The outcome of psychoanalysis - The hope of a future

Peter Fonagy assesses evidence for the effectiveness of psychoanalytic treatment.
At first we hope too much, later on, not enough. (Joseph Roux, Meditations of a Parish Priest, 1886) In 1903, in his contribution to Loewenfeld’s book on obsessional phenomena, Freud wrote: …the number of persons suitable for psycho-analytic treatment is extraordinarily large and the extension which has come to our therapeutic powers from this method is…very considerable. (Freud, 1904/1961a, p.254) Earlier, in a series of three lectures on hysteria in October 1905, he had asserted: And I may say that the analytic method of psychotherapy is one that penetrates most deeply and carries farthest, the one by means of which the most effective transformations can be effected in patients. (Freud, 1905/1961b, p.260) Freud’s therapeutic optimism persisted for at least two decades. In 1917 he wrote: Through the overcoming of these resistances the patient’s mental life is permanently changed, is raised to a higher level of development and remains protected against a fresh possibility of falling ill. (Freud, 1916–17/1961c, p.451) Fifteen years later, however, his optimism apparently wilted and he claimed ‘never [to have] been a therapeutic enthusiast’ (Freud, 1933/1961d, p.151).

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