[Problem of indications in psychotherapy].

Abstract

In psychotherapy, the crucial question of indication-and more particularly, the question of differential indication-has, for a long time, not received the attention it deserves. This has been the case both in research and in the training of psychotherapists, and the decisions made by psychotherapists when choosing a type of intervention for a patient (or the patient for an intervention), have scarcely been informed by research results. This state of things is changing due to a series of factors, and the scientific, the clinical, the socio-political, and the legal aspects of the problem gain more and more attention. The fact that a psychoanalysis during five years with four sessions a week (the therapeutic effects of which are not established) takes almost the same therapeutic effort as the treatment of fourty patients receiving a short-term therapy of twenty six sessions during a half year, or of eighty patients having thirteen sessions (these twenty six or thirteen sessions likely to yield quite satisfying therapeutic effects) is something of which everybody begins to be strikingly aware. But differential indication-globally the question: what therapy for what patient?- continues to pose problems. Do we have valuable criteria for choosing, and why don't we use those we have? In this paper we distinguish two types of problems: those at the conceptual and technical level and the problems pertaining to the ethical and professional domain. Their description will be followed by some conclusions and recommendations that might be useful for treatment selection.