.tandfonline.com/action/journalInformation?journalCode=hpsi20

Download by: [University of Nebraska, Lincoln] Date: 04 June 2016, At: 02:42
 Notes on Psychoanalysis, Psychotherapy
and Methodology
Downloaded by [University of Nebraska, Lincoln] at 02:42 04 June 2016

H E N R Y M. B A C H R A C H, Ph.D.

Abstract

Technical innovations always carry with them clinical and

scientific challenges. The aim of this paper is to provide a
context for exploring the consequences of technical innovations
for psychoanalysis as an interrelated method of observation,
treatment, and body of knowledge about mental functioning.
The problems are approached from a methodological perspective
because scientific progress requires methodological clarity. The
inquiry begins with a methodological investigation of the
technical and theoretical consequences of first principles, that
is, the consequences of the assumptions and methods we adopt
for the kind of data that are obtained by their application and
for the theory required to understand and unify the resulting
observations. The conclusion suggests that if one organizes a
doctor-patient relationship around the clinical-historical and
free-association methods with the aim of removing all obstacles
to communication, if the understandings that emerge include a
full range of dynamic, structural, genetic and adaptive
propositions, one is engaged in psychoanalytic inquiry. The
circumstances under which Rothstein’s technical recommenda-


Dr. Bachrach is a member of the Faculty, New York Psychoanalytic Institute;
Clinical Professor of Psychiatry, New York Medical College.

541
 542 HENRY M. BACHRACH

tions enable such understandings to develop are an important

topic for future research.

F ROM ITS INCEPTION PSYCHOANALYSIS HAS BEEN an interrelated method

of observation, therapeutic procedure, and theory of mental
functioning. No sooner than when he began listening to his patients,
Freud developed hypotheses about the genesis of their disturbances,
how his methods worked and how the mind functioned—theories of
Downloaded by [University of Nebraska, Lincoln] at 02:42 04 June 2016

neurosogenesis, therapeutics and mental functioning. At first, the idea

of pathogenically repressed memories and associated noxious affects
gave rise to hypnotic-like techniques based upon mechanisms of
abreaction and suggestion, and then further clinical observation led
to disconfirmations and revisions continuing though many
reformulations to the very day. Our methods, theories and
understanding of the nature of normal and pathological mental activity
is a far cry from what it was at the turn of the last century. Psycho-
analysis has become a preeminent theory of psychopathology and
therapeutics, and it remains the most comprehensive theory of
personality organization and development in the Western world. One
essential ingredient in this far ranging evolution was the vast array
of patients available to sustain the clinical and scientific effort.
In the early days of psychoanalysis practitioners had a plentifully
supply of patients for study because there were few, if any, other
rational therapeutic methods available. From the turn of the past
century many analysts continued with Freud, first to improve upon
the therapeutic efficacy and conceptual soundness of their methods,
and second to broaden their reach to a wider range of patients by
developing psychotherapies based upon analytic principles. It was
largely not until the mid-1950’s that additional scientifically grounded
therapeutic methods came into being, such as beginnings of effective
psychopharmacology and psychotherapies based upon models other
than psychoanalysis. At that time these new treatments did not have
substantial impact upon the pool of patient available to analysts
because they were still in their early phases of development and more
suited to the kinds of persons and clinical conditions generally
considered beyond the reach of psychoanalysis.
That was a half-century ago! In the meantime, some of these
alternative treatment approaches, especially psychopharmacology,
have undergone a clinical and scientific revolution and demonstrated
 PSYCHOANALYSIS, PSYCHOTHERAPY, AND METHODOLOGY 543

their own efficacy—not only in improving functioning in the kinds

of conditions generally considered beyond the reach of
psychoanalysis, i.e. the major psychoses, but also in relieving
symptoms in the kinds of clinical conditions that often lead patients
to consult analysts, i.e. anxiety and depressive states. This contributed
to the situation in which we now find ourselves where large numbers
of patients who might have previously consulted analysts are being
treated—and in many cases effectively, depending upon one’s point
Downloaded by [University of Nebraska, Lincoln] at 02:42 04 June 2016

