The Unconscious Fantasy as Therapeutic Agent in Psychoanalytic Treatment

What is the psychological process that brings about change in psychoanalytic treatment? The consensual opinion among psychoanalysts is that the main agent of change is insight with the qualification that the insight must be experienced emotionally as well as cognitively and that it be “worked through.” But as to whether there are other subsidiary agents of change, there is no consensus. Or at least, there is no consensus on whether other processes that can lead to change during psychoanalytic treatment are “legitimate” — i.e., whether they are to be viewed as compatible with the main agent of change and with the psychoanalytic goal of “structural personality change.” Thus, in answering this latter question, many analysts would respond with an emphatic “no,” maintaining that in properly conducted psychoanalytic treatment, insight is the only legitimate agent of change and that if any other process is in evidence, it should be nullified by subjecting it to analysis. Another substantial group, on the other hand, would legitimize at least certain other agents of change as long as they met the criteria of not impeding insight and the realization of structural personality change.

What are these other agents of change that I have been referring to? They include what has been termed “transference gratifications” (Freud, 1915), internalizing the analyst as “auxiliary superego” (Strachey, 1934), “identification with the analyst” (Sterba, 1934),