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When I graduated analytic training, one of my classmates congratulated me and said, “Allan, I must tell you, you have changed so much since you started training. Your analysis has obviously been a great success!” Uncertain whether to preen at the compliment to my “new self” or wince at the implications of my “old self,” I inquired in a carefully neutral tone as to how she felt I had changed, hoping optimistically that some of my newfound attributes of stability, wisdom, and maturity had impressed her.
“Oh,” she said, “It's obvious to everyone! You no longer wear those hideously garish neckties!”
I smiled weakly as I nervously fingered my tie. For not only was this not the kind of change for which I was expecting acclaim, but I had never been aware that my neckties had been regarded by anyone as sartorial disasters. Modishly daring, perhaps. But hideously garish?
I tell this tale of narcissistic deflation only to illustrate that change, like beauty, is often in the eye of the beholder. In this instance, the patient was not only unaware of the pathology but unaware of the cure. In other instances, the patient, alone, may be aware of some subtle change in inner state, not obviously reflected in behavior. To make a comprehensive assessment of changes consequent on psychotherapy requires our attention, then, to two sets of data: (1) introspective data from the patient regarding changes in mental and emotional state, and (2) observations by the therapist (or by the patient or a third party) of changes in the patient's behavior, either in the interview situation or outside it, from which inferences can be drawn regarding more general changes in behavior and in psychic or inner state.