Psychoanalysis: Indications and contraindications for analytic treatment

Using the various analytic theories to assess mental problems, several particular constellations of problems are particularly suited for analytic techniques (see below) whereas other problems respond better to medicines and different interpersonal interventions.

To be treated with psychoanalysis, whatever the presenting problem, the person requesting help must demonstrate

1. good capacity to organize thought (integrative function)
2. good abstraction ability
3. reasonable ability to observe self and others
4. some capacity for trust and empathy
5. some ability to control emotion and urges, and
6. good contact with reality (excludes most psychotic patients)
7. some guilt and shame (excludes most criminals and sex offenders)
8. reasonable self-preservation ability (excludes severely suicidal patients)

If any of the above are faulty, then modifications of techniques, or completely different treatment approaches, must be instituted. The more there are deficits of serious magnitude in any of the above mental operations (1-8), the more psychoanalysis as treatment is contraindicated, and the more medication and supportive approaches are indicated. In non-psychotic first-degree criminals, any treatment is often contraindicated.

The problems treatable with analysis include: phobias, conversions, compulsions, obsessions, anxiety attacks, depressions, sexual dysfunctions, a wide variety of relationship problems (such as dating and marital strife), and a wide variety of character problems (for example, painful shyness, meanness, obnoxiousness, workaholism, hyperseductiveness, hyperemotionality, hyperfastidiousness). The fact that many of such patients also demonstrate deficits in numbers 1-8 above makes diagnosis and treatment selection difficult.

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