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Zetzel, E.R. (1965). The Theory of Therapy in Relation to a Developmental Model of the Psychic Apparatus. Int. J. Psycho-Anal., 46:39-52.

(1965). International Journal of Psycho-Analysis, 46:39-52

The Theory of Therapy in Relation to a Developmental Model of the Psychic Apparatus

Elizabeth R. Zetzel

SUMMARY

I will reiterate my earlier statements regarding the significance of intrapsychic conflict and its resolution in respect of the theory of the psycho-analytic process. Psycho-analytic treatment presents many analogies to the early developmental process which may be summarized very briefly. First, successful development in the later stages of infancy is contingent on the earlier establishment of good object relationships which must be maintained throughout. In parallel, successful emergence and resolution of the transference neurosis in clinical psycho-analysis is contingent on the establishment and maintenance of the therapeutic alliance at all times. The qualities, moreover, in the analyst which best foster the therapeutic alliance correspond in many ways to those intuitive responses in the mother which lead to successful early ego development in the baby. Second, psychic development implies at all stages both progressive and regressive manifestations. Regression is thus an inevitable concomitant of forward progressive movement. Such regression can only lead to mastery and added adaptation if basic functions of the ego are maintained. This applies to the infantile neurosis, adolescence, and other developmental crises. It is central to the developmental implications of controlled regression during the analytic process.

Finally, just as healthy development through childhood and adolescence leads to independence, maturity, and significant autonomy in the young adult, so too satisfactory termination of a successful analysis also implies autonomy and independence. Both demand a process of separation which includes components of grief and mourning, leading to the reintegration of successful, stable ego identifications. Neither maturity nor successful analysis, however, are to be regarded as absolute achievements. A crucial capacity for both includes the acceptance of realistic limitations, the renunciation of omnipotent fantasies, and the ability to seek help or support when needed. In this sense, no psycho-analysis should be regarded as conclusively terminated, however successful its outcome may be.

I have attempted in this paper to combine a longstanding interest in affect and its tolerance (1949), (1965) with an implicit theory of object relations which I believe may facilitate developmental differentiation between certain ego functions. I have thus tried to narrow the gap between Hartmann's concept of secondary autonomy of the ego and theories emphasizing early object relations by a developmental model which attributes major ego functions to their initiation in the early mother-child relationship. I have also tried to indicate in this model differentiation within the analytic situation between different forms of regression in terms of the developmental origin of the ego functions involved. In conclusion, to quote Hartmann, 'I do not think that the necessity not only to enrich our clinical experience, but also to develop the body of hypotheses we use in dealing with it, is less obvious today than it was in Freud's time.'

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