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In 1980, Frank Lachmann and Bob Stolorow wrote a book entitled Psychoanalysis of Developmental Arrests (Stolorow and Lachmann, 1980). They described how psychoanalysis is changing from the treatment of classical psychoneurosis to the treatment of severe disorders caused by developmental voids, deficits, and arrests. I think there is a general consensus that psychoanalysis has gone through a major change in the last 30 years since that book was published and as a reminder, Kohut’s (1971) The Analysis of the Self is less than 40 years old. Thanks to those two authors, and to the many others who have brought to us in the recent past, new ideas for our practice: among others motivational systems theory, the relevance of infant research in our treatment of adults, attachment research, theories of mentalization, theory of the mind and affects, neural biology, relational theory, intersubjectivity theory, specificity theory and non linear systems theory, we are more able to treat such patients described by Stolorow and Lachmann.
I might have been able to treat Mrs. E, had I seen her thirty years ago, but I am truly indebted to the many theoreticians who have changed the scope of psychoanalytic technique and treatment.
Kohut’s last book, published in 1984, three years after his death and completed by Arnold Goldberg and Paul Stepanky, was entitled How Does Analysis Cure. It is a question that is extremely difficult to answer; in fact, Philip Reiff wrote that “psychoanalysis does not cure, it merely reconciles” (1959, p. 13). I am sure every psychoanalyst has had that question raised by some patient, at the beginning of treatment or during the analytic process. At times, I even ask myself, “How will I ever help to cure this patient? He or she really needs help.” There are so many things that are taking place in the clinical exchange, either explicitly or implicitly, that we can never give an adequate answer to that question. Why some patients with severe def