THE TIME UNITY OF PERSONALITY Andrew Tershakovec This concept, an extension of Karen Horney theory, utilizes principles similar to the self-correcting processes occurring spontaneously between people. It is suggested that its application might shorten psychotherapy, at least with some types of patients.

The Goals of Psychotherapy In the past, though change toward health at times was attributed to other factors, 1'2 psychoanalysis and psychoanalytically oriented psychotherapy remained mostly insight-oriented. In Freudian formulation, a change is produced when the previously repressed infantile personality becomes accessible by being experienced in terms of emotions based on secondary thinking? Being thus confronted with reality, this archaic personality--which so far resisted change in the timeless unconscious--is forced to give up the dominance which it exerted until now via the repetition compulsion. Freud's conceptualization of neurotic pathology can thus be seen as a fixation of the personality in the time level of the past. Influential as this formula was, in view of the importance of the multiplier effect of pathology that begins during the formative years of life, dissatisfaction with its limitations was expressed as early as 1929. Sterba,4 by researching the therapeutic relationship taking place in the present, hereby extended the inquiry into the dynamics of interpersonal relationships in that time level. Sterba's "reasonable ego" was followed by Zetzel's "therapeutic alliance, ''5 Greenson's "working alliance, ''6 and Stone's "mature transference. ''7 The non-Freudians conceptualized the arising of pathology in the time level of the present. A few of the many examples among these contributions include H. S. Sullivan's theory of interpersonal relations 8's and Horney's early work? ° The only complete conceptualization of another reparative effort, however, Andrew Tershakovec, M . D . , Faculty, American Institute for Psychoanalysisof hey Institute and Center; Chief of Service, Manhattan Psychiatric Center. The American Journal of Psychoanalysis

© 1979 Association for the Advancementof Psychoanalysis

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which results in the fixation in the crucial time level of the future, is by Karen Homey. Therefore, even though such pathology can probably be conceptualized in the framework of other existing theories of neurosis, Horney's description of the clinical results of neurotic fixation in the time level of the future will be used. Homey, who evolved her theory in the 1940s and 1950s, thought of neurosis as having its inital impetus from basic anxiety--i.e., from a feeling induced by growing up alone and isolated in a world perceived as basically hostile. The reactions to it are ad hoc strategies, such as inappropriately, indiscriminately, and compulsively moving against people (aggression), toward people (compliance), and away from people (withdrawal). Mutually exclusive, these trends, equaling libidinal trends in the strength of their impact, leave the personality in severe conflict. Horney's revolutionary contribution is the conceptualization of a new neurotic configuration that develops fully when the ability to think abstractly first appears. This ability, essential to the concept of the future, contributes to the creation of another effort to deal with the continuing conflict. This is a new model of the self, which she called "idealized image." In it, as if in attempt at superrationalization, faults are turned into virtues---compliance into saintliness, aggression into righteous self-assertion, withdrawal into a wise, philosophical attitude toward life. This model, consciously perceived by the individual as an ideal to be attained in the future, is accepted unconsciously as if it were a present reality--"a bit of psychosis in every neurosis." Accordingly, fantastic, hoped-for values are perceived as already present, whereas an awareness of problems requiring realistic efforts is repressed. This gross falsification of the present, which results from accepting a distorted future image as reality, needs a personality structure to support it. Consequently, the process called "alienation from one's own real self" sets in. The past, in turn, instead of serving as a matrix of creativity, merely siphons off additional energy, as it has to be rationalized away. The resulting impoverishment of the personality forces the individual into additional neurotic adjustments, such as externalized living. 11 Horney's model of the neurotic personality as it evolved via fragmentation in time levels is a valuable clinical contribution. 121s At whatever time level the fixation occurs, as a reparation it is as futile as are other neurotic measures. An attempt at giving an illusion of wholeness to what in effect is a time fragment of personality permits the person to go on living but, in the long run, results in an even greater estrangement from reality. The need to deal with pathology prompts efforts toward the understanding of it, and so it precedes conceptualization of health. However, with Horney's contribution, the time has arrived to introduce the concept of the time unity of personality as a prerequisite for mental health, which is in reciprocal relationship with reality orientation.

