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Viewing development during adulthood as a universal human potential and embracing a previously enunciated process model of development, this paper outlines criteria, conditions, kinds, and ways of adult development. The focus is on development in the therapeutic relationship. It is proposed that both therapeutic and developmental processes take place in the interaction between patient and analyst, and that these processes be regarded as separate but complementary. As the analysis proceeds, therapeutic process undoes an aspect of pathology and opens up the pathology-closed area of the mental system to development. With the analyst as the developmental object, development can then take place in the involved area. Along with therapeutic process, such development
Dr. Settlage is a training and supervising analyst in adult and child analysis at the San Francisco Psychoanalytic Institute and a Clinical Professor of Psychiatry at the University of California, San Francisco.
This paper was presented as the Second Annual Lecture in honor of Earl J. Simburg, M.D., Alta Bates-Herrick Hospital, Berkeley, California, April 11, 1991.
I am indebted to the members of the Study Group on Adult Development (Settlage, Curtis, Lozoff, Lozoff, Silberschatz, and Simburg, 1988) at the San Francisco Psychoanalytic Institute for their contributions to this paper.
contributes to the revision of the patient's psychic structure. The improved structure in turn enables an increased ability to confront unconscious conflict and tolerate the threatening feelings associated with the transference reenactment of the childhood past. The paper delineates elements and implications of the developmental stance assumed by an analyst who is persuaded of the validity and importance of development in the analytic relationship. The presented concepts are illustrated by case vignettes of three patients in early, middle, and late adulthood, respectively.