The Criteria of Progress in a Patient During Analysis1

The assessment of progress during analysis presents real difficulties. A change in the symptoms or complaints of the patient is not a satisfactory guide to the patient's progress. We know that quick seeming improvements may be followed by relapse or even temporary deterioration. In view of these difficulties it appears desirable to formulate certain criteria on which to base judgement on the progress of the individual treatment. It is obvious that these criteria must be based on the psychological processes within the patient.2

One could choose many aspects on which to base an assessment of progress. To name only a few: development of insight; the patient's ability to associate freely; his tolerance of his own unconscious material; the flow of speech during the session; the rapport between patient and analyst; the transference situation as a whole. I appreciate that these are valid indicators which are constantly used by analysts. Above all, the clinical improvement of the patient cannot be ignored if it is substantiated by a parallel change recognizable in the analysis. In my view, the parallel change of analytical material and clinical improvement is the most important guide. In order to understand that parallel development it is important to get a clear idea of the events in the unconscious of the patient which should be recognized by the analyst and the patient.

Joan Riviere3 referred in her paper on 'A Contribution to the Analysis of the Negative Therapeutic Reaction' to Freud's remark about certain refractory patients who were unable to acknowledge progress. In utilizing concepts based on Melanie Klein's work, in particular the depressive position, Joan Riviere described the negative therapeutic reaction of the patient as an attempt to escape the depressive reaction: by accepting the analysis, or the analyst, as a good object, the patient will feel indebted to him and thus be exposed to a feeling of guilt. In a recent paper 'On the Criteria for the T