What Leads to Basic Change in Psychoanalytic Therapy?

The title of this meeting poses, with disarming simplicity, the most difficult problem in psychoanalytic theory. Surely it is significant that now, almost three-quarters of a century after the creation of psychoanalysis, meetings are devoted to this subject. I would like to begin by calling attention to the words “basic change” in our title. Such words did not always appear in the psychoanalytic literature. In earlier years the word “cure” was more popular. Psychoanalysts are today somewhat more modest, but the use of the word “change” is not mere modesty. It reflects a shift in emphasis and concept which connects cure, whatever that may be, with change. The qualifying adjective, “basic,” suggests that there may be various kinds of change, some of which are not basic.

The first change we seek is, of course, symptomatic relief. But psychoanalysts now look for other changes in aspects of living not necessarily directly related to the symptoms. Furthermore, there is frequently an expectation, or at least a desire, that the changes shall be lasting and shall be proof against future stresses. Beyond this, the words “basic change” suggest that what is to be changed is not merely a person's observable behavior but also the underlying psychodynamic constellations which determine behavior.

This notion was, of course, introduced by Freud and has remained as part of the meaning of cure or basic change in psychoanalysis. The concept has an appealing simplicity of outline, even though the details may be very complex. At the same time, this concept ties the definition of change to a specific theory. This is not in itself objectionable, but there are many psychodynamic theories, some of which differ in important respects. The dilemma which this state of affairs poses is readily apparent if we consider the much abused term “insight” and recall what widely diverse insights different analysts seek to impart to their patients.

I do not intend, at this point, to