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Psychoanalysts have recently become more concerned with specifying what we have to offer that is distinct and valuable in the treatment of mental illness. In doing so we are inspecting our data and the relation between data and theory more carefully, and resorting less to authority or charisma as the final arbiter of correct procedure. The present panel is a contribution to this trend.
There are two questions we were asked to address on this panel: (1) What is it that changes in the course of what we would regard as a successful analysis? (2) What are the essential aspects of the treatment that are conducive to such change?
The change that interests us occurs in the mind of the patient. Those aspects of the patient's mental functioning that produce in the patient a feeling of being ill are to be altered in a way such that the feeling of illness no longer exists. In addition, those aspects of the patient's functioning that are not at the outset experienced by the patient as illness but that are nevertheless pathological—meaning, essentially, maladaptive—are, so far as possible, to be brought into the focus of the treatment (to the extent the maladaptive behaviors become a concern to the patient) and then into the process of change.
What changes in the course of a successful analysis? The theories of causation that have been developed in psychoanalysis, and on which the treatment procedure is based, are theories of the mind. Mind is a function of the brain (Brenner, 1982; Reiser, 1984). We can study the structure of the brain or study its function at a number