Changes

The [[psychic ]] changes observable during [[psychoanalytic ]] [[treatment ]] involve two distinct [[processes]]. First, the therapeutic [[process ]] applies to [[symptoms]], [[personality ]] traits, and behaviors amenable to transformation. Second, the psychoanalytic process applies to how the [[experience ]] created by the [[analytic ]] setting and the rules of [[technique ]] is lived out. The articulation of these two processes defines the question of change in [[psychoanalysis]].

Without ever acquiring a specific [[conceptual ]] status, the [[idea ]] of change has been the focus of continual questioning since the beginning of psychoanalysis. As pointed out by Daniel Widlöcher (1970), it is easily traced in Sigmund [[Freud]]'s [[work]]. As early as their preliminary [[communication ]] of 1893, which served to introduce their Studies on [[Hysteria ]] (1895d), Freud and [[Breuer ]] established both the modus operandi of the cathartic treatment of hysteria and the idea that the [[mechanism ]] of treating the [[symptom ]] is the reverse of the mechanism of its [[formation]]. The [[recollection ]] of an [[event ]] and its [[affective ]] charge spark a process that reverses the pathogenic process brought [[about ]] by [[repression]]. From that point on and indeed throughout the rest of his work, Freud drew on his observation of [[resistances ]] to change to modify, deepen, and refine his [[model ]] of change. [[Three ]] moments mark the beginnings of psychoanalysis: the [[development ]] of the rules of technique, the shift in focus from [[trauma ]] [[theory ]] to the [[role ]] of [[fantasy]], and the introduction of the [[concept ]] of change in the [[form ]] of [[libidinal ]] development. Here we have an indication of the importance of a model of change to psychoanalysis.

Freud's discovery of the extent and importance of the [[transference ]] between 1904 and 1910 introduced a new model of change, which is particularly well explained in his Introductory Lectures on [[Psycho]]-[[Analysis ]] (1916-1917a [1915-1917]). Transference affects the processes of change in several ways. It is an obstacle used by [[resistance]], and it hinders the processes of [[association ]] and [[remembering ]] by encouraging [[repetition ]] through [[acting out]]. But it is also a lever for therapeutic transformation, because the [[patient ]] cathects with the therapist and this reveals features of [[past ]] attachments and conflicts. Above all, repetition in the transference leads the patient to externalize a conflicted intrapsychic [[structure ]] and displace it onto the [[relationship ]] with the [[analyst]]. This is the origin of the [[tripartite ]] therapeutic model of [[clinical ]] [[neurosis]], transference neurosis, and [[infantile ]] neurosis.

Beginning in the 1920s, growing doubts about the therapeutic effectiveness of psychoanalysis led Freud to make two basic [[theoretical ]] revisions. First, he introduced the [[dualism ]] of the [[life ]] and [[death ]] [[instincts ]] to account for the force of the [[compulsion ]] for repetition as compared with the inertia of libidinal-[[object ]] [[choice]]. The second revision was based on a more diversified analysis of the processes of resistance to change, which allowed Freud, in "Inhibitions, Symptoms, and [[Anxiety]]" (1926d [1925]), to differentiate the resistances of the id, the ego, and the superego—a [[distinction ]] made possible by the new [[structural ]] model but also strengthened the clinical effectiveness of treatment. On this basis Freud constructed a [[third ]] model, which he formulated in a binary manner: "Where id was, there ego shall be," he wrote in "New [[Introductory Lectures on Psycho-Analysis]]" (1933a [1932], p. 80). In "[[Analysis Terminable and Interminable]]" (1937c), Freud offered a more modest version of this formulation, evoking a kind of to-and-fro between ego analysis and id analysis. He was also careful to [[recall ]] the bases of resistance to change (libidinal viscosity, the [[repetition compulsion]], and also [[penis ]] [[envy ]] in [[women ]] and [[masculine ]] protest in men).

