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Akeystone of psychoanalytic teaching over the past four or five decades has been the concept that the principal goal and optimal achievement of “successful” psychoanalysis is a change in “psychic structure,” brought about by the “resolution” of the analysand's infantile and childhood neuroses and conflicts. This formulation has characteristically stressed the contrast between structural changes and the more limited goals and achievements of psychoanalytically oriented psychotherapy, wherein only some modification of derivative aspects of the deepest neurotic conflicts is sought, while the “core” conflicts themselves are permitted to remain intact. Even though a patient in psychotherapy may have achieved marked changes in “derivative” behavior, this traditional formulation asserts that the patient is deemed to be vulnerable to subsequent neurotic difficulties.
Most analysts who advance this point of view hasten to add that they do not believe psychoanalytically oriented psychotherapy is an inferior treatment, compared to psychoanalysis, but that it is merely a different form of therapy, usually with different indications, different goals, and, to some extent, different techniques. That psychoanalysis is described as “going deeper,” having a greater prophylactic power, more “enduring,” able to modify the “roots” (core conflicts) of a disorder and not only its “branches” (symptoms, etc.) makes clear that, in point of fact, a hierarchy of