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Raphling, D.L. (2002). Psychic Change in Analysis: Its Relation to Analyst's and Patient's Goals. J. Amer. Psychoanal. Assn., 50(3):765-777.
    

(2002). Journal of the American Psychoanalytic Association, 50(3):765-777

Psychic Change in Analysis: Its Relation to Analyst's and Patient's Goals

David L. Raphling

Patient (after two years of analysis): I think I'm done.

Analyst: You're only half done. We need to turn you over and do the other side.

In the minds of both analyst and patient, analytic progress carries with it a notion of an ultimate outcome. As the highly personal investments of analyst and patient in their preferred analytic goals solidify, the similarities and differences between their goals become more apparent. Their individual aims for analytic cure can be a source of strain, so that patients may become reluctant to assume responsibility for their own goals and attribute them instead to the analyst. The actual expectations and influence of analysts, as well as the expectations and influence attributed to them by patients, have the beneficial effect of reinforcing psychic change. A patient's identification with the analyst's goals may be a defense against the dangers of self-determination. Although this must ultimately be analyzed, it may be temporarily accepted by both parties as part of an adaptive, incremental process of psychic transformation.

From the very beginning of an analysis, through the decision to terminate, and to the end of the last hour, an analyst offers a patient both understanding and direction through consistent lines of interpretation of pathogenic conflicts. Whatever their content, analytic interventions convey expectations of the patient, which eventually include the goals for the analysis that the analyst deems appropriate.

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