PEP Web - On the Therapeutic Action of Psycho-Analysis

Advances in our understanding of the therapeutic action of psycho-analysis should be based on deeper insight into the psycho-analytic process. By 'psycho-analytic process' I mean the significant interactions between patient and analyst which ultimately lead to structural changes in the patient's personality. Today, after more than fifty years of psycho-analytic investigation and practice, we are in a position to appreciate, if not to understand better, the role which interaction with environment plays in the formation, development, and continued integrity of the psychic apparatus. Psycho-analytic ego-psychology, based on a variety of investigations concerned with ego-development, has given us some tools to deal with the central problem of the relationship between the development of psychic structures and interaction with other psychic structures, and of the connexion between ego-formation and object-relations. If 'structural changes in the patient's personality' means anything, it must mean that we assume that ego-development is resumed in the therapeutic process in psycho-analysis. And this resumption of ego-development is contingent on the relationship with a new object, the analyst. The nature and the effects of this new relationship are under discussion. It should be fruitful to attempt to correlate our understanding of the significance of object-relations for the formation and development of the psychic apparatus with the dynamics of the therapeutic process. A first approach to this task is made here. Problems, however, of more or less established psycho-analytic theory and tradition concerning object-relations, the phenomenon of transference, the relations between instinctual drives and ego, as well as concerning the function of the analyst in the analytic situation, have to be dealt with. I, at any rate, found it unavoidable, for clarification of my own thinking, to diverge repeatedly from the central theme so as to deal with such problems. The paper, therefore, is anything but a systematic presentation of the subject-matter. The four parts of the paper intend to light up the scenery from different angles, in the hope that the central characters will be recognizable although they may scarcely speak themselves. A more systematic approach to the subject would also have to deal extensively with the pertinent literature, a task which I have found impossible to assume at this time. Before I proceed, I wish to make it clear that this is not a paper on psycho-analytic technique. It does not attempt to suggest modifications or variations in technique. Psycho-analytic technique has changed since the beginning of psycho-analysis and is going to continue to change. A better understanding of the therapeutic action of psycho-analysis may lead to changes in technique, but anything such clarification may entail as far as technique is concerned will have to be worked out carefully and is not the topic of this paper.