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By this time you will have formed an impression that the field of analytic psychotherapy is a very narrow one, since you have in fact heard nothing from me except indications that point against it. There remain, however, cases and types of disease enough on which this therapy may be tested - as, for instance, all chronic forms of hysteria with residual manifestations, the broad field of obsessive conditions, aboulias, and the like.

It is gratifying that precisely the most valuable and most highly developed persons are best suited for this procedure; and one may also safely claim that in cases where analytic psychotherapy has been able to achieve but little, any other therapy would certainly not have been able to effect anything at all.

(e) You will no doubt wish to enquire about the possibility of doing harm by undertaking a psycho-analysis. In reply to this I may say that if you are willing to judge impartially, if you will consider this procedure in the same spirit of critical fairness that you show to our other therapeutic methods, you will have to agree with me that no injury to the patient is to be feared when the treatment is conducted with comprehension. Anyone who is accustomed, like the lay public, to blame the treatment for whatever happens during an illness will doubtless judge differently. It is not so very long since the same prejudice was directed against our hydropathic establishments. Many patients who were advised to go into an establishment of that kind hesitated because they had known someone who had entered the place as a nervous invalid and had become insane there. As you may guess, these were cases of early general paralysis that could still in their first stage be sent to a hydropathic establishment; once there, they had run their inevitable course until manifest mental disorder supervened: but the public blamed the water for this disastrous change. When it is a matter of new kinds of therapeutic treatment even physicians are not always free from such errors of judgement. I recall once making an attempt at psychotherapy with a woman who had passed the greater part of her life in a state alternating between mania and melancholia. I took on the case at the close of a period of melancholia and for two weeks things seemed to go smoothly; in the third week we were already at the beginning of the next attack of mania. This was undoubtedly a spontaneous transformation of the clinical picture, since in two weeks analytic psychotherapy cannot accomplish anything. And yet the eminent physician (now deceased) who saw the case with me could not refrain from the remark that psychotherapy was probably to blame for this ‘relapse’. I am quite convinced that in other circumstances he would have shown a more critical judgement.