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The species-unique ability of humans to think abstractly imposes a strict and constant interdependence and reciprocity between the time levels. The model of personality emphasizes the future. This is the logical location for it to be in the human being who--as every living organism--grows by anamorphosis, 18 that is, by differentiation into ever-more-complex structures, because such a model must be a plan for a more complex structure than the existing one. Only such a model of future self can bring shape, order, and meaning to the present by supporting certain attitudes and suppressing others. The present, in turn, is the only workshop where this model can be tested against reality and where appropriate decisions must be made about the options envisaged by the model. The past is a rich storehouse of creative material and a catalyst to the whole process. (In pathology, where the future model disregards reality, the present is distorted, and the past must be rationalized away or else fantasized). 17-19 Whereas the philosophical aspect of the time-personality relationship was explored before, 2°'21the proposed concept of the time unity of personality has relevance for treatment. This becomes apparent when we view it within a framework of the new concept of the growth process pointed out by Piaget, Erikson, and the representatives of the general systems theory. According to this concept, growth is seen as occurring by exchanging the outgrown, archaic model of the personality for a broader and more adequate one. (In normal growth, the change is toward a more complex personality model; in treatment, toward a healthier one). A (personality) model should be understood to be an inner representation of the entire personality, which functions as a blueprint, a common point of reference on the basis of which all the decisions of the organism are made. (It is in reciprocal relationship with the model of the outside world, 22but its primacy must be accepted, because in assigning arbitrary values, 23'24the personality perceives the world in terms of its own frame of reference to such an extent that an individual may be said to be living "not in the world of things but of ideas. ''2s The goal of therapy must be seen, then, as a change of personality model from a restricting, neurotic, to an open, healthy one, with the time unity of personality considered as one of the criteria of health. In this, the process in therapy is like the process in normal growth; for here, too, change must occur in a dialectic fashion: when the quantity of new psychological material increases to a critical point, change to a new quality--new model--becomes unavoidable. This critical point obtains when a "lack of fit" between the model and the mass of psychological material that it is supposed to represent reaches dimensions inconsistent with the person's well-being. In normal development, this is announced by tension, e.g., the turbulence of adolescence; in neurosis, by anxiety or by increasing feeling of alienation from one's own self? 3 (It is possible that this feeling of loss of control over one's own fate was for the first

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time in the history of mankind artistically expressed in classic Greek tragedy as helplessness in the face of fate or hostile gods. In Freud's analysis, the tragedy of Oedipus was a dramatization of an attempt to deal with that burden of unconscious conflict by acting it out in real life.) Certain principles by which growth takes place must be mentioned here. In terms of the general systems theory 16'2sthe personality's model would be considered its leading part--that is, the hierarchically highest structure around which everything else centers. Any change in it follows the rules of the trigger causality, in which an energetically insignificant change, when applied from this fulcrum of power causes considerable change in the entire organism. (It differs from the ordinary conservation type causality, in which cause equals effect). The reason is thus supplied for the extraordinary sensitivity and resistance of the personality to change. (Laboratory experiments provide a measure of such sensitivity: any sudden interference with the personality's model, as demonstrated by the sensory deprivation experiments, causes rapid disintegration). 22 Due to the trigger causality, changes in a personality's leading part--its model--are magnified to such a degree that any changes are feared and are avoided. Defense mechanisms, devices to keep the status quo, act even when the change is acknowledged to be beneficial by the patient himself; they then become resistances in therapy. (In H. S. Sullivan's formulation, anxiety plays a major role in defending the person from change. 8 Homey, however, demonstrated that the defense mechanisms act even before the anxiety is activated, by narrowing the person's awareness of his feelings and resulting alienation). This sensitivity to change puts the person in a dilemma. Although the organism's long-term survival depends on its model's reality orientation, for immediate survival, this model's stability is required. In case of a conflict between the two, the needs of the moment have the priority. When all other defense mechanisms fail, the personality represses the threatening material into the unconscious. In this frame of reference, the unconscious must be seen as whatever the current model of personality needs it to be to secure its stability. Healthy characteristics are repressed when they cannot be integrated into the model. 13'~4'18,2sBecause they cannot be solved immediately, neurotic conflicts are also repressed. However, once they become part of the model's structure, they cannot be solved except by changingthe model. This explains why the change is delayed as long as possible, but why, when it does occur, it is relatively rapid (Erikson's epigenetic crisis). The destabilized model makes a personality as vulnerable as is an animal in its molting stage. How does this concept relate to treatment? It provides a solution to a dilemma which previously seemed insoluble. The traditional pathologyoriented approach favored by most existing psychoanalytically oriented psychotherapies, as restated recently, 26 stresses the need for the passivity on the part of the therapist. Passivity is needed so that the patient's pathology

