Evaluation of Change

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.

Our Task, as psychoanalysis, is to help our patients change. We conceive of neurosis as a character disorder, a way of life in which a person is compulsively driven in an unhealthy direction by a variety of rigid and conflicting needs. This precarious way of life begins in childhood with basic anxiety1 and basic conflict,2 and continues with the person's desperate and contradictory unconscious attempts to solve his inner conflict. Of these neurotic attempts at conflict solution, perhaps the most significant is the creation, in imagination, of an idealized self.⁸ The idealized image becomes more real to the person than his real self, and his life becomes devoted to the attempt to actualize it. Our therapeutic aim is to help our patients change from striving mainly for self-idealizing to striving mainly for self-fulfillment.4 Unless there is change in this direction, we cannot say that our therapeutic endeavors have been successful. It is not enough that a patient acquires insight, that he becomes aware of something he didn't know previously—knowledge without inner change is sterile.

It is therefore essential that we evaluate the degree and nature of change in our patients if we are to assess accurately the effectiveness of our work. This is easier said than done. Many factors make it difficult to evaluate change. Among these are the following:

1. We are dependent, to a degree, on what the patient communicates to us during the analytic hours. We do not have the opportunity to observe him at home and at work, among relatives, friends, and strangers. Also, we do not interview his wife, children, teachers, employers, employees, and peers. In short, we do not have the benefit of the observations of others, including pe