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The fundamental goal of all psychotherapies is the promotion of clinical change. However, the criteria for improvement or cure vary considerably, and range from symptom removal to alterations of personality structure. Psychoanalysts do not speak in terms of “cure,” but rather focus on changes in specific parameters, including: symptom reduction, affective regulation, resolution of intrapsychic conflict, improved self-integration, modifications of pathological defenses, more realistic perceptions of the analyst and others, as well as greater conscious awareness of unconscious processes—“where id was, there ego shall be” (Freud, 1933, p. 80). These intrapsychic changes are expected to result in interpersonal ones as well: the capacity for more trusting, self-revealing, emotionally spontaneous relationships, and the ability to maintain long-term, intimate, loving relationships with important others. Moreover, we anticipate that these intrapsychic and interpersonal changes will continue to be maintained long after treatment is formally terminated.
By and large, two major areas have been identified that contribute to clinical change. These include: (1) insight or understanding; that is, the acquisition of knowledge or some type of rationale that helps the patient explain his or her symptoms or problems; (2) the therapeutic relationship; that is, the quality and nature of the interaction between patient and therapist. Historically, the development of insight has been regarded as the primary factor in promoting change.
Freud (1917a) stated that “By means of the work of interpretation, which transforms what is unconscious into what is conscious, the ego is enlarged” (p. 455). His emphasis on interpretation and the achievement of insight remained the centerpiece of psychoanalytic treatment, notwithstanding the evolution of his metapsychological theories. Strachey (1934) elaborated on the curative role of mutative interpretation, defining it as that type of interpretation which