of view—through these alternative modalities. Add to this the

penchant for the practical over the reflective in American society,
the lure of quick and easy remedies, changing life-styles, new family
structures and patterns of child rearing associated with changing role
expectations and tolerances for intimacy, new economic and
“managed” health-care systems with little use for extended,
individualized treatment procedures such as psychoanalysis, and the
stage is set for a decline in the number of patients being treated by
psychoanalysis.
In a series of papers and books spanning over a decade, Arnold
Rothstein (i.e. 1990, 1995) has been telling us that another reason
psychoanalytic practice has diminished is because analysts have not
been consistent in asserting their analytic identity and methods in
their attitudes toward patients. Rather they have been encumbered
by their pre-analytic heritage and have not fully accepted their new
identities and roles as psychoanalysts. As a consequence, in these
times they behave more like psychiatrists, psychologists or social
workers in dealing with patients, pondering ill-conceived diagnostic
schemes and idealized conceptions of differential therapeutics moored
in a Zeitgeist of uncritical acceptance of published research findings
irrespective of their clinical, conceptual or methodological
limitations. Rothstein (1995), whose thinking is moored in the
contemporary conflict model (as is my own), tells us that he believes
psychoanalysis is the optimal treatment for most non-psychotic or
organically unimpaired patients, and that their analyzability cannot
be established in any way other than analysis itself. Therefore, most
patients consulting analysts should be considered analyzable until
proven otherwise, and if analysts adhered to this attitude they would
be conducting more analysis. New patients should be seen as potential
analysands and if they are reluctant to undertake the commitments
and intimacies required of analysis, the analyst should understand
 544 HENRY M. BACHRACH

these reluctances as resistances, and work with these patients on their

terms while maintaining an analytic attitude, including attempts to
understand why they have difficulty accepting the recommended
optimal manner of working until their analyzability can be
determined, i.e. accepting the necessary commitments and intimacies
required of psychoanalysis.
There is another factor, implicated by Rothstein’s (1995) argument,
which is also associated with the diminishing number patients being
Downloaded by [University of Nebraska, Lincoln] at 02:42 04 June 2016

treated by psychoanalysis. This factor is what Rangell (1997) has

referred to as the failure of psychoanalysis to fully maintain its
scientific moorings—the continued elaboration of the relationship
between psychoanalytic methods and theories fundamental to the
development of new knowledge. A major point of Rangell’s (1997)
assessment of psychoanalysis at the turn of this century is that the
development and easy acceptance of the bewildering array of diverse
psychoanalytic methods and paradigms (in search of a common
ground) has occurred without sufficient consideration of the
comparability of their methods, data and theory. What therefore comes
into question is to what extent does this or that observation, generated
by this or that method, fit into, correspond with, elaborate or is simply
peripheral to the observations and theory generated by another
method, as for example with the consequences of Rothstein’s
technical recommendations? This is significant because we need to
know if and how the new ideas of diverse approaches can build upon
one another, rather than coexisting democratically more than
scientifically. In Rangell’s (1997) view, had we paid more attention
to the conceptual consequences of what we have done clinically over
the past forty years, we would be clearer about our methods, and
what we can and cannot do with our methods, in comparison to what
can and cannot be done with other methods. As a result, our
development has faltered and our clinical and scientific credibility
has diminished in relation to alternative treatments and psychologies.
In what follows I shall attempt to examine the consequences of
new methods developing to meet the challenges of the present climate
for psychoanalysis as an interrelated treatment method and body of
knowledge. I shall approach the problem from a methodological
perspective because scientific distinctions require methodological
clarity. This inevitably will involve revisiting the problem of the
difference between psychoanalysis and psychotherapy. I shall first
 PSYCHOANALYSIS, PSYCHOTHERAPY, AND METHODOLOGY 545

