The Curative Factors in Psycho-Analysis—Contributions to Discussion1

My interest in this Symposium that deals with matters close to our daily concern is heightened by the different approaches chosen by the three contributors. Thus Gitelson casts his net very widely. He integrates a variety of concepts used in the literature and presents a profile of his own theories. Nacht focuses on one fundamental factor, itself a composite of many elements, and Segal uses the one-way screen method by giving records from three analytic situations, connected by expositions of Melanie Klein's theories.

Nacht starts with a commendably brief definition of mental health as 'essentially the ability to live in a permanent state of harmony with oneself and with other people'. The precondition for this is a strong ego, and therefore the therapeutic endeavour must be directed towards the ego. Comparing the factors which interfere with the development of a strong ego at the time at which Freud developed his theories on technique with present conditions, Nacht concludes that in our present world it is the aggressive energies which represent the severe test on man, in contrast to the Victorian era which demanded repression of sexual impulses. He gives illustrative figures from the patient population coming to the Paris Institute for analysis; only a small percentage is supplied by obsessional and phobic neuroses. I believe that other psycho-analytic clinics too experience the difficulty of finding the, as they are sometimes called, normal neuroses for their candidates. Nacht emphasizes the need to adapt our technique to the changes in the type of the disturbances from which our patients suffer, and he maintains that interpretation alone does not suffice. Nacht quotes Glover's formulations concerning 'the humane relation in the transference' and his postulating that 'a prerequisite of the efficiency of interpretation is the attitude, the true unconscious attitude, of the analyst'. This emphasis on the humane analyst as the 'com