Insight, Empathy, and Internalization: Elements of Clinical Change (Glucksman, 1993)

“Insight, Empathy, and Internalization: Elements of Clinical Change” explores the major factors involved in facilitating change during the therapeutic process. It begins with a review of the goals of psychoanalytic treatment, including: symptom reduction, affective regulation, resolution of intrapsychic conflict and irrational beliefs, improved self-integration, modification of pathological defenses, and more realistic perceptions of the analyst and others, as well as greater conscious awareness of unconscious processes. These intrapsychic changes are expected to result in ego stability, improved interpersonal relationships, and the ability to maintain long-term trusting, intimate, and even loving relationships with significant others. Two major areas of the therapeutic process are identified that contribute to clinical change: (1) insight or understanding, that is, knowledge of irrational impulses, fears, beliefs, and maladaptive defenses; and (2) the therapeutic relationship, that is, the quality and nature of interactions between the analyst and patient. Insight, usually through interpretations of conscious and unconscious mentation, provides the patient with an awareness of how or why symptoms, fantasies, perceptions, feelings, and behavior are determined. The therapeutic relationship consists of two components: (1) transference, and (2) the “real relationship.”

Transference is defined as the projection of former or “old” object relationships onto the analyst. The “real relationship” is the undistorted, realistic, genuine part of the therapeutic relationship. In clinical practice, it is often difficult to distinguish transferential from nontransferential aspects of the therapeutic relationship. For those patients, in particular, who have suffered from emotional and physical traumas to the self (e.g., negative attachment experience), internalization of reparative interactions with the analyst promotes healing and growth