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WHEN I CONSIDERED THE TOPIC of this symposium, I was reminded that all patients are difficult patients and, also, that all therapeutic relationships are difficult relationships. Furthermore, these "difficulties" are not merely occasional or incidental to our work, nor can they properly be considered obstacles to it. They are central to the therapeutic work and intrinsic to it because they are expressions of the object of the work. All that being so, I have chosen to discuss the nature of certain of these difficulties rather than particular sorts of patients or relationships.
I should say at the outset that the difficulties I have in mind are not primarily those that simply reflect the fact that people do not change easily. That, of course, is so. People are not very plastic. Personality or character is a self-regulating organization and any self-regulating organization is elastic and resistant to change. The more we have realized that our therapeutic aims require not merely the recovery of memories of particular conflicts but some degree of personality change, the more we have realized that.