You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
I think of therapeutic change in analysis as the result of several interacting factors. The extent to which these operate in any given case varies according to the psychology of the patient, including the degree of flexibility of the patient's mind, the tenacity of the resistances, the extent that certain fixations have taken place, the kind and amount of psychological trauma which the patient has experienced, and the degree of access that the patient has to core memories that contain and express his or her early psychological experiences and the way that these have been created and recreated in the mind. All of the factors that I will mention, however, I believe to be important, and each contributes to the process of therapeutic change.
The first factor concerns the widening of the patient's vision, both about himself, the workings of his mind, and his view of others who have been, and are now, important in his life.
The patient's view of himself and the world he lives in has been limited by the operation of particular defences and particular ways of relating to himself and others that are unconscious and automatic. The result of both interpersonal experience and intrapsychic recreation and elaboration of that experience in the form of unconscious fantasy, these automatic reactions are encased in compromise formations that are lived out continuously as part of what has been termed procedural memory.
For these fixed patterns to change, the patient has first to become aware of them and to gain understanding of how, when, and why they operate. This is accomplished primarily, although not exclusively, through the interpretation of these unconscious patterns as they arise in the immediacy of the transference. The specificity, concreteness and clarity of the here-and-now experience as it relates to the interaction of patient and analyst offers a unique opportunity for the patient to grasp the unconscious patterns that dominate his psychic life statu nascendi;