What Leads to Basic Change in Psychoanalytic Therapy?

THe Scientific Progress which psychoanalysis has made in the last half-century was not accompanied by a corresponding increase in therapeutic effectiveness, leading to basic change. By “basic change” I refer to changes of motivation and character structure, not of mere behavioral patterns. The diagnosis of basic change cannot be made via a change in the anxiety level since change in the direction of health is often accompanied by growth anxiety which is very different in quality from neurotic anxiety. Nor is basic change indicated by the disappearance of symptoms—mental and psychosomatic symptoms often increase temporarily during forward moves, while they decrease during times of lessened involvement and therefore less progress; nor by the degree of so-called adaptation, since much adaptational behavior consists only in compulsive conforming and self-elimination; nor, finally, by the mere change of behavioral patterns—a movement toward another person may signify greater freedom in interpersonal relationships, an increased capacity for friendship or love, but it may also express needs for dependency and symbiosis. An aggressive move may signify healthy assertion or vindictive hostility; withdrawal may be motivated by the need to avoid anxiety and conflict or by the healthy wish for self-consolidation or a creative effort. A meaningful evaluation of change in therapy has to be based, therefore, not on the presently used criteria of change in anxiety level, symptoms or behavior, but on evidence which reflects change in motivation and psychodynamics.

A great variety of factors has been considered effective in leading to basic change: making the unconscious conscious through free associations; childhood memories, dreams and well-timed interpretations; the re-experiencing of the past as a basis for the understanding of the present; fostering the development of the so-called transference neurosis followed by the analysis of the transference in the patient-doctor relationshi