Indications for Psychoanalytic Psychotherapy
Although current psychotherapy research attempts to ascertain which specific disorder in which type of patient is most effectively treated by what specific psychotherapeutic approach, studies have not as yet provided the answers to these questions. Conditions and disorders for which psychoanalytic psychotherapy appears to be indicated include personality disorders (except antisocial personality disorder); post traumatic stress disorders; symptom neuroses or neurotic conflicts; adjustment disorders; paraphilias; and some mood, anxiety, somatoform, sexual and gender identity, eating, substance abuse and dissociative disorders (Table 66.8). In addition, psychoanalytic psychotherapy is often employed in treating patients who present with relational problems and those
problems that are the result of abuse or neglect. It may also be useful to patients with certain impulse disorders and to patients whose psychological problems are affecting or are the result of their primary medical illnesses. In short, psychoanalytic psycho-therapy, often in combination with medication, is an appropriate intervention in a broad range of disorders, conditions and psychi-atric illnesses (Karasu, 1989; Gabbard, 1995).
The characteristics of the patient assumed to be correlated with positive outcome in psychoanalytic psychotherapy include introspectiveness (psychological mindedness); ability to estab-lish and maintain human relationships, even “unhealthy” ones; vocational stability; high degree of motivation; absence of for-mal thought disorder; and psychological resources sufficient to withstand the possible frustration during the treatment and its characteristic therapeutic regression and accompanying strong affects. Patients with more severe disturbances may be best ap-proached using supportive psychoanalytic psychotherapy dis-cussed below.