briefly address the problem of distinctions based upon extrinsic and

intrinsic criteria, and then move on to distinctions as they emerge
from methodological considerations.
* * *
Freud’s (1914) once simply stated that any approach that attempts
to deal with transference and resistance should be considered
psychoanalysis. However, this statement must be understood in the
Downloaded by [University of Nebraska, Lincoln] at 02:42 04 June 2016

context of its time and purpose, and does not serve well as a scientific
definition of psychoanalysis. In fact, it could (and has) be used to
justify all manner of mischief. To cite an absurd example. One can
certainly see a patient once a month and attempt to deal primarily
transferences and resistances, but the resulting influences and
observations would hardly be comparable to what would be obtained
if the patient were seen three, five or six times a week! Note that
Freud was quick to observe that Adler or Jung’s methods, for example,
did not yield observations comparable to the observations elicited
by his methods even though they dealt with transferences and
resistances. This line is therefore not likely to be very helpful to our
inquiry.
One might also approach the problem through an examination of
“extrinsic” and “intrinsic” criteria of psychoanalysis, a venerable way
in which the problem been studied over the years. By extrinsic we
have meant matters such as the frequency of visits, use of the couch,
appointments of the analysts’ office, extra-analytic contacts, or
anything else beyond what is intrinsic to the analytic work. By
intrinsic we have meant the presence of a patient in need, the use of
free-association, the analyst’s empathic, non-judgmental, technically
abstinent and neutral attitudes single mindedly aimed at exploration
and understanding, the centrality of interpretation, and all else that
goes along with the possibilities for the expression and analysis of
transference/resistance configurations as they are repeated
(remembered) in the immediate and historical moment of the
analysand-analyst relationship. These intrinsic criteria have always
been considered the more important because they emerge directly
from a psychoanalytic theory of mental functioning, neurosogenesis
and therapeutics. Extrinsic criteria have been offered as a sort of
operational short-hand because it was widely believed that intrinsic
factors were dependent upon the extrinsic factors. However, there
 546 HENRY M. BACHRACH

have always been gray areas and the correlation between extrinsic
and intrinsic has hardly been perfect. All analysts of some experience
have had occasion to have treated patients four or five times a week,
using a couch and maintaining all the fundamentals of the analytic
armature, in which the mutative processes associated with intrinsic
factors have hardly developed at all, or only to a very limited degree.
At the same time they have also had the experience of seeing patients
at a lesser frequency where the intrinsic factors have emerged along
Downloaded by [University of Nebraska, Lincoln] at 02:42 04 June 2016

with their associated mutative processes. When Freud moved from

seeing some patients from six to five times a week, or when necessity
dictated a change from five to four times a week, the psychoanalytic
edifice did not collapse. The issue is one of a delicate tension between
the extrinsic and intrinsic factors in any given case, which depend,
in part, upon the analysand’s qualities of mind, character and conflicts,
and in part, upon the analyst’s qualities, experience and technical
proficiency.
Hence, it does not seem the solutions to the problem of the
difference between psychoanalysis and psychotherapy are to be found
in definitions, for definitions are largely matters of strategy. Nor are
they to be necessarily found along the traditional road of making
clinical or operational distinctions, even between “intrinsic” and
“extrinsic” distinctions between the clinical and theoretical
consequences of varying methods because such distinctions emerge
from basic principles. To answer our questions we must return to the
technical and theoretical consequences of first principles, or to put it
another way, the consequences of the methods we adopt, i.e.
methodological analysis.
By methodological analysis I am not referring to what analysts
typically mean by methodology, i.e. principles of clinical technique.
Rather, I am referring to what Rapaport (1944), most notably, spoke
of as investigating the consequences of adopting a method for the
kind of data that are obtained by its application, and the consequences
for the theory required to understand and unify the observations.
“Methodology tries to establish (1) how much of the material that is
obtained is determined by the method used. How the selection of the
observational material depends on the method used. (2) How a theory
can be predicted in advance without empirical observation.” (p. 171)
* * *
In 1944 Rapaport undertook the beginnings of a methodological
analysis of psychoanalytic theory based upon the psychoanalytic
 PSYCHOANALYSIS, PSYCHOTHERAPY, AND METHODOLOGY 547

