When Does Need Become Desire and Desire Need

MY TITLE, WITH ITS REFERENCE TO need and to desire, has an obvious connection with current discussions about the relative merits of self psychology and a more classical, analytically oriented psychology for the understanding and treatment of mental patients. The difference in approach between a self psychology and a more classical theory is often epitomized by the terms "deficit" and "conflict" rather than by "need" and "desire." Classical psychoanalysis tends to view the significant aspects of most psychopathology as secondary to unresolved conflict. Thus, someone who is phobic, inhibited or unable to sustain relationships is considered to have conflicts about his sexual wishes and about his angry reactions when his sexual wishes are frustrated. His fear or guilt about his sexual and angry feelings and fantasies leads him to repress or otherwise defend against them. However, he pays a price in that his freedom to express himself and interact with others is impaired. Treatment consists of resolving the conflict, that is in helping him tolerate, become aware of and understand the implications of his sexual desires and his aggressive feelings and fantasies.

Self psychology, in contrast, views a considerable aspect of psychopathology as a manifestation of a deficit in maturation, that is a lack of development in some significant areas of functioning, secondary to a failure on the part of the parents to provide the appropriate conditions for emotional growth. This deficit consists of an inability to cope adequately in many situations, for example, to maintain self esteem in the face of narcissistic blows or to be realistic about one's expectations. Along with this, the individual with the deficit has an excessive dependency upon what are called "self-objects." He uses other people to maintain his self esteem or to confirm his expectations. Treatment involves providing, at least initially, a highly sustaining relationship. The patient gradually becomes