La clinique des entretiens préliminaires en psychanalyse

Abstract

Few studies have been made on the practice of preliminary interviews, which are sessions that rely on less psychoanalytical theory than the following sessions, in analytical therapies. However, the first sessions with a new patient matter greatly to all analysts—a fact that our study confirms thanks to therapists’ answers to a standardized questionnaire that we validated in a previous study. The clinical observation data in our recently published study on the practice of preliminary interviews in psychoanalysis were collected empirically in the Department of Psychiatry of the Pitié-Salpêtrière University Hospital among 30 therapists—15 therapists with at least 10 years’ experience and 15 therapists with less than 5 years’ experience. They were asked to answer regarding the preliminary interviews with a patient they had seen two to five times by the time they answered the questionnaire. For this study we used an updated version of our questionnaire, with new to-the-point questions regarding the patient’s meta-communication. Thirty-six items cover five variables chosen according to the therapist’s degree of involvement in his decision to follow that patient. An additional evaluation scoring sheet, with a validated inter-judge reliability, allows the data to be assessed by members of the psychoanalyst group. The results of the evaluation scoring sheet are the “objective” aspect of the research. The questions regarding the five variables we focus on, allow the therapists to evaluate whether or not they feel they have answered the questionnaire. Their own assessment of their clinical work is the “subjective” aspect of the study. Though the patient’s meta-communication is slight during the very first sessions, all of the therapists involved in this study are able to spot it as one of the most promising elements for a psychoanalysis to be possible. The clinical data allow us to speculate that the psychodynamic hypothesis is worked out on the basis of what is heard of the patient’s meta-communication abilities. This is supported by psychoanalytical theory on the one band and on the other band by what the analyst’s experiences in his understanding of transference and counter-transference.