Overall Results—and Their Bases

The discussions in the various chapters of this section can be brought together at this point under an array of sequential propositions regarding the appropriateness, the efficacy, the reach, and the limitations of psychoanalysis (varyingly “classical” and modified) and psychoanalytic psychotherapy or psychotherapies (varyingly expressive and supportive)—always, of course, as discerned within this particular patient population, those (usually sicker) individuals who were brought to or sought out their treatment within this psychoanalytic sanatorium setting.

The first proposition has to do with the distinction so regularly made in the psychodynamic literature between “structural change” and “behavioral change.” Presumably, the interpretive exposure and resolution of unconscious intrapsychic conflicts result in varieties of underlying “structural changes” (or “real changes”) in the ego and in the other psychic entities as well (cf. Bibring, 1937, pp. 171-189), such as the particular changes adduced by S. A. Appelbaum (1977) in specific Patient Variables. On the other hand, “behavioral changes” or changes in “manifest behavior patterns” are (invidiously) considered “just altered techniques of adjustment” and presumably are all that can come out of all other nonexpressive, noninterpretive, non-insight-aiming change mechanisms (i.e., all the varieties of supportive psychotherapeutic techniques and implementations presented throughout this book). Intrinsic to this way of dichotomizing between kinds of change has always been the easy assumption that only “structural change” or “real change,” as brought about through conflict resolution marked by appropriate insight, can have some guarantee of inherent stability, durability, and capacity to weather at least ordinary future environmental vicissitudes. It goes without saving that the commonplace value distinction automatically follows—that change brought