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can come out unhindered by any possible suggestion. The dilemma is created when the defense mechanisms are actually being intensified during the long transference neurosis while the only thing which could diminish them--that is, the bringing out of the healthy model--is a taboo because of fear of the "transference cure." The dilemma is irrelevant to our frame of reference, because even though transference cure is still to be watched out for, the active bringing in of our notion of a healthy model into therapy during its early stages is unavoidable, as will be discussed below. We are going to influence the patient anyway, but if we are not aware of the dynamics involved, we are bound to support his neurotic time-fragmented self to the extent to which this fits our own unconscious needs. We can attempt a therapeutic shortcut by helping the patient to effect the change of his old leading part--his old personality model--directly by means of sensing the future, healthy one. This would decrease the need for defense mechanisms because, as was said above, such defenses guard the organism first from the state of being without its leading part, the model; .with the new model being within sight, so to say, there would be no danger of such a panic-inducing situation. This, after all, is precisely what people seem to be doing spontaneously, although this only rarely has been reflected in psychoanalytic literature. In 1960, Loewald 27 proposed that there is a therapeutic potential in psychoanalysis akin to the situation between the mother and the child when the mother's mental picture of the Child's potential (hence of the child in the future) becomes part of child's image of itself. This promotes the growth of the child in the direction foreseen by the mother. Spontaneous Attempts at Self-correction. There are two observations by the communication theory23 that explain the reasons for the universality of this phenomenon. The first is that because of the dual nature of communication, 23 a natu ral assessment upon meeting a stranger is also a command to be the kind of person we perceive him to be. This command is transmitted in various ways. 28The second is that the human codification system usesthe Gestalten; 23 in interpersonal communications, the highest Gestalt of them all, the entire personality, is being used. (This fact is well known from the psychoanalytic "first session phenomenon," when the patient's entire personality is being correctly assessed, even though many of the data are initially suppressed because of the analyst's particular frame of reference.) The core of such communication is sensing the core of the other person--in our terms, his or her future model of personality. Such an image of what one wou Id have the pa~ner be in one's own future is a continuum; at one extreme, as in neurotic transference (as it will be defined below), the partner is essentially a creation of the neurotic needs of the

