What Brings About Change in Psychoanalytic Treatment?

Two general points of view have developed regarding what brings about change in psychoanalytic treatment. One approach emphasizes interpretation, especially of the transference, and historical or narrative reconstruction. The other approach emphasizes the experiential and transactional aspects of a new and better human relationship. In this article I will briefly discuss various current conceptualizations that illustrate this difference in emphasis and suggest how both interpretive and interpersonal factors work together to produce change in psychoanalytic treatment. Then I wish to concentrate on what I regard as the bedrock of the psychoanalytic process, the uncovering of the patient's unique, individualized core preoedi-pal fantasies that undergo subsequent elaboration and repression during the oedipal period, and the analysis of these fantasies as representing compromise formations arising out of early preoedipal and oedipal infantile conflicts.

I will not discuss in detail the current controversies about the exact nature and metapsychological status of these early fantasy formations, as this has been recently covered in a series of articles (Abend, 1990, Dowling, 1990, Inderbitziw and Levy, 1990, Shane and Shane, 1990, Shapiro, 1990, Trosman, 1990). Suffice it to say that behind the fixed and organized repressed unconscious fantasies is what Dowling (1990) calls “the blurred, undifferentiated precon-ceptual thought of early oedipal and preoedipal life” that perhaps includes “sensorimotor or behavioral memories, which arise primarily from preverbal experience and remain influential throughout childhood and adult life” (p. 109). Indeed, sometimes the first clue to such fantasies appears in the patient's behavior rather than in his or her verbalization during the analytic process. These fantasies