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Treatment of illness through psychoanalysis and psychotherapy1 is a demanding task. All of us who practice these procedures experience serious demands and frustrations but, interestingly, we also have the sense of engaging in an especially worthy endeavor. What is there about the experience that gives us such a feeling? Surely, we are not merely grandiose professionals who have gathered together to carry out practices that feed our own self-esteem. Nor are we guided by quasireligious or mystical beliefs that we try to impart to our patients. Indeed, many of us feel that we practice without such beliefs or illusions to any large degree, and even pride ourselves on appraising reality well and avoiding excessive value judgments. Yet, most of us do have this sense of something especially worthwhile occurring. Our patients tell us this — often in an exaggerated way — but even after these excesses are analyzed and discounted, the feeling remains. It is the anticipation of experiencing this special worthiness that often carries us through the sometimes wearisome and frustrating hours, days, and years of difficult therapies.
From a broad scientific perspective, there are indeed reasons to insist that treatment of mental and emotional illness goes beyond traditional medical considerations of eradicating external or internal physical insults, or of repairing defects and malfunctions. Life, on an emotional and mental plane, is so complex and so fraught with risk and insult for everyone, that psychotherapy must go beyond simplistically conceived designations of a healing mark. Persons who have suffered from mental and emotional illness need