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image-maker; in this case, the selection of the partner occurs on the basis of a predetermined image. The whole process is then ritualized, rigid, and usually very rapid, and leading not to growth, but to repetition of neurotic involvement. At the other, healthy extreme, the future image consists of realityoriented components and is conducive to growth. The first of three examples deals with the most neurotic case. Case 1. A male patient described how he met his partner in a sadomasochistic relationship that was to last many years. Having just extricated himself from one such relationship, he came to a ski lodge hoping to find there a different kind of woman with whom he could start a new life. He went down into the crowded living room and spent about ten minutes ambling around. A woman observed his movements across the room, although he did not see her. As he was buying cigarettes from a vending machine, she approached him from behind and asked in a whining babyvoice: "What are you doing?" He turned around, looked her over, gave her a brusque answer, and took her away with him. The woman's baby voice and his brusque commanding action were ritual moves, never used except in an intimate situation with a partner. From a few minutes' observation, the woman was able to assess her future partner's personality and reflect to him his idealized future imagc~ that of a slave-driver. The patient reciprocated as rapidly. The accurate recognition and reflection of the roles they were to play in the future was completed in less than a quarter of an hour. Later, in treatment, the patient tried to reconstruct what happened. He remembered reading in Proust descriptions of similar nonverbal recognition of a future partner; but try as he might, he was unable to become aware of signals that must have been exchanged in his case. Case 2. Another example is that of a less neurotic relationship that nevertheless proved not to be viable because each of the partners reflected each other's future image primarily to use each other neurotically. A patient whose six-year-old marriage was about to be dissolved was preoccupied with the question of why he and his wife married in the first place, and over a period of time came to this conclusion: "She married me mostly because of the image I had of her--that of a glittering and effervescent creature who will make everybody around her alive. This deeply moved and fascinated me, because I knew that aliveness is something I desired but never had. Of her many suitors, I probably demonstrated the most sincere appreciation of that potential in her." He thought that this won her, as she was sensitive about being appreciated for her looks only. However, this was only a part of the image he had of her; the secret part, which he now realized was always present deep down, was that of a confused and weak person. He said, "1 must have always known that, otherwise I would have never had the guts to marry her, because I knew my weakness. Not only that, but I now realize that I always tried to keep her

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that way; the strange part is that it was somehow all right with her." He realized that a similar situation obtained on her part. The main reason he married her, he thought, was the image she had of him--that of a person who, although not strong at present, could be strong in the future. He said, "In those days I was merely withdrawn, and I honestly do not remember ever having pretended I was strong; yet in her presence I felt I could be. This was the most wonderful experience I ever had." He said further, "However, now I know that even then she also sensed my weakness, and no matter how she nags me for being a failure, I really feel that she needs me to be one, to be weak. If she can tolerate anyone at all, it is a weak person, who will go away when she tel Is him to. I don't think she ever really wanted to be married to anyone. She cannot stand anyone that close." This sensing of each other took place in the very first days of their courtship. In each case, the mutual reflection of the healthy potential that each partner sensed in the other was what provided conscious mutual attraction. However, it was more important that the image contained a repressed secret covenant, which put a premium on each partner's secretly perceived present and future weakness as a guarantee of not interfering with the other partner's neurosis in any real sense. Case 3. Because pathology is ritualized, repetitious, and therefore more readily recognizable, 23healthier processes of this kind will be more complex. Nevertheless, such a process is described in Dostoevsky's The Idiot in a manner which suggests that it also occurs with reasonable speed. The hero, who earned his nickname because of an unconventional overwhelming interest in what goes on between people, on the strength of this quality, befriends a trio of spirited young sisters. The first meeting ends, at the girls' request, with the hero prophesying each person's future image, with the exception of the youngest beauty Aglaia, of whom he states that he is not certain what to think, but to whom, some months later, he writes a brief letter stating that he needs her though he does not know why. The next contact, which brings the couple to an understanding, is a date which, in a move unusual for a young Victorian lady, the girl requests. She tells him that she considers him to be a better person than anyone she knows, even though he appears to be mentally ill and may even be so in a certain sense. Yet since his "main mind" is so superior, she wants him to be a person to whom she can tell all and whom she expects to be just as open; she hopes that he can show her how to be socially useful, and not to be merely a young lady waiting to get married. The hero agrees, and in his turn, tries to define how he sees her in his future, "1 think of you as of my light." This development, so important in the couple's lives, takes place after personal contact of only a few hours. Its essence is a reflection to the partner of partner's image in the future, which is more complex than the present, and therefore growth-oriented.

