The Stress of Self-Realization

For many years I have been interested in the paradox of the analytic patient's tremendous fear of, anxiety about, and resistance to the emergence of his or her authentic self. Change is inevitable in the course of analysis, and with change there is always anxiety in varying degrees. However, anxiety can be so overwhelming that even if it occurs in the process of growth, the patient will not be able to sustain it and will do everything he or she can to prevent its occurrence. Often the analyst can recognize signs of growth to which the patient pays little attention. In order for us to be able to do this effectively and help the patient endure the necessary stress, we must have an understanding of the process of self-realization and recognize its value as a goal in analysis.

Recently I have been working with many women in my practice who are making major external and intrapsychic changes as a result of the women's movement. In this group are some who are venturing into activities and having experiences which cause a great deal of stress in that they are required to move rapidly from a predominantly self-effacing position to a more assertive one. A change in behavior is required of them before they have made inner changes in their feelings and attitudes toward self. Usually in the course of analysis attitudes and feelings change before behavioral patterns, and usually at a more gradual pace. However, this group of women are living in a very unusual time. They are participants in a period of social change which is producing an acceleration of intrapsychic pressure. In working with these patients I have seen highlighted some of the major issues in analysis. In this paper I will discuss my concept of self-realization, the factors which make it stressful, and the various clinicial forms which it takes. Before going into the clinical material I will give some historical and theoretical background.

A major contribution that Horney made to the field of psychoanalysis was recogn