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Werman focuses on the way some writers use changes in psychic structures as a shibboleth to distinguish psychoanalysis from psychotherapy with its more limited "modifications" of derivative aspects of deeper conflicts. He believes the literature regarding change in psychoanalysis can be divided into that which focuses on structural change and that which focuses on observable behavior. For Werman "the idea of structural change based on metapsychological concepts has outlived whatever usefulness it might ever have had." He traces the literature up to 1950, pointing out how frequently change in psychoanalysis was conceptualized in clinical (behavioral) terms, not structural ones. Beginning in 1950, the literature began to be more heavily weighted toward concepts of structural change, in an attempt to distinguish psychoanalysis from psychotherapy but at the price of neglecting the clinical picture. He points to the (inevitable?) awkwardness of structural metaphors and suggests that this very awkwardness interferes with a clear understanding of the clinical behavioral picture. The more recent literature suggests that (1) structural change in psychoanalysis is not as far-reaching or permanent as was once thought, and (2) structural change is possible through psychoanalytically oriented psychotherapy. Werman is very suspicious of any structural change not accompanied by behavioral change. After discarding the concept of structural change, he proposes that what separates psychoanalysis from dynamic psychotherapies is the practical arrangements of the psychoanalytic situation.