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In psychotherapy, whether or not it is psychoanalytically oriented, primary attention must be given to the issue of the patient's functioning through choice or through compulsion. In her writings and lectures, Horney emphasized the importance of making the patient aware that it was largely his neurotic forces, rather than those emanating from his real self, which were in the driver's seat. In patients who are in therapy, changes can be detected when dreams are no longer reported in which the patient is in the back seat, feeling helpless and vulnerable while the car speeds recklessly towards disaster. A move to the driver's position is an indication of constructive change and a growing capacity for understanding of oneself and what is happening to oneself. Mechanisms of projection, externalization and shifting responsibility are diminished in intensity and extensity.
The following exemplifies the working through of blocks which interfere with the patient's being in his own driver's seat.
John R., a forty-nine year-old, successful account executive, with a puritanical, upper-class background, has been in individual and group psychoanalytic treatment for one year because of his self-effacing and compliant way of life. This was manifested itself in intermittent sexual impotence and a recent moderately severe coronary episode. In the months following the cardiac episode, he has been able to give up his little boy “please-like-me-be-cause-l-am-such-a-nice-guy” behavior, to be in touch with his anger, and to assert himself more at home and at work. He related the following dream recently:
“I recollect having made a very risky takeoff in an airplane with my wife in the pilot's seat. The weather was extremely cold but nonetheless she pulled the throttle too rapidly for the plane to take off without first warming up the engine. I have a clear memory of the runway all white and the cold barren landscape. There were forbidding low clouds, laden with cold. The wings of the plane we