Prologue

The question of change and therapeutic effectiveness is at the heart of the therapeutic enterprise and has played a special role in the development of psychoanalysis and its close relative, psychoanalytic psychotherapy. Arguably, the issue of therapeutic effectiveness influences the present standing of psychoanalysis and psychoanalytic psychotherapy perhaps more than any other that might be raised. It is the sum and substance of the psychoanalytic undertaking.

Freud on various occasions (1913, 1914, 1923b, 1925, 1933, 1940) took pains to emphasize that psychoanalysis was much more than simply a form of treatment. He stressed the value of psychoanalysis as a method of scientific inquiry, as a general psychology of the mind, and as a cultural achievement; in the context of technique, he (1912, 1933) warned against therapeutic zeal. Nonetheless, for many the significance of psychoanalysis has been tied primarily to its therapeutic potential, to its capacity to bring relief to a broad range of emotional disorders, perhaps even to “cure” them.

Psychoanalysis has taken special pride in its power to bring about psychic change, and in fact this has been viewed as a special attribute of analytic therapy in comparison with and in contrast to other therapies. From the beginning, its qualifications as a “depth psychology” have meant that psychoanalysis sought to go deeper than the symptoms and their alleviation, that it sought to deal with the unconscious factors that underlie the neurosis and are responsible for its unfolding. After the advent of the structural theory