| The beginning phase of psychotherapy begins with preliminary contacts between a patient and a therapist. An initial phone call from the patient can be an early opportunity to weed out those who have unrealistic expectations about therapy. Selecting patients for psychotherapy is determined during preliminary contacts by the evaluation of analyzability. Four major criteria of analyzability are motivations, capacities, traits of personality and character, and feasibility. The lists to assess how the patient react to the therapist are as follows；1) functioning in the world, 2) object relations, 3) affects, 4) character traits, 5) motivation, and 6) the superego. The goal of psychotherapy is the maximal resolution of intrapsychic conflicts. Psychoanalytic treatment is neither able nor intended to eliminate psychological conflicts.
The provision of an appropriate atmosphere by the psychotherapist is extremely important. Early in the therapy, it is the patient’s feeling of vulnerability that should have first priority. Free association brings into consciousness the repressed material which was held back by resistances. Uncovering the resistance is the first step to overcome it. The role of psychotherapist will be limited to questions to elucidate the repressed material and to interpretations, confrontations, and reconstructions which represent the major therapeutic interventions.
The technique of interviewing is even more of an art than a science, and the initial interview must be therapeutic and not traumatic. Psychotherapist has no right to disturb patient's defenses and provoke more anxiety or transference complications and a tactful history-taking interview is necessary. Prognostic interview follows a diagnostic interview. Among prognostic factors in the patient’s life, the history of object relations is the most important. Psychotherapist should know the history of intense or affect-laden or emotionally meaningful relationships to people in his family. Psychotherapist next turns to a history of sexual identification of the patient；the sexual direction. Premature mention of cure may be disastrous. The best attitude is to indicte that psychotherapist can help the patient to help himself.
Later interviews provide an opportunity for the patient to correct any misinformation that he provided in the first meeting. The development of a therapeutic relationship comes from the therapist’s efforts that he tries to acquaint himself actively with the patient as not a transferential object, but a real person who currently experiences in a real world. |
