Meeting of the Psychoanalytic Association of New York

January 9, 1989. SOME ASPECTS OF PSYCHIC CHANGE. Betty Joseph.

Psychic change is an ambiguous term sometimes used to mean "any kind of change in the mental state or functioning of our patients"; at other times it connotes a "more long-term durable and desirable kind of change." Both uses of the term and their relationship to each other were discussed by Miss Joseph. She began by asserting that psychic change is not just a long-term objective in analysis but also an ongoing process which takes place between, as well as within, individual sessions. She warned against viewing these "moment to moment" changes as evidence of progress or retreat, emphasizing instead that the analyst's task is to understand them as the patient's unique "method of dealing with anxieties and relationships." Being concerned with whether the shifts are positive or negative interferes with our ability to listen fully. It may bring unconscious pressure on our patients to comply with our felt wishes, or it may result in the patient's feeling misunderstood. At the same time, of course, every analyst has, at the back of her or his mind, and theories about long-term treatment objectives—Miss Joseph's second meaning of the term, psychic change. Patients come to analysis with the conscious desire for change, without which analysis would certainly fail. Yet patients simultaneously and unconsciously "dread" changes in their "established mental and emotional equilibrium." This equilibrium, or balance, is maintained by tightly interlocking elements, and shifts in one area must cause disturbances in another. Patients do sense this, and so unconsciously feel the whole process of analysis as threatening. Moment to moment shifts in the psychic balance are the stuff of the analytic process, re-experienced and explored within the transference, and one hopes that they will lead to long-term positive psychic change.