method. At this point I shall present and carry forward the outlines
of this analysis. To begin, the psychoanalytic method starts with a
patient in need whom you ask to tell you about themselves and their
problems. This Rapaport referred to as the clinical method. What
invariably occurs, if you do not interrupt or re-direct the patient, is
that as the patient will tell you their story. The narration will begin
with the present and move backward in time toward their view of
how things got that way. At some point the patient will pause and/or
Downloaded by [University of Nebraska, Lincoln] at 02:42 04 June 2016

shift to another topic. If you begin your inquiry with a basic postulate
of psychic determinism, it follows that you must account for why
the shift has occurred at this point in time. This postulate requires
that you must assume the pause or shift is somehow connected to the
whatever the patient just said which leads to a concept of association
and the continuity of mental activity, that there is a causal connection
between what the patient just said (or thought) and the pause or shift.
It is the combination of the clinical-historical method along with the
postulate of psychic determinism that leads to a concept of
unconscious mental activity because the association and continuity
must be accounted for and there is nothing that requires that the patient
must be aware of the connection. In fact, in applying this method
and principle one observes that people often cannot convincingly
tell you why they may have paused or moved on to another topic,
which then leads to the idea that mental activity occurs at varying
levels of consciousness. Following this line of reasoning, a concept
of unconscious mental activity is not a basic postulate of
psychoanalysis, but a necessary consequence of what follows when
you apply the clinical-historical method in combination with a
postulate of psychic determinism (Shevrin, 1984). However, this
consequence does not tell us anything about the nature of unconscious
mental activity. What the nature of this activity is follows from
observation. Whether unconscious mental activity is static or
dynamic, whether it is best conceptualized by topographic, structural
or other models follows only from efforts to provide the best
understanding of what one observes in the most parsimonious way
that does not conflict with anything else we know that is
methodologically germane about the nature of mental activity, i.e.
that it can not occur in-vitro because of insufficient cerebral
mylenization. None of this, however, is distinctively psychoanalytic.
Association, continuity, intrapsychic conflict and unconscious mental
functioning are only consequences of the clinical-historical method.
 548 HENRY M. BACHRACH

Rapaport (1944) went on to ask what must be required to make

the clinical-historical method distinctively psychoanalytic? He
suggested that a specific kind of stable relationship between two
people and the use of the free-association method. About the first,
which he called the “interpersonal method”, he suggested that what
makes analyst-analysand relationship specifically psychoanalytic is
that it aims to carry communication to its “last consequences”—the
person who handles the relationship takes responsibility for
Downloaded by [University of Nebraska, Lincoln] at 02:42 04 June 2016

