Insight, Structural Change, and Their Relationship Reconsidered

Central to conceptualizations of the theory of psychoanalytic therapy has always been the idea that properly mutative interpretations leading to insight into hitherto repressed unconscious conflicts constitute the basis of “real” structural change in the personality, and thus are the foundation for stable and enduring amelioration of symptoms and for alterations of attitudes and behaviors in desired directions. It has always been less clear that every component aspect of this formulation has all along been more or less admittedly problematic, both empirically and conceptually, and that the various controversies surrounding each of these issues have not to this point been satisfactorily enough resolved in the crucible of accumulating clinical experience and data-based theorizing.

There is indeed a whole theoretical literature centering around each of these issues. Freud, of course, wrote a good deal in various places about the nature of interpretation, the first issue mentioned; see especially his 1911-1915 series of “Papers on Technique” (Freud, Standard Edition, Vol.  12, pp.  83-173↗). Major controversy was generated by James Strachey's 1934 paper “The Nature of the Therapeutic Action of Psycho-Analysis,” in which he forcefully propounded the concept that the transference interpretation is the only properly mutative interpretation and that all other interpretive endeavor is only useful to the extent that it builds toward the salient transference interpretation. This particular controversy has been given renewed vitality by Gill, with his reiteration in a series of papers (Gill, 1979; Gill & Muslin, 1976, and others since) that the early and continuing vigorous interpretation of the transference in the “here and now” is not only the critically important element, but also an often quite neglected area of analytic work and thus deserving of intensified emphasis. Stone (1981) has responded extensively to these ass