Psychic change: insight or relationship?

The phenomenon of psychic change has been a subject of interest since the beginning of psychoanalysis. The author presents clinical material from a four-year analysis of a 50-year-old man, including a verbatim session, which illuminates two questions raised about psychic change. (1) What criteria may be used to evaluate psychic change and how do those criteria relate to the concept of 'structural change'? (2) Is it insight or the effects of a new object relationship that is most responsible for the changes that a patient is able to achieve? The search for a single mechanism of psychic change is doomed to frustration. But the author argues that insight is crucial to psychoanalytic change, both for its own sake and for its role in maintaining an understanding relationship.