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Freud's early faith in the value of catharsis (Breuer and Freud, 1893-1895) as a mechanism of therapeutic change gave way to emphasis on insight and working through (Freud, 1914), processes that require considerable cognitive effort, the achievement of affective conviction, and repeated relearning, reconviction, and testing over time. Though these processes are in the foreground of those through which change is achieved in psychoanalysis, other processes are also present in the background. In this paper I shall deal with some of those background factors. Interestingly, when we turn beyond classical psychoanalytic treatment to work with more seriously ill patients with deficient ego functioning, many of those background factors come into the foreground as instruments of change.
Drawing from a parent-child model, I shall address aspects of the facilitation of development as these apply to issues of therapeutic change. Specifically, the role of identification with and other internalizations from the analyst/therapist is discussed, as is the role of safety (in the therapy and in the parent-child relationship) that permits change or development, respectively, to take place (Sandler, 1960). Since it seems unlikely that developmental processes that have not taken place earlier can always take place in the context of therapy, issues of reversibility of psychopathology, and of critical periods as well, are inevitably raised.