The Curative Factors in Psycho-Analysis1

Before we embark on the subject of curative factors, let us briefly recall what we mean by the state of mental health. Mental health as we see it is essentially the ability to live in a permanent state of harmony with oneself and with other people. It therefore implies that there should be a minimizing of intrapsychic conflicts, and consequently the presence of a strong ego; for, as we know, it is the weakness of the ego that leads to a neurosis. To ensure that the ego possesses the strength, control, and flexibility necessary to mental health, Freud has taught us that 'where id was, there shall ego be'; in other words, the unconscious instinctual forces must become conscious, in order to afford life-giving nourishment to the ego.

Psycho-analytic technique is based on these essential ideas, for all methods of ouring a sick mind concern the ego and are effected through it. It follows that there should in principle be a reciprocal relationship between theory and technique. However, at the International Congress of 1936 (19) the question was raised whether there was always complete agreement between theory and technique. Today we are asking ourselves the same question even though a quarter of a century has since elapsed.

Perusal of most psycho-analytic publications would lead one to suppose that we analyse our patients today in exactly the same way as we did twenty, thirty, or even fifty years ago. Now the conditions under which we work—the 'context', shall we say, of the treatment—have changed considerably since then: theoretical knowledge concerning the functions of the ego has greatly deepened and, with few exceptions, the very content of our clinical work has changed. We no longer treat quite the same sort of illnesses as in Freud's day. We all know that Freud elaborated his technical principles primarily through the treatment of hysterical or obsessional cases, that is to say of patients suffering from typical neuroses; whereas today