“Insight” As an Aim of Treatment*

I am going to start by giving you an excerpt of a case study and some material: only the “case” is myself, and the “material” is concerned with the different conflicts and stages I went through in struggling with the topic for this Study Weekend.

I began with a most ambivalent feeling; “Aims of Treatment” seemed an almost impossibly vast, vague and difficult subject. Simultaneously I felt that one could not shirk it; we are all engaged in treating children, and we all have ideas as to our aims of treatment. But as soon as I looked beyond the glib formula the difficulties seemed to become almost insurmountable.

I started out by thinking about the aims of Psycho-analysis in general and looked up some literature. The symposium on the “Criteria for the Termination of an Analysis” (1950) contained interesting papers; however the formulation of criteria such as: an ego strong enough to cope with tensions, to tolerate frustration without resorting to defences; or the attainment of firmly established genital primacy; or a sufficient working through of depressive anxiety, a capacity to mourn, were all (as was also stated in the symposium) perfectionist. What was needed, it was pointed out, was a definition as to what would constitute an admissible deviation from these criteria. This tallied with my own feeling, that it was all very well to say what we would like to achieve, under ideal circumstances, but it was perhaps more important to see what we actually achieve, how far these results deviate from some theoretical ideal, yet in a manner which is still satisfactory to both patient and therapist.

I now reflected about the problem of “cure” in our work, and about the concepts of “health” and “normality”. I thought of the fact that we have in practice departed a long way from the concepts of physical medicine: no one would nowadays feel that we can diagnose a well defined “illness” in most of our patients, nor consider the removal of symptoms as our main aim; nor thi