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J Am Psychoanal Assoc. 1999;47(3):679-704; discussion 704-40.

Making the case for psychoanalytic therapies in the current psychiatric environment.

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  • 1Ambulatory Personality Disorder Services, McLean Hospital, Belmont, MA 02178-9106, USA.


A variety of political, economic, and scientific forces have caused psychoanalytic therapies to become marginalized in psychiatry. These therapies are given short shrift in recently developed treatment guidelines, which are based largely on notions of empirical validation narrowly construed. Questions about the efficacy of psychoanalytic therapy can be meaningfully addressed by systematic assessment of available knowledge and potential data bases and by explicit efforts to locate the role of psychoanalytic therapies alongside other modalities. Several steps that might lend the psychoanalytic therapies greater credibility are proposed: (1) define the distinguishing features; (2) identify clear indications and contraindications; (3) systematically collect case histories of successfully treated mentally ill (diagnosable) patients; (4) increase vigilance (together with the patient) toward assessing progress in treatment.

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