The term initial or preliminary interview(s) refers to the meeting or meetings that take place between a psychoanalyst and the person who must decide whether or not to enter into analysis. The purpose of the initial interview or consultation is to determine the person's need for treatment.
The initial interview became standard procedure at the same time that Sigmund Freud clearly instituted the framework for the psychoanalytic situation: patient lying down, analyst hidden from the patient's view. These conditions in fact produce a radical change in a relationship that, during the preliminary interview, was fairly similar to consultation with a physician or psychologist, or indeed an interview for the purpose of soliciting advice of any type.
The issue of course is whether analysis is indicated, and this implies referring to criteria assessing "analyzability" and the degree to which such an undertaking is possible. From the beginning, however, from the phone call setting up the first meeting, the subtle mechanisms of transference and counter-transference are set in motion, shedding an entirely different light on the criteria for choices.
It is because of these intersubjective parameters that Freud advised, in "On Beginning the Treatment (Further Recommendations on Technique of Psycho-Analysis)" (1913c):
I may add . . . that I have made it my habit, when I know little about a patient, only to take him on at first provisionally, for a period of one to two weeks. . . . No other kind of preliminary examination but this procedure is at our disposal; the most lengthy discussions and questionings in ordinary consultations would offer no substitute. This preliminary experiment, however, is itself the beginning of a psycho-analysis and must conform to its rules. . . . Lengthy preliminary discussions before the beginning of the analytic treatment, previous treatment by another method and also previous acquaintance between the doctor and the patient who is to be analyzed, have special disadvantageous consequences for which one must be prepared. They result in the patient's meeting the doctor with a transference attitude which is already established and which the doctor must first slowly uncover instead of having the opportunity to observe the growth and development of the transference from the outset (pp. 123-125).
In 1930, his responses to his analysand Smiley Blanton, as revealed in the latter's Diary of My Analysis with Freud (1971), showed no change in this point of view. According to Blanton's entry for March 7, Freud told him: "[T]he lying down is but a matter of convenience. But there is one point that is essential: the analysand must not see the face of the analyst. If he did, he would be influenced by the face of the analyst" (p. 50). In his entry for August 9, 1935, Blanton recalled: "In a discussion about technique, I asked Freud if he advocated talking to a patient several hours before analysis—or, rather, to begin an analysis with several hours of discussion. He replied, "With a student in training it may be permissible. With a patient who is there for treatment, no"' (p. 71).
In later years, trial analysis fell out of practice, and the status of the preliminary interviews has become somewhat vague; these vary, according to different schools, in their frequency and duration, as well as in terms of whether they may be free of charge. Some practitioners limit them to one or two meetings, the latter case being intended to assess the patient's capacity for insight and working over, following the initial meeting: Was there a dream, a parapraxis, a lifting of amnesia, or an instance of acting out? Other analysts advise having several interviews to avoid the possibility of having to interrupt an analysis that, too late, turned out to be unjustified. Several authors have emphasized the importance of preliminary interviews with borderline patients, for whom, more than with other patients, possible modifications to the analytic situation may be considered.
The analyst's listening attitude, the absence of questions of a medical nature, discreet emphasis on preconscious manifestations, recognition of mental suffering and its possible modes of expression other than acting out, and assessing possible lateral transferences (if a colleague has already interviewed the patient) are among the themes evoked most frequently by authors in their discussion of preliminary interviews. Similarly, these authors have underscored the need, once the preliminary interviews have ended and if a decision has been made to undertake analysis, to establish clearly and in detail with the patient the conditions in which the treatment will take place. Such conditions include the length and frequency of sessions, scheduled times for them, method of payment, policy in case of absence from sessions, and vacation periods.
Also to be considered is certain psychoanalysts' practice of switching to a classical analytic mode of treatment after a long series of sessions of psychoanalytically inspired therapy; in their view, this move is similar to what happens after traditional preliminary interviews. In all cases, there remains first and foremost the problem, raised by Freud, of the psychoanalytic handling of the transference and counter-transference, which in the classic view is only possible within the psychoanalytic setting.
Alain de Mijolla
See also: Analyzability; Framework of the psychoanalytic cure; Psychoanalytic treatment; Face-to-face situation; Indications and contraindications for psychoanalysis for an adult; Technique with adults, psychoanalytic.
Blanton, Smiley. (1971). Diary of my analysis with Freud. New York: Hawthorn.
Freud, Sigmund. (1913c). On beginning the treatment (Further recommendations on technique of psycho-analysis I). SE, 12: 121-144.
Quinodoz, Danielle. (1992). The psychoanalytic setting as the instrument of the container function. International Journal of Psycho-Analysis, 73, 627.
Console, William, et. al. (1977). The first encounter: The beginnings in psychotherapy. New York: Jason Aronson.
Gill, Merton, et. al. (1954). The initial interview in psychiatric practice. New York: International Universities Press.
Jacobs, Theodore J., and Rothstein, Arnold. (Eds.), (1990). On beginning an analysis. Madison, CT: International Universities Press.