ABSTRACT
Meissner (1991) wrote, “The nature of change in psychoanalysis and the explanation for the effectiveness of psychoanalytic interventions has been one of the perennial problems in the understanding of the psychoanalytic process” (p. 4). Meissner traced the trend from a strict adherence to the concept of mutative (transference) interpretations (Strachey, 1934) to the current emphasis on relational factors that began with Loewald (1960) and received greater impetus in the postulates of many object relations and self psychology theorists. Modell (1984, 1986) contributed a valuable suggestion of one way to avoid being trapped in the insight versus relationship polarization. He suggested that the content of an interpretation is not mutative in itself. Rather, the implementation of the symbolic actualization of a holding environment provides the basis for the effectiveness of transference interpretations. In addition, the complex nature of therapeutic action was debated by eight analysts (Fischer and Fischer, 1996) with respect to the centrality or balance among three factors: the attainment of insight, the intensity of the emotions evoked, and the interpersonal nature of the experience. Adding to the complexity, the “insight” cited as most relevant varied with the theoretical base: ego psychology, Kleinian, Lacanian, self psychology, Mahlerian, and social constructivist. Fischer and Fischer pose two possibilities to explain the enigma of positive results despite such clinical and theoretical differences. One explanation is “Like a broad spectrum antibiotic, the treatment approaches, though different, would nevertheless have a sufficient spectrum of ‘curative’ qualities to promote growth and therapeutic change.” The second possibility is: “the commonalities of the treatment approaches … would allow the patient to take from the treatment experience that which was most useful for him or to mold the treatment situation to best suit his conflict resolution and/or growth promoting needs” (pp. 309–310).
