Causes and Mechanisms of Ego Distortion1

When the Scientific Committee of the Congress asked me to contribute to the discussion on Ego Distortion—a subject which, so far as I know at any rate, has not yet been dealt with—I accepted willingly, for the occasion gave me the opportunity to clarify and bring together a number of clinical observations which had for some time aroused my interest in, and drawn my attention to, the technical implications they involved. Indeed, my own observations had led me to the same conclusions as those authors who, having studied psychoses psycho-analytically,2 stressed the importance of the therapist's deep positive attitude towards his patient.

At the time that I made these observations, while treating certain types of patients who were neither psychotic nor pre-psychotic, I had not yet heard about the findings of those to whom I have just referred. I had for my part noted, however, in analysing patients of an unusual structure, but in no way psychotic, that it was possible to observe in them, during the course of treatment, the development of certain tendencies producing needs identical with those seen in psychotics.

As I have shown elsewhere3 these patients can only be cured if, in following the course of a classical analysis, they feel, when this becomes indispensable to them, that the analyst, apart from the benevolent neutrality he has shown them, is besides and authentically the 'good object' of which they were previously deprived. I became convinced that with this type of patient traumatic situations had engendered a need to receive as it were a 'reparative gift'. This need transferred on to the analyst became indispensable to recovery.

At the same time I noted that the unusual seriousness of the traumatic situations was due in such cases to the fact that these traumas had been brought about not by important events of a more or less subjective kind, but by real events, by factors objectively harmful.

I was then able to establish, as to their effect, a difference betwee