Psychic change and its clinical evaluation

The author looks at the question of psychic change from the viewpoint of difficulties involved in this change, starting with a short historical overview. He discusses 'the difficult patient as a specialist in resisting change' and describes the clinical characteristics of such patients over and above their psychopathological diagnoses. Some specific clinical cases are described to clarify the theoretical ideas. The author then covers the nature of changes best studied within the field of transference and countertransference. Finally, he examines change as a process of change and suggests that qualitative differences exist between psychic functions relating to 'traumas' in narcissistic constraints. These differences are apparent in psychic content. The connexions between interpretation, insight, anxiety and change are described. The nature of the negative therapeutic reaction is discussed. The notion of an underlying deficiency in the development of genuine egoistic resources required to bring about psychic change is examined.