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Nunberg states that the evaluation of analysis as a therapeutic method is difficult because there is 'only one psychotherapeutic method', analysis, and therefore one has nothing with which to compare it. One can, however, scrutinize the changes produced by analysis. Another difficulty is the vagueness and obscurity of definitions of mental health and illness.
The evaluation of analysis as a therapeutic method must take into account the personality of the analyst; some succeed with patients with whom other analysts have failed. One must also consider the influence of the environment. The time required for treatment should not be used as a criterion in evaluation: the diabetic, who needs medical supervision for the rest of his life, is like some patients analysts must treat. When one succeeds in freeing preconscious thoughts from the domination of the primary process, and when intrusions of the unconscious into the ego are again pushed back into the id (repressed), analytic endeavor has been highly successful. Occasionally the patient and his family are satisfied with the therapeutic results but the analyst is not. In such cases one deals with a flight into health, symptomatic improvement without adequate working through. These factors must be borne in mind in evaluating the results of analysis. Only when there has been significant change in reaction of the ego can one look on cure of symptoms as dependable. The therapeutic goal is 'integration of the ego', which is 'essentially synthesis or assimilation of the repressed material'. Repressed material, whether instinct or parts of the ego, is under the domination of the primary process. The therapeutic task has been achieved if the ego is strengthened in extending the influence of the secondary process over such repressed material, if the past is separated from the present, if contradictions are eliminated, if synthesis is effected, if the sense of time and reality play a role where they previously did not.