What is meant by the term “basic change”? It is difficult to know precisely. “Change” is clear enough in its meaning with reference to what may happen to the personality as a result of psychoanalytic therapy. “Basic” adds to this a quantitative concept and refers to how much or what degree of change. It might be fairly easy to determine whether personality change has occurred in any given case in which psychoanalytic therapy has been terminated, but it might not be easy to reach agreement upon the quantitative aspect of this. Since it would be difficult to reach a consensus on what is meant by “basic change,” perhaps it would be more profitable to avoid the attempt to define the term “basic” and instead devote our efforts toward determining what in psychoanalytic therapy leads to “change.”

In May 1960, 1 read a paper on this topic before the Academy of Psychoanalysis. The broad conclusion of that paper (subsequently published in Volume IV of Science and Psychoanalysis) was that personality change occurs in psychoanalytic therapy as a result of two factors: (1) the production of insight; (2) the life experience which evolves from the impact of the personality of the patient with that of the therapist.

The production of insight may best be understood with reference to the concept of what neurotic illness is and how it occurs. In the paper referred to, the view presented of the genesis and nature of neurotic illness was that constitutional factors (i.e., heredity), may well play a role in this, but our knowledge of these at present is so sparse and nebulous that we are constrained to concentrate our thinking upon environmental factors and their effects upon the development of personality.

Traumatic experiences of the child-mainly before the ages of 5, 6, or 7—are apt to lead to speculation by the child as to why they have occurred. Such speculative conclusions, while at first conscious and held merely tentatively, may as time goes on become unconscious for a variety of reasons and be maintained with feelings of greater certainty. Their further existence occurs in the form of unconscious assumptions or convictions about the nature of the child himself, of others, and of the relationships existing between himself and others. From this position of unconscious certainty, such convictions govern the attitudes and behavior of the child in later childhood and in adult life.

For example, the child may perceive that a younger sibling has displaced him at the mother’s breast, may feel envy of the sibling and, in trying to understand this, may conclude that the mother loves the sibling more than himself. He may further speculate that the mother is fickle and inconstant or that the fault lies in himself—that he has some intrinsic quality or that he has behaved in some way which causes the mother to reject him in favor of the younger sibling. These different speculations may occupy the child’s attention intermittently or one of them may be ultimately preferred over the others. In any case, these speculations and the situation giving rise to them soon become repressed and unconscious because of the pain and suffering which clear memory of them might cause the child to feel. Such unconsciously held convictions as are referred to in the above example might take the form, in adult life, of strong mistrust of women (“like mother, all women are fickle and inconstant toward me”) or of strong and persistent feelings of inadequacy and inferiority.

It is an important part of psychoanalytic therapy to uncover the existence of such unconsciously held convictions; to make clear when and under what circumstances they were arrived at; and to help the patient see how they have affected and still affect his view of himself, of others, and of his relationships with others. In performing these tasks the various technical devices of psychoanalytic therapy will be utilized: interpretation in general and of dreams and fantasies in particular; detecting transference manifestations and interpreting them; detecting and handling resistance.

The various aspects of the production of insight can be taught and learned, and they constitute the major part of the content of courses in psychoanalytic training. It is also to be noted that this aspect of psychoanalytic therapy is highly verbal—much talking occurs, both on the part of the patient and the therapist.

The other factor involved in personality change—what one might call the “life experience” factor—cannot so readily be taught or learned, and it is so little dependent upon verbalization that it might be termed the “silent” aspect of psychoanalysis. One inevitably recalls Harry Stack Sullivan’s view of the psychoanalyst’s role as “participant observer.” My own view of this goes somewhat farther. The patient is apt to regard the therapist as a helper, a teacher, a parental figure. Above all, if the therapy is to be fruitful for the patient, the therapist has to be someone whom the patient trusts. The therapist cannot bring this about by verbal communication. This impact of personality upon personality, resulting in trust of one by the other, either takes place or it does not. It may have something to do with the degree of stability which the analyst has achieved; or with the therapist’s respect for his patient as a person and his faith in the patient’s genuine motivation in seeking therapy; or with the genuineness of the analyst’s concern for the patient’s ultimate welfare. In any case, it relates to those qualities that make it possible for one person to influence another.

As I have said, this factor in psychoanalytic therapy is for the most part silent. However, situations may arise in which it becomes necessary to discuss the factor of trust. I tried to deal with this in a paper published in 1955 under the title “Acting Out versus Insight (Silverberg, 1955).” The clinical material demonstrated that the patient considered my attempts to produce insight for him as a means of coercing him in a disciplinary fashion. Such a situation called for discussion of what the patient regarded as the analyst’s role and involved the matter of to what extent the patient trusted the analyst’s good will toward him.

Can we, at this point, say anything pertinent about what leads to personality change in psychoanalytic therapy? It would seem that insight alone cannot produce this result, nor can the patient’s trust in the analyst, no matter how great. It seems, rather, that the two factors have to work hand in hand, the trustworthiness of the therapist serving to confirm sufficiently the new insight, to enable the patient to act upon it in the sense of being able to deal in new ways with old situations so that he need no longer be handicapped by the anxiety aroused by the lifelong assumptions and convictions hitherto unconsciously believed to be true. In other words, he learns that these convictions are not necessarily true and that it is usually safe to ignore them. The better the outcome of such novel behavior, the more the trust in the analyst becomes confirmed.

This was the conclusion of the paper “An Experiential Theory of the Process of Psychoanalytic Therapy,” (Silverberg, 1960), which I referred to above. In a recent discussion with a colleague, it seemed to me that in considering how change in personality occurs as a result of psychoanalytic therapy there may be a factor implied but hardly ever mentioned by psychoanalysts, namely, the exercise of will power by the patient. It is a curious fact that the term “will power” appears rarely in psychoanalytic writings and, when it is referred to among psychoanalysts, usually has a flavor of ridicule, as if it were a vestigial term that was meaningful to those who lived a century or so ago, but is no longer a part of the vocabulary of this century. A reference to will power may crop up in the discussion of a patient and his shortcomings by the patient’s family or non-psychoanalytic physician. When the term does come into such discussions the psychoanalysts, as a rule, counter it by saying “If the patient could deal with his situation by will power, he would have done it long ago,” or words to that effect. The implication is either that will power is non-existent or insignificant insofar as it has any effect at all.

With this attitude, it is not surprising that there is no psychoanalytic definition of the term. As it is used, it might be defined as “the capacity to perform an act by means of exerting strength to persist against obstacles.” I think it necessary to point out that the concept of will power as herein defined indicates that it bears a close relationship to the concept of effective aggression which was first mentioned by me in a paper (Silverberg, 1944) in which I pointed out that this was essentially a quantitative concept related to the degree of success accompanying activities directed either toward defense or toward achievement. The question might be raised as to whether will power and effective aggression are equivalent or merely related concepts. In any case, it seems to me that a factor of this general nature may be of considerable importance in the process of personality change resulting from psychoanalytic therapy, and that it would be important to understand by what means something like will power or effective aggression can be mobilized in the patient.

In this paper I have been able to mention will power only as a possible factor in addition to the two factors already dealt with more extensively. It would seem to me that deeper investigation into the clinical situations in which personality change occurs would be necessary to establish in detail how important this factor of will power or effective aggression and its mobilization in a given situation actually may be.