Description
Success and failure in psychotherapy and psychoanalysis have been discussed in the literature for many decades. Practitioners have been eager to show how and why they themselves have done well with their patients and have shown little reluctance to formulate reasons why their colleagues have failed with similar patients. Yet a scientific appraisal of a psychotherapeutic experience is difficult to make. Who is to judge—the patient? the therapist? an independent professional? Most therapists and patients have a strong subjective investment in the therapy and so might not be the most reliable evaluators: the testimony they offer may be subtly contaminated by their wishes, fears, or defensive operations. Yet the presence in the consultation room of a neutral judge or even a tape recorder is likely to influence the therapeutic encounter and its outcome.
A further problem lies in establishing criteria for measurement. As Freud pointed out in Civilization and Its Discontents, feelings are difficult to measure. They are elusive, they vary from day to day, and their exact nature is not easily determined. Yet if psychoanalysis and psychotherapy are to be considered scientific enterprises, their outcome must be evaluated scientifically.
Benjamin Wolman has assembled a distinguished and able group of colleagues in order to clearly and courageously present some interesting examples and penetrating analyses of their own failures and successes in performing psychotherapy and psychoanalysis. Initiating the presentations are Freud’s paper “Transference Love” and Adler’s paper “Resistances.” Although these papers were written many years ago, they have timely significance if for no other reason than that many therapeutic failures can still be attributed to the therapist’s inability to understand the patient’s overidealization of him as deriving from unresolved childish wishes. As other papers in this volume attest, psychotherapy may fail because neither member of the therapeutic team can deal with the patient’s resistances and the therapist’s counterresistances. Aaron Stein’s paper “Causes of Failure in Psychoanalytic Psychotherapy” offers case material which reaffirms Freud’s and Adler’s positions. He notes other factors which contribute to failure, such as incorrect diagnosis, untoward external conditions, and weak definitions of therapeutic goals.