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Tragically, Dostoevsky's heroes are unsuccessful, but this major selfcorrecting effort of their lives can illustrate the dynamics of growth-oriented relationship. Both of these young people reflect to each other images of what it would be like in the future, to unlock the traps which hold them in the present. For the man, the trap consists of a destructive relationship; for the woman, it is a developmental eddy; but both understand intuitively that the present can only have meaningful shape if the future model of the personality, for which the present serves as a logistic base, is reality-oriented. It will now be apparent why the therapeutic principle described by Loewald is a universal phenomenon occurring regularly between people. To put it simply, if there is to be a correction through the awareness of the present, it can only occur by sensing the future. This reaction commonly escapes our attention because it is so automatic; but it is accurately sensed by a psychopath who manipulates people by referring to them not in terms of what they are, but in terms of what they would like to be. Perhaps this should not be surprising, because if any attribute had a chance of becoming part of our biological makeup it would be the ability to think in terms of the future, because those who can do so are one step ahead of their competitors in the struggle for survival. As we have seen in the above examples, the whole process is also rapid; this might have moved Angya129 to propose the existence within us of a healthy structure along with the neurotic one. In treatment, inasmuch as the role of the partner, crucial for this process, is to be played by the therapist, its dynamics must be examined more closely.

The Dynamics of Change in Treatment The Situation of Closeness. An awareness of self cannot occur without a special relationship with another person. This fact was probably alluded to by Adler in his concept of "social feel ing, ''3° but it was not fully conceptualized until Ruesch and Bateson did so in the 1950s. According to these authors, it is probably impossible for any organism to become aware of its own identity without the presence of another specimen of the same species? 3 In terms of common human experience, it is impossible to become aware of one's own human attributes, such as loveability, apart from a human relationship in which feelings are reflected with honesty between the partners, with growth as a mutual goal; for the purpose of this paper I shall call it a "relationship of closeness." Our hypothetical patient may or may not have experienced this spontaneous tendency to strive for closeness and, therefore, emotional growth. Therefore it might be useful to describe its typical expression. A search for closeness exists at all developmental levels, and it is pursued by means innate to a given level of development. Chumship, well described by

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several authors, is defined by H. S. Sullivan 9 as a period in which, for the first time in the life of an individual, another person, the chum, becomes as important to one as one's own self. The ability to abstract (which according to Piaget begins at age twelve or so with the stage of formal abstract operations) permits conceiving the future and thus the beginning of an adult personality. In a beautifully written description by Leo Tolstoy in his Childhood, two adolescents, in order to achieve closeness, which they know is necessary in order for them to be able to perceive their budding adult personalities and to break out of their old models characterized by their egocentric clan and childhood "ideologies, ''31 swear each other to absolute secrecy. Only then, they feel, can the essential "telling each other all" be assured. The search for closeness with which people are perhaps more familiar begins at the time when the sexual drive is sufficently well-established. Its combined expression with the need to achieve closeness (human love) becomes the most-potent human relationship. It is this closeness that gives it that wellknown power to "make" a person or to "break" him if it is neurotically misused. Mankind intuitively tried to tame this power by restricting it to marriage. Goethe noted this aspect of love when he wrote to Frau von Stein, a woman several years his senior for whom he left the renowned beauty of the time, the talented 26-year-old actress Corona Schroeter, "1 don't even know whether I love you, or whether to be near you is like being near a mirror so crystal clear that it is delightful to look at oneself therein. ''32 In trying to understand how closeness is being neurotically misused, a certain analogy between the development of our self-awareness and man's awareness of the outer world might help. Lacking the power of logical thinking, using the primitive anthropomorphising logic (Arieti's paleologic3), man constructed a fantastic picture of the world he lived in. We are just emerging from this period in mankind's development; the remnants of the old logic are found in many cultures, including our own (we still swear at a chair and not at our own clumsiness if we hit a shin in the darkness). This logic served to create an illusion of mastering reality by accepting an inner construct in lieu of reality. Perception, awareness of the inner self, suffered from a similar vulnerability to distortion as soon as it became composed of high-order emotions based on abstract thinking. 3 The only practical way to achieve a true awareness of self that is, a feedback from another person in a situation of closeness--is abandoned under stress when human beings fall back on what possibly was an archaic inner constitution. In such cases, an illusion of interpersonal feedback is achieved by creating an illusory person within ourselves, "an imaginary entity made up of condensed traces of past experiences [which] represents within an individual the missing outside person. However, a crucial difference exists between interpersonal and intrapersonal communications with

