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It is possible to formulate with fair clarity clinical criteria of significant psychological change; but the technical problems of how to develop precise qualitative or quantitative tests for this have never been faced and consequently have never been solved. My hope in this paper is only to confront myself and my readers with some of the questions that must first be considered in any approach to these difficult issues.
Throughout life, human mental processes continue in sleep as they do in the waking state. This is one among the reasons why we must conclude that one is never wholly asleep nor wholly awake; that these states are bands along a continuous spectrum. Furthermore, everywhere along this spectrum there is an incessant input, of which only a small fraction is consciously perceived, much of it entering the central stream without conscious images or sensory awareness, i.e., as a preconscious process. There it is stored, registered, ordered, compared, coded, etc., until, out of widening ripples of central disturbances, there comes an equally continuous but variable and also largely preconscious output, emotionally colored in changing and sometimes alternating hues.
What is usually spoken of as “consciousness” is actually this continuous process of gathering fragmentary and weighted samples of this central activity and representing them by means of sensory afterimages and their projections, along with the verbal, paralinguistic, and somatic symbols and related effects. In an incessant inner activity of this kind, what constitutes significant change, change that is more than ripples and waves in the recurrent ebb and flow of activity? What changes? And what constitutes enduring change? These are basic questions. Furthermore, since most of our mental activities take place on neither a conscious nor an unconscious level, but preconsciously, the difficult technical challenge for the future is to develop methods by which preconscious processing and its cha