Each one of us involved in psychoanalytic treatment has asked, and must continue to ask the question: What leads to basic change in psychoanalytic therapy? I recall Dr. Horney lecturing in psychoanalytic technique, and saying: “When we know what does what, how, then I could write the book on technique that I have been trying to write for years.” My hope is that each of our speakers will illuminate some aspects of what does what, how and that they will comment on what they define as “basic” and how they evaluate “change.” I hope they also will say something about their theories of human behavior and motivation upon which their theories of treatment are then based, for it is the philosophical and theoretical frame of reference that serves as the personal guide to action and influences procedures in treatment.

There are many questions to be considered. What is the significance of the doctor–patient relationship? Must it be analyzed and worked through in the therapeutic transference neurosis as Freud postulated? Or, going to the other end of the spectrum, should, as Carl Rodgers suggests, the relationship between doctor and patient be ignored? What kind of therapeutic climate should the therapist provide? Should he be a blank screen, a warm and accepting person whose chief function is the supporting of constructive strivings, or a “participant–observer”? Should the therapist come from the same socio-economic background, have the same values, speak the same language?

How effective and necessary is the development of insight by the recall, understanding and emotional reliving of childhood memories? What emphasis and weight should be given to the interpretation of dreams? How do we help a patient work through a problem to achieve emotional insight?

What about the decreasing of the alienating process that reveals itself in, to quote Horney, “the remoteness of a neurotic from his own feelings, wishes, beliefs and energies?” How important is it to help the patient experience, to quote Kelman, “his wholeness, his whatness, and thereby, his howness, here and now, from moment to moment, while we therapists are doing likewise with reference to ourselves. The multitudinous whats in the moment, implicit and explicit, describable and inferred, constitute the how, and extended in time are the pattern and the poetry of living” (Kelman, 1956, p. 4).

I can ask many more questions. What about the assumption of constructive energies in man? What leads to greater tolerance for anxiety and the increasing ability of the individual to confront the source of the anxiety and deal with it, rather than continuing with compulsive solutions? And, as you well know, this is only a partial listing.

To me, basic change implies a major shifting in the direction of how the person is evolving. However, shift may be from one sick way of being to another that may or may not be more socially acceptable. My long-range goal is the shifting of the patient’s energies from the maintenance of a compulsive constricting existing, toward the direction of freely choosing, expanding, creating patterns of living. Our direction is in helping a person toward becoming a whole personality, toward resolving his acquired inner conflicts, toward the greater experiencing and accepting of the entirety of himself. He will be freer to accept or reject various values he finds in his culture. He will be more capable of actualizing, in loving, his capacity for self-fulfillment. He will be more able to acquire satisfactions in working independently and on his own initiative in an environment, which, at times, will inevitably frustrate him and threaten his strivings toward self-realization.

What leads more efficiently and effectively to this changing will be clearer, I am sure, after tonight’s discussion.