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Psychoanalysts are impressed by differences between patients in terms of the rate at which psychic change occurs. They are aware that an individual's capacity for change is difficult to predict on the basis of symptoms and history alone. In trying to understand why some patients change relatively quickly whilst others are refractory to treatment, numerous theoretical constructs related to the nature of pathology have been put forward. These include pathological internalized object relations, pathological unconscious fantasy, early trauma, adhesiveness of libidinal fixations, imbalances in defensive structure, ego restrictions, deficits in ego functioning and object relatedness and pathological psychic organizations. The multiplicity of available accounts to explain the variability of the rate of psychic change in itself suggests the need to reexamine the issue. In this paper we wish to complement our developmental psychoanalytic approach with a cognitive perspective in an attempt to understand the problem of the rate and stability of psychic change.
Analytic work with young children gives an opportunity to observe early mental functioning in the process of development and to witness how infantile elements of the child's mental life come to be transformed and integrated. Observations of children's behaviour can be usefully