Clinical Indicators of Structural Change

A question that inevitably faces analytically minded clinicians is how to decide if deep and lasting personality change, true structural change, has occurred in patients. The question bears relevance because the meaning and value of the clinical enterprise relies on how clinicians view their work as benefiting those seeking assistance. Furthermore, technical considerations in individual instances often turn on whether nontrivial, nonsuperficial change is perceived to have occurred.

The issue of structure itself, in the sense of personality structure, arose when Freud realized that the topographical theory and its treatment goal (“making the unconscious conscious”) was insufficient. After all, if, as seemed the case, the agent responsible for causing repression is itself repressed, then only obscurity results. To overcome this difficulty, in 1923 Freud formulated the structural theory and its treatment goal (“where id was ego shall be”); Freud believed that repression was chiefly grounded in castration anxiety.1

Because of its potential application to a theory of personality structure, Rene Thom's mathematical proof, published in Structural Stability and Morphogenesis, deserves our consideration.2 Thom has established a model, referred to as the catastrophe model, that seems to improve comprehension of those phenomena that naturally undergo sudden transformation, although the underlying structure and the system as a whole remain intact. A structure is inaccessible to direct observation, whereas the behaviors by which the structure is made manifest not only allow direct observation but also enable the observer to infer the properties of the structure. A structure is an inference. The breaking of an ocean wave serves as an illustration of how discontinuous behavior occurs in nature despite a stable underlying structure of vector components determining that behavior. The model invites our interest because psychic phenomena,