Psychoanalysis and psychotherapy: a long and troubled relationship.

The extended, inconclusive debate over distinguishing psychoanalysis and psychotherapy has been muddied by two underlying issues. The scientific identity that psychoanalysis claimed, leading it to affirm that it was more than a treatment modality, was in conflict with the actual therapeutic mission it assumed. Psychoanalysis was further hampered in those discussion by its internal conflicts over doctrinal purity; deviations for psychotherapeutic ends were vulnerable to the charge of dissidence. More recently, the debate has been clouded by the fact that newer candidates, by and large, can anticipate careers primarily as psychotherapists, driving a wedge between generations within institutes. The course of the debate and the problems encountered in it are affected by the formal relations between the psychoanalytic establishment and the health-care industry, including government agencies. In the long run, it appears to make little difference whether psychoanalysis is officially recognized as a mental-health treatment, as in Germany, or attempts to maintain its independence, as in the UK. Finally, as the debate appears to be winding down, the fate of dynamic psychotherapy is also in the balance. If in the past psychoanalysis seemed at risk of losing its specific identity, today dynamic psychotherapy is in danger as well.