eliminating “any and all” obstacles to communication to the roots of

the disturbances that occur “wherever these roots may lead.” (Note
how this construction of an interpersonal relationship is radically
different from everyday interpersonal relations in which persons
interact in ways centered about gratifying their wishes.) This leads
to ideas about basic trust or therapeutic alliance, irrespective of how
they are conceptualized. Two consequences follow when the free-
association method is employed in the context in a stable relationship
between two people who are important to one another. The first is
that there will be a valence for both to go on to form their relationship
with one another in all of the ways that are characteristic of the ways
they form relationships, though the one who assumes responsibility
for handling the relationship (analyst) will be able to monitor his or
her mental activity toward the end of eliminating “any and all”
obstacles to communication, while the other (analysand) will mostly
go on to form the relationship in the ways that are characteristic of
the ways they form relationships. The second consequence is that
the free-association method brings manifest gaps and shifts in
communication repeatedly into bold relief. The free-association
method sharpens the field of observation and provides the data for
investigating how and why the analysand perceives and constructs
the relationship in the way they do. The ideas of transference and
resistance are the natural consequences.
To sum up to this point, if you start with a clinical-historical and
interpersonal method which attempts to remove any and all obstacles
to communication no matter where they may lead, add the method of
free-association and include the postulate of psychic determinism,
you wind up with a theory which must include ideas of association,
continuity, meaning, unconscious mental activity, intrapsychic
conflict, therapeutic alliance, transference and resistance to account
for the resulting observations.
 PSYCHOANALYSIS, PSYCHOTHERAPY, AND METHODOLOGY 549

* * *
In 1959, Rapaport and Gill attempted to delineate the minimal
number of necessary independent points of view required for a
psychoanalytic understanding of mental activity. They concluded that
a specifically psychoanalytic understanding required dynamic,
structural, genetic, economic and adaptive propositions. Surprisingly,
as Shevrin (1984) pointed out, Rapaport did not include
methodological considerations in this analysis and suggested that
Downloaded by [University of Nebraska, Lincoln] at 02:42 04 June 2016

much was lost by its absence. Shevrin (1984) then applied

methodological principles to Rapaport and Gill’s (1959) analysis and
concluded that only genetic and adaptive propositions were
consequences of the psychoanalytic method, and that dynamic and
structural propositions were empirical findings resulting from
application of the method; he was moot about the methodological
status of economic point of view. However, the dynamic and structural
points of view also can be seen as inherent consequences of the
method. Dynamic propositions refer to psychological forces and
structural propositions refer to abiding psychological configurations
with a slow rate of change. The very ideas of “stable interpersonal
relationship” or the “historical” in the “clinical-historical” method,
or the method of free-association as a basis for communication and
understanding seem to imply this much. You can’t have stability,
historical continuity, characteristic gaps, shifts or redundancies in
associations without dynamic and structural propositions. In fact, it
seems these two propositions are inexorably interwoven in
psychoanalysis and that the primary interest of psychoanalysis is in
dynamic patterns that have become structuralized, i.e. the persistence
of intrapsychic conflict.
* * *
What are the consequences of this methodological analysis for
psychoanalytic treatment? They suggest that if you organize your
approach to a patient around the clinical-historical, interpersonal and
free-association methods, and aim to take communication to its final
consequences which lead to understandings that include at least
dynamic, structural, genetic and adaptive propositions, you are then
conducting a psychoanalytic treatment. Note that none of these
considerations require that understandings include infantile sexuality,
oedipal or preoedipal considerations. These are the kinds of things
 550 HENRY M. BACHRACH

you discover empirically from application of the methods. Nor do

they include the use of the couch, specify the frequency of visits or
any of the other extrinsic factors often associated with psychoanalysis
beyond those which have already emerged as basic to the methods.
This does not necessarily mean that they are not important to the
enterprise. Methodological analysis can only get you so far. Its aim
is to help you maintain your bearings once you have adopted a
particular method and it suggests where you should nor should not
Downloaded by [University of Nebraska, Lincoln] at 02:42 04 June 2016