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regard to the registration of mistakes. In the interpersonal situation the effects of purposive or expressive action can be evaluated and, if necessary, corrected. In the intrapersonal, fantasy, communication, to perceive that one misinterprets one's own messages is extremely difficult if not impossible, and correction rarely if ever occurs. ''23 In an ingenious metaphor, this way of avoiding self-awareness and, hence, growth is called "talking to oneself.,,33(pp. 2~8-219~ Clinically, this should be nothing new. Experienced analysts have been deceived by "free associations" that led no-where, as reported by Greenson. ° These may be instances of just such "talking to ourselves." Transference. If we define, as I think we should, transference as a perception of another individual in terms of the needs of one's own character structure in toto (rather than transference of such needs pertaining to the past only), we see transference as an unconscious attempt to transform the person we are dealing with (by dint of endowing him or her with characteristics as needed) into just such a "person within ourselves." Relating to such a person is then another case of "talking to oneself"--that is, of having an illusion of growing through relating to someone, while in fact remaining the same. In view of these difficulties, it is much more important to be able to read the patient's concealed efforts at communication, of which two will be described. Provoking Countertransference as an Effort to Communicate. Ruesch propose'd, "Correction of mistakes is a basic means of communication and is actually the only source of communication which will permit the unobserved observer to form inferences about the communication and codification system of the observed. ''23 This can be translated into terms of common human experience when we feel that a person "is too perfect to be true" and thus that we do not know him. Only if such a person makes a mistake and we observe how he handles it can we begin to feel about him as "human." At times the desire to "show somebody up" may be actually caused by an unconscious wish to get closer to that person by causing him to make a mistake so we can see how he corrects it, in that way getting to know him. A patient who repeatedly evokes strong countertransference feelings may be motivated by just such a need (among many other possibilities). He may signal in this way his fear of us, his vague desire for closeness, and his ignorance of how to get close except in this way. If the countertransference repeatedly relates to some specific area, it may mean that the patient already singled out some deficiency of his and signals his need for more-intense communication in that area. Case 4. One patient attacked me so viciously that I thought I was dealing with a decompensating paranoid person. The attacks were quite personal-directed at my ability, my taste in furnishing my office, and the like. I hid my resentment and dismay behind a noncommittal, wait-and-see attitude. In both

