Understanding the Patient as the Basis of All Technique

Compiled and edited from lectures on Psychoanalytic Technique given by the late Karen Horney at the American Institute for Psychoanalysis during the years 1946, 1950, 1951 and 1952. Further lectures in this series will appear in subsequent issues of the Journal.

Analysis is a cooperative enterprise; the analytical situation is a process going on between two persons for the purpose of helping the partner who is sick. Yet though both partners have this common purpose, their ultimate goals differ. The patient's goal is divided: consciously he wants to understand himself, his compulsiveness, his fears; but he is unaware of his inner need to maintain the status quo, to actualize his neurotic fantasies, to live without limitations according to the dictates of his idealized image. He expects magic help and he demands it. The analyst's goal is undivided: he strives for truth, for an understanding of the patient and his difficulties, their development and their present manifestations. He sees the patient as he is today and is interested in this human being's growth and in those factors which have impeded healthy development. His focus is on the road toward self-realization and on those forces which obstruct this road. The analyst brings to this task his interest, his professional training, his experience, his feelings, his wish to understand. Yet he is an outsider from the start.

The patient is involved; he has the raw data, but is interested only in some of them and may even be driven to hide or distort vital parts of them. Living in fantasies, he is often unaware of this distortion of reality. When the analyst tries to understand the patient's difficulties this effort will help to interest the patient again in those aspects of himself which he may have eclipsed, effaced, overevaluated or thwarted.

Understanding is a social and specific human process, a moving with one aspect of our being toward the stand which another person maintains, but while so mov