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Meissner reviews the historical context of Strachey's classic paper in which mutative interpretations were proposed as the central vehicle for change in psychoanalysis. He traces the development of crucial theoretical schools since Strachey's paper,
and identifies their major contributions to the current analytic scene. These are: ego psychology with its emphasis on defense mechanisms and the conflict-free sphere; object relations theory with its attention to the "reality" of the objects in the developing infant's world and interest in early preoedipal phases of development; self psychology and its concern for the vicissitudes of narcissism and "selfobject needs"; and developmental theory with its focus on ongoing developmental process throughout life, with special attention to the early separation-individuation process and its effects on later development. With the growth of these schools has come a much more complicated and comprehensive view of the process of change. In spite of this, Strachey's view is still correct. Meissner feels that Strachey anticipated the concepts of transference and therapeutic alliance, and he emphasizes his own view of the importance of the concept of therapeutic alliance in change. Strachey emphasized the process of internalization that must take place for mutative interpretations to be effective. Meissner distinguishes two processes that lead to internalizations. The first includes projection-introjection, which is more closely tied to drive derivative elements related to the transference relationship, and externalization-identifications, which are related to the therapeutic alliance. The second of these processes emphasizes more strongly the give-and-take of the therapeutic alliance, secondary process, and autonomous ego functions. It provides a more stable set of psychic structures. This work follows, builds on, and consolidates the earlier, more primary-process, projection-introjection. Whereas Strachey limited himse