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human and therapeutic terms, this was a mistake, because when I finally acknowledged the feelings of both of us and we began to work on them it became apparent that the patient was not paranoid at all. Her compulsive aggression was actually a reaction to her compulsive compliance. Being either compliant or aggressive, but unable to be assertive, the patient provoked her husband and other people close to her into situations where they would be forced to demonstrate how they handle their anger in a realistic manner, by asserting themselves. Acting Out as an Effort to Communicate. Ruesch's statement, "It is necessary to insist upon a dual relationship between information and a c t i o n . . , it is necessary to recognize that action liberates codified information which is unavailable until the action is in the full progress...,,23 is pertinent to another very common human situation, in which people have a distinct feeling that "talking will bring us no further, now is the time to act." Acting in this case means involvement in the situation of closeness. What we call "acting out" can be seen as such an attempt at unlocking through action. This attempt fails either because the patient either unconsciously selects a neurotic partner or (as he will try to do with the therapist) remakes him into one in his imagination, using transference mechanisms as defined above. Case 5. One patient, a perceptive young woman, remarked sadly upon noticing her growing erotic interest in me that she was sorry for the feeling that it replaced. She knew that it is "supposed to happen in treatment," in fact, this is why she selected a male analyst. From tal king to friends, before starting treatment, she identified her compulsive falling in love as an attempt to find a magic way out, and thought that with the male therapist she could confront her problem most directly. She said, "1 now feel toward you as I felt toward my men---excited, but also on guard as if you were my enemy. The feeling of trust which I so rarely felt toward men is gone and I begin to doubt that it ever existed. I guess one has many foolish hopes when beginning treatment." This familiar situation became a time-saving opener. When encouraged, the patient was able to remember men to whom she felt attracted but whom she finally left because they proved "boring." Instead, she chose sadistic partners. She came to realize that by feeling bored, she covered up fears of trusting anyone when closeness was offered. She later recovered glimpses of her "trusting" side and was able to have her first distinct sense of an alternative to her acting out, which was one of engaging in action in Ruesch's sense, that is of entering a situation of closeness. Acting out in treatment was for this young woman an interpersonal phenomenon, an attempt at communication. She was in a position similar to that of a person who, unable to ask a question, "What shall I do now?" acts instead, to find out for himself. Acting out for her really was a way to ask, "What do I feel?" This young woman was raised by parents who, themselves fearful of feelings, tried to find guidance for them-

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selves and their children in an impersonally understood religion. Intuitively searching for closeness, the patient thought that she found it during the first glow and excitement of an affair. Frightened of deeper feelings, she withdrew as soon as they emerged, only to try again with same results. She remembered asking herself at the beginning of some of her affairs, "Is this love?" She cou Id have paraphrased herself as having asked on those occasions, "Is this closeness I feel?" There are still several problems to be considered with regard to the therapist's task. One of them concerns artistic ability that may be required of the therapist, as alluded to by Loewald. ~ The future image of the patient must reflect character traits unique to him in a new combination--it should be something new, but uniquely his. How is the analyst to achieve the degree of consanguinity that occurs between people choosing each other spontaneously in the psychoanalytic relationship, which is most often by referral? The answer appears to be that what is lost in spontaneity is more than made up for by avoidance of the neurotic use of each other (as in Case 2). However, for this to occur, it is essential that countertransference be understood in its wider meaning. Countertransference should be seen as perceiving the patient in terms of the needs of the analyst's entire character structure. Karen Horney 35showed how this structure can profoundly influence the course of treatment. In our case, there might be a possibility of a "transference cure," in which an analyst with expansive omnipotent trends might attempt to distort the whole process in trying to make the patient over, Pygmalion fashion, into a copy of himself. It is essential to recognize the therapeutic limitations. The patient's future image depends only partly on the quality of the therapist's perception of the patient. To a large extent it depends on the patient's resources. This is a cooperative enterprise, but the creator in the final count is the patient himself. Another factor in the patient's realization of a future image is the therapist's ability to convey this image in terms that are meaningful to the patient. Because of the rigidity of the model of the self, anything expressed in terms other than his own will be rejected--i.e., repressed or, as described by Su II ivan, 9dissociated. In terms of common human experience, we will not accept ideas from someone who "does not understand us." As we are talking of the patient's old self, we are talking of his pathology. Its place in our frame of reference can now be seen more clearly. It is important to be aware of the patient's pathology, because such awareness facilitates our communication with him. As for the patient himself, the sooner he senses just how he is ill, the sooner he can sense what it is to be healthy. Finally, it should be repeated that in fact we may not even have a choice as to whether or not we engage in this aspect of therapeutic