Life Changes, Analytic Changes Revisited: Current Perspectives on their Relationship

Theodore Jacobs introduced the panel saying that the relationship between analytic treatment aims and the goal of positively affecting patients' lives is not clear-cut. Some patients appear engaged in analysis but remain static. They leave discontented, despite having attained “the oft-cited goal of understanding how their minds work.” Others fall short of analytic goals, do not make internal rearrangements, but alter their lives significantly. Such patients may change due to nonanalytic factors, though they believe analytic work caused their improvement. Substantial analytic work can be done without affecting the patient's life, while in other instances major life goals are achieved following meager analytic change. We emphasize insight or structural change, and believe these dynamic changes result in more adaptive compromise formations. This formulation “says nothing about the patient's life.” But in reporting cases we stress “life gains, not new intrapsychic relationships,” though we believe one follows the other. It is said that “we should not be overly concerned with our patients' lives.” Analysts must adhere to analytic goals, and the patient is responsible for using what analysis provides. Thus, “life goals should not enter the mind of the analyst,” lest therapeutic zeal or overinvestment in the patient's problems “muck up the treatment.” Yet we are not content if analytic work yields few life changes. Jacobs suggested that “many of the changes in technique in the direction of more active engagement with patients have been proposed by colleagues who