go. While it does influence, constrain and predetermine what you

may do or see, it does not tell you exactly what you will find. What
you find is a matter of empirical observation alone.
* * *
For the past century psychoanalysts have gathered countless
empirical observations by application of their methods, discussed
them with colleagues, evaluated them in study groups and shared
them in scientific journals. Some observations have proven more
enduring and useful than others, and most have continually undergone
some sort of modification and refinement. These observations first
led analysts to believe that psychoanalytic treatment could only be
effectively conducted with patients functioning within a neurotic
range. This set of hypotheses was tested in the 1940’s as analysts
attempted to apply their methods to the treatment of severely
psychotic and psychosomatic patients, but the hypotheses were not
disconfirmed. Yet, attempts to apply psychoanalytic methods in
modified form to the treatment of a “borderline” range of patients in
the 1950’s led to more clinically felicitous results, and to
disconfirmation of some hypotheses. We learned, for example, that
productive analytic work could be conducted in a face to face setting
with some patients psychologically unable to assume a recumbent
position, or that some especially enactment prone patients required
a degree of confrontation and limit-setting beyond what is customarily
associated with the psychoanalytic method. Some of these alterations
have only entailed a modification of extrinsic factors, while others
have influenced intrinsic factors, i.e. confrontation and limit-setting
alters the relationship of free association to the transference and it is
no longer be possible to understand what patients tell us in customary
ways because the intentions and meanings of their communications
may be different. The clinical elasticity of the psychoanalytic method
 PSYCHOANALYSIS, PSYCHOTHERAPY, AND METHODOLOGY 551

has always been greater than its scientific elasticity because

alterations of method influence the data that are obtained and the
theoretical constructs required to best understand the observations.
For example, if you treat a patient but do not attempt to take the
interpersonal relationship to its final consequences, for justifiable
clinical or other reasons, you will wind up with a supportive
psychotherapy no matter how much you base your interventions and
understandings on transference and resistance. In such a treatment
Downloaded by [University of Nebraska, Lincoln] at 02:42 04 June 2016

you will be unable to generate a full range of dynamic, structural

and genetic understandings.
Technical modifications do not have all or none consequences.
The question is at what point does a change in quantity become a
change in quality? In what ways does it matter if you see a patient
two instead of five times a week, use the couch or not, tell a patient
where you are going on a vacation, judiciously disclose your feelings,
and the like? In any particular case it will depend upon the
consequences of conflict for the patient’s mental functioning.
However, the analyst’s attitudes, the parameters of the psychoanalytic
situation and extrinsic arrangements are technical considerations
which have been tested by empirical observation. If the analysis and
the analyst are to become centrally important to the analysand,
frequency of visits does become a crucial factor in most cases. If the
analytic work is to be moored more in data than inference, the greater
the frequency of visits the greater the continuity, possibilities for
mutual observation and learning. If your aim is to study intrapsychic
conflict and the field of observation is to be as free as possible from
distraction, the recumbent position is simply better suited. If your
aim is to study interpersonal conflict and the field of observation is
to be interpersonal interaction, then reflective self disclosure and
the vis-a-vie position is more suitable. If the aim of technique is
transference analysis, giving advice or revealing your feelings will
influence the patient’s perceptions and the meaning of transference
representations. If technique is to be based upon interpretation rather
than suggestion, you must be in a position to gather a great deal of
evidence before you present your conjunctures. If you eliminate the
structural point of view, unlimited change is possible. Once the aim
and orienting principles of the method have been established, much
of what follows is given by empirical observation.
 552 HENRY M. BACHRACH

* * *
As much as psychoanalysis has attempted to maintain its position
as an interrelated method of observation, treatment and body of
theory, it remains that it is first and foremost a clinical procedure.
Without patients, there would be nothing to observe and nothing to
develop a theory about. With patients, clinical considerations are first
and foremost. There is a dialectic between the interests of the patients
and the interests of the science. The clinical aim of psychoanalysis
Downloaded by [University of Nebraska, Lincoln] at 02:42 04 June 2016

is to help patients alter enduring pathological compromise formations.

