Change in Psychoanalytic Treatment*

Psychoanalytic treatment aims not simply at removal of symptoms but at basic characterologic improvement. Although change in psychoanalytic treatment is traditionally attributed primarily to insight, the author asserts that insight, although valuable, is not essential to the achievement of such change. Other elements basic to the therapeutic efficacy of all psychoanalytic techniques regardless of their theoretical orientation are discussed. Among additional factors, the implications of warmth and activity on the part of the analyst, and of setting a termination-date, are specifically elaborated on.

Introduction

What do we mean by change in psychoanalytic treatment? I believe we would all agree that basically one of the things which distinguishes the goal of psychoanalytic treatment from that of most other therapies is that it aims not simply at removal of symptoms but at basic characterologic change. Whether these changes are subsumed under the concept of genitality, as in libido theory, or under such concepts as self-realization or the full development of the self, I believe it is clear that they are concerned with basically similar goals of improving the ego-adaptive capacity of individuals, of helping them to achieve greater emotional maturity, to love unselfishly, to have meaningful and satisfying sexual relationships, to work effectively, and to be socially responsible and productive human beings within the limits of their capacities. Although these are ideal goals, any movement in the direction of these goals is what we mean when we speak of change as a result of psychoanalytic treatment.

Traditionally and historically, change in psychoanalytic treatment has always been ascribed to one of two factors, or a combination of the two: (a) increased cognitive awareness via the insight or the interpretations that the analyst made to the patient; or (b) the release of repressed affect, which Freud called abreaction. Freud linked abreaction to the recall of infanti