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This paper was first given as a public lecture of the British Psycho-Analytical Society in November 1986, and is here published for the first time.
There is some ambiguity about our use of the term ‘psychic change’. We sometimes use it to mean any kind of change in the mental state or functioning of our patients; sometimes we use it to mean a more long-term, durable, and desirable kind of change. In this chapter I want to consider both uses of the term and their interrelationship.
One of the main points that I want to make here is that psychic change is not just an end, a final state, but is always going on in treatment and that we as analysts need to be able to find and follow the moment-to-moment changes in our patients, without concerning ourselves as to whether they are positive, or signs of progress or of retreat, but seeing them as our patient's own individual method of dealing with his anxieties and relationships in his own unique way. Otherwise we cannot hope to help our patients to achieve real, long-term, positive psychic change as a result of treatment. If we get caught up in preoccupations about whether the shifts show progress or not, looking for evidence to support this, we may become enthusiastic for what we feel to be progress or disappointed when there is apparent regression; we shall find that we get thrown off course and unable to listen fully; or we may well bring unconscious pressure on our patients to fit in, to comply with our felt wishes, our needs; or our patients may just feel misunderstood.
Indeed, our capacity to listen fully and stay with our patients must help them increasingly to be able to observe, tolerate, and understand their own habitual ways of dealing with anxiety and relationships, and this is part of the process of changing these habitual ways and becoming what we could call psychically ‘more healthy’. However, although we need, I am suggesting, to be able to stay with and to follow our patient's own
ways of dealing with his p