Its scientific aim is to further our understanding of mental activity,
including, but not limited to, the nature and development of these
compromise formations and how our techniques lead to their
modification. These aims intersect in the idea of analyzability because
theory is dependent upon data, data is dependent upon observation,
and observation is dependent upon method. If a patient won’t or can’t
free-associate, develop a sense of candor, or respond reflectively to
interpretation, for example, you won’t be able to study the meanings
of gaps and shifts in associations, or any of the other methodological/
theoretical consequences of the method. You may be able to help
your patient and you may be able to learn about many things, some
of which may be significant, but you won’t learn about the things
you have set about to study psychoanalytically.
The idea of analyzability has had a long and complex history in
psychoanalytic inquiry. It first emerged from efforts to delineate what
kinds of persons and clinical conditions were amenable to influence
and study by psychoanalytic techniques—specifically, the analysis
of transference by interpretation and the amelioration of the
structuralized infantile neurosis as it is expressed (remembered) in
transferences. Change brought about in this manner was thought to
be more reaching and enduring than by other means, i.e. advice or
suggestion. The analyzable patient was the one who was able to
productively participate in the work of psychoanalysis and thereby
both achieve therapeutic benefit and provide an opportunity to learn
more about the nature of mental activity through consistent and
reliable methods.
In the years immediately following World War II, psychoanalysis
was seen as indicated for a varied range of conditions among patients
capable of forming workable transferences and capable of making
ameliorative uses of insight. Extrinsic criteria were seen as
 PSYCHOANALYSIS, PSYCHOTHERAPY, AND METHODOLOGY 553

codeterminents of intrinsic processes. Then in 1954 in the Arden

House symposium on the similarities and differences between
psychoanalysis and psychotherapy, Stone called attention to the gray
areas of psychopathology and technique, eloquently raised questions
about the close correlation between extrinsic and intrinsic factors,
and suggested the scope of indications for psychoanalysis might be
widened without essential compromise of its intrinsic components.
These were heady times for psychoanalysis. Its popularity had reached
Downloaded by [University of Nebraska, Lincoln] at 02:42 04 June 2016

its zenith and the National Institutes of Mental Health even bestowed
a large grant to the Menninger Foundation to study nature of change
in psychoanalysis and psychotherapy. By the mid-1960’s the gray
areas so carefully discussed at Arden House burgeoned into a
“widened scope” of indications, which, in some quarters left nearly
every form of psychopathology potentially amenable to some form
of “modified” psychoanalysis. Believing that the wish of therapeutic
zeal was blurring the lens of clinical reality, in 1954 Anna Freud had
already called for a narrowing of the scope of indications, in 1971
Tyson and Sandler emphasized the distinction between the indications
for psychoanalysis and the suitability of the patient for the psycho-
analytic undertaking, and in 1975 Rangell spoke of a need to recognize
an “optimum scope” for psychoanalytic therapy, and within this scope
to “use psychoanalysis for what it can do” (p. 96). At issue was the
difference between the analyst’s ability to understand the patient and
the patient’s ability to benefit from that understanding, and that
analyzability was in danger of becoming equated with a simple
concept of treatability. The climate in which psychoanalysis was
evolving continued to change. Formal research was gaining a foothold
in clinical disciplines, alternative treatments were beginning to show
their mettle, and psychoanalytic values came into question. By the
1980’s it was becoming more necessary for psychoanalysis to more
systematically clarify and elucidate its fundamental propositions, to
take cognizance of formal research, and to demonstrate its place in
relation to alternative treatment methods. One consequence was an
effort to more clearly delineate the difference between analyzability
and therapeutic benefit. The meaning of analyzability returned to
the quality of the analysand’s participation in the psychoanalytic
work, though now the contribution of the analyst to the dyadic
interplay became a focus of greater attention. By the 1990’s world
wide communication became commonplace, information and ideas
 554 HENRY M. BACHRACH

about psychoanalysis crossed national, cultural and conceptual

boundaries, raising questions about the methodological
correspondences between the expanded range of ideas. We are now
challenged by the influences of the changes in our society upon our
patients, ourselves and clinical techniques, and in an age of
comparative psychoanalysis. While it may be too soon to determine
effects of these influences, we shall have to find ways of
understanding the conceptual consequences of emerging technical
Downloaded by [University of Nebraska, Lincoln] at 02:42 04 June 2016

