Self-Psychology Illustrated on the Issue of Moral Masochism: Clinical Implications

Some years ago in a discussion, a colleague who had been practicing some 10 or 15 years asked: “Why is it that after a certain time in the analysis of a patient we give up the analytic stance and tend to exhort our patients to give up their neurotic behavior?” Obviously the analyst in this case was disturbed by the fact that analysis in itself did not seem to work-analysis in this sense meaning primarily the acquiring of insight. But the fact that insight alone is not curative has been known for a long time. Freud himself spoke of the need for “working through” the insights, for experiencing the emotions that accompany them, especially as these appear in the transference. Yet often all these procedures do not effect change. We might well ask why. It is time to examine the premises upon which our therapeutic expectations are based.

The empirical method of science with which the Weltanschauung of our modern civilization is embued sometimes leads us to be unaware of the broad premises which form the framework within which our observations are made. Whether psychoanalysis and psychotherapy are sciences or not is a debatable issue. Yet within their operation, observations about human behavior, thoughts, and feelings are being made, and some positive therapeutic results are being achieved. However, the fundamental premises upon which observations and procedures are based are rarely challenged; they are indeed rarely perceived at all. They are taken for granted as the psychological air we breathe. Even when new advances in understanding are arrived at, the attempt is usually made to fit them into the framework of the original premises or to disregard their implications entirely. Still, the recent interest in a psychology of the self, especially as it is reflected in the