Discussion of the Paper by David Liberman on 'Changes in the Theory and Practice of Psychoanalysis'

Although it is tempting to discuss Dr Liberman's paper (this issue) point-by-point as he presents his ideas, I believe it will be more useful if I follow an organization somewhat different from his but with a clear intent to discuss most if not all of the issues he describes. It is my aim to focus on what I consider Dr Liberman's most important topic: what is essential in psychoanalysis that we wish to preserve in spite of changes in society or patient population and/or advances in psychoanalytic theory and technique.

I share with Wallerstein (1969) the view that psychoanalysis is the method 'which analyses transference and resistance back to their genetic-dynamic roots in the infantile psychic life'. The primary aim of the psychoanalytic process is for the analysand to learn how his mind functions and how it came to function that way. To achieve this aim, it is essential that the patient accomplish several analytic objectives (or perhaps 'assignments' or 'tasks'). My discussion of Liberman's paper will be organized around four essential objectives: motivation, free association, insight and change.

First, the patient has to be motivated to learn about himself or herself. Ideally the patient suffers from his emotional problems and, because of pain, is willing to explore his inner life to the fullest in the strong anticipation that his suffering will be relieved through understanding. Liberman reports that, unfortunately, 'the bulk of patients' now come with a weak motivation; namely, they are 'quasi-colleagues' who want to be analysed, at least in large measure, for narcissistic gain or as an education by means of which they can function better in their profession. To change their motivation, such as by demonstrating ways in which they do indeed suffer from their emotional problems, becomes a primary objective of the analysis.

That this is not a hopeless task is implied by two recent studies on training analyses, comparable with but not identical to 'quasicolle