innovations, if analyzability is to mean more than a simple idea of

treatability governed by psychoanalytically informed concepts.
All this brings us full circle to questions about the consequences
of Rothstein’s (1995) technical recommendations. His emphasis upon
the importance of the analyst’s attitudes and conviction about the
therapeutic efficacy of psychoanalysis is well taken, and cannot but
help some patients to think more reflectively about their attitudes,
fears and resistances, and optimize the nature of their contacts. Albeit,
strength of conviction can be experienced as suggestion and lead to
compliance as much as understanding. Similarly, seeing patients on
their own terms for prolonged periods will influence their perceptions,
and we do not know the extent to which communication, especially
about subsequent transferences, will be able to be carried to its final
consequences. What we do know is if the patient becomes able to
free associate and carry communication to its final consequences, a
situation is likely to develop in which we may be able to generate a
full metapsychological understanding of the workings of the patient’s
mind, and develop expanded understandings about the nature of
mental activity. On the other hand, if a reluctant patient becomes
able to make more optimal use of the clinical situation but remains
limited in their ability to free associate or carry communication to
its final consequences, it will be less possible to develop analytically
relevant understandings, even if the patient may achieve substantial
therapeutic benefit. The extent to which Rothstein’s (1995) technical
recommendations are a prescription for analyzability or for
therapeutic benefit can only be determined by the consequences of
conflict in each individual analytic dyad. The extent to which they
are generalizable prescriptions for analyzability (in contrast to simply
being able to see a greater number of patients more frequently in an
analytic frame, for example) is a matter for continued empirical
observation. His observations come to us in the spirit of discovery,
 PSYCHOANALYSIS, PSYCHOTHERAPY, AND METHODOLOGY 555

and inspire the next phase of scientific inquiry: independent

evaluation and elaboration. In this effort it remains central that we
maintain our methodological bearings if psychoanalysis is to remain
a scientifically interrelated method of observation, treatment and
theory of mental functioning.

REFERENCES
Downloaded by [University of Nebraska, Lincoln] at 02:42 04 June 2016

Freud, A. (1954), The widening scope of indications for psychoanalysis: Discussion.

J. Amer. Psychoanal. Assn., 2:607–620.
Freud, S. (1914), On the history of the psycho-analytic movement. Standard Edition,
14:7–66. London: Hogarth Press, 1957.
Rangell, L. (1975), Psychoanalysis and the process of change. An essay on the
past, present and future. Internat. J. Psycho-Anal., 56:87–98.
 (1997), At century’s end: A unitary theory of psychoanalysis. J. Clin.
Psychoanal., 6:465–484.
Rapaport, D. (1944), The scientific methodology of psychoanalysis. In: The
Collected Papers of David Rapaport, ed. M. Gill. New York: Basic Books, 1967,
pp. 165–220.
 & Gill, M. (1959), The points of view and assumptions of metapsychology.
Internat. J. Psycho-Anal., 40:153–162.
Rothstein, A. (1990), On beginning analysis with a reluctant patient. In: On
Beginning an Analysis, ed. T. Jacobs & A. Rothstein. Madison, CT: International
Universities Press, pp. 153–162.
 (1995), Psychoanalytic Technique and the Creation of Analytic Patients.
Madison, CT: International Universities Press.
Shevrin, H. (1984), The fate of the five metapsychological principles. Psychoanal.
Inq., 4:33–58.
Stone, L. (1954), The widening scope of indications for psychoanalysis. J. Amer.
Psychoanal. Assn., 2:567–594.
Tyson, A. & Sandler, J. (1971), Problems in the selection of patients for
psychoanalysis: Comments on the application of concepts of “indications”,
“suitability” and “analyzability.” Brit. J. Med. Psychol., 44:211–228.

903 Park Avenue

New York, NY 10021