Of patients who come for psychiatric evaluation, psychoanalysis has been called the treatment of choice for that narrow middle group that is sick enough to need it and well enough to tolerate it (Gill, 1951)

For patients with fragile or vulnerable "ego strength" (including a tenuous hold on reality), psychoanalysis can be psychologically disorganizing, with dangers of regressive, even psychotic swings, severe acting out, flight from treatment, or suicidal pressures. such patients, are often deemed too ill for psychoanalysis and need to be treated by other dynamic (more supportive) psychotherapies.

Review of General Psychiatry 5th edition Howard H Goldman McGraw-Hill US P454,5