Throughout his work, in fact, Freud emphasized the study of resistances. In "Analysis Terminable and Interminable" (1937c), he emphasized, "Instead of an enquiry into how a cure by analysis comes about (a matter which I [[think ]] has been sufficiently elucidated) the question should be asked of what are the obstacles that stand in the way of such a cure" (p. 221).

Have developments in psychoanalytic [[thinking ]] since Freud followed through on this recommendation? Probably in part, even though the various theories have focused chiefly on their respective models of change. The development of many different [[schools ]] of [[thought ]] after Freud owes a great deal to modifications of technique (though only in close association with the work of [[interpretation]]) and, in the final analysis, to theoretical approaches that seek to specify the articulations between a pathological model, a [[developmental ]] model, and a model of change through treatment. Yet all schools of psychoanalysis have based themselves on theoretical and clinical elements already [[present ]] in Freud's work. Rather than an expression of allegiance, this is a consequence of the fact that Freud's theory of change (and the different models successively added to it) covers a very [[complex ]] [[reality]], of which the various schools have tried to specify a [[particular ]] portion.

It is worth drawing out a few main themes of these schools, though without reviewing the technical and theoretical frameworks of each (which are rarely presented in connection with the processes of change and resistance to change). The first theme concerns the [[psychoanalyst]]'s involvement in the process of change. The idea of a neutral therapist, whose "noninvolvement" ensures the necessary capacity for [[listening ]] and interpretation, has given way to an ever narrower focus on the analyst's [[mental ]] efforts and role in change. This trend, already well underway in Sándor Ferenczi's innovations in technique, is evident in studies of the role of [[counter-transference ]] by Paula Meimann and Heinrich Racker, and is currently [[being ]] developed around the [[concepts ]] of interaction, [[empathy ]] (Ralph Greenson, Heinz Kohut), and "co-thinking" (Widlöcher).

Rather different from the foregoing is the [[narrative ]] or constructivist tendency. This trend includes the otherwise varied approaches of Jacques [[Lacan]], Roy Schafer, and Serge Viderman, all of whom in their respective ways emphasized how the work of interpretation is constructive.

[[Another ]] theme is the mechanisms of externalization and [[internalization]]. Authors here have returned to the model of transference neurosis to show how pathological [[structures ]] are [[displaced ]] in the therapeutic relationship. Often abandoning the classical model of neurosis, these authors (including Melanie [[Klein ]] and her students, as well as [[object-relations ]] theorists) describe more archaic processes that become amenable to analysis once they are externalized in the transference.

A third approach stresses the reparative function of the process of change. Change is expected to [[affect ]] choices of libidinal [[objects]]. This trend develops the [[Freudian ]] idea of the "revision of the process" by placing considerable emphasis on the emotions and the psychoanalyst's containing function. Such authors as Michael [[Balint]], Donald [[Winnicott]], and Wilfred R. Bion, very different in [[other ]] respects, belong to this trend.

Other dimensions of change could, of course, be taken into consideration. The most important [[thing]], perhaps, is to [[identify ]] the reasons for the various divergences on the [[nature ]] of [[psychic change ]] and their impact on the [[activity ]] and [[future ]] development of the institutions of psychoanalysis. The problem is less one of justifying the [[existence ]] of several models (which, as noted earlier, has to do with the complexity of the processes involved) than of explaining the reasons for theoretical choices. Clearly, the extension of [[psychoanalytic treatment ]] to a broader range of cases and the application of psychoanalysis to serious pathologies have had a decisive impact on evolving [[ideas ]] about change. Will this trend toward disparate models of psychic change continue? If not, what other trend will supplant it? What role will planned research studies, which tend to objectify certain data, play at a [[time ]] when [[psychoanalysts ]] are increasingly being held accountable for treatment choices, their effectiveness, and their cost?

# [[Freud, Sigmund]]. (1916-1917a [1915-1917]). Introductory lectures on psycho-analysis. SE, 15-16.

# ——, & Breuer, Josef. (1893a). On the [[psychical ]] mechanism of [[hysterical ]] phenomina: Preliminary communication. SE, 2: 1-17.