Analytic Cures

There is an abundant theoretical literature in psychoanalysis concerning the criteria for cure and for termination, as well as the goals of psychoanalysis against which its actual reach and limitations need to be assessed. I have in two previous publications from PRP discussed the conceptual dilemmas that make it very difficult to deal straightforwardly and definitively with these questions in a manner at all comparable to the (presumed) greater precision that operates in the realm of physical illness and its treatment. In a paper on “The Problem of the Assessment of Change in Psychotherapy” (Wallerstein, 1963), I indicated that posing the question of effectiveness of treatment (in reaching its goals, in “curing”) implied at least tacit agreement that there exist reasonably accepted criteria of three kinds: “(1) criteria of illness—specifications of the degree and kind of deviations that merit the designation, pathological; (2) criteria of a state of ideal mental health (called ‘positive mental health’ in the current literature (Jahoda, 1958) and (3) measures of improvement as the degree to which the patient has diminished the gap between his state of mental illness prior to treatment and these desiderata of mental health” (p. 31). I then said that of the three, we only actually possess the first—criteria of illness—and that these constitute, of course, the whole body of knowledge of psychopathology and psychodynamics. I then tried to elaborate the conceptual complexity involved in trying to define criteria of optimal mental health and measures of improvement, including the central role of value judgments in hobbling the effort to give empirical psychological meaning to these criteria and these measures.

In a subsequent paper from PRP, written for a panel discussion on the limitations of psychoanalysis (Wallerstein, 1965), I tried further to outline the ideal and the practical goals of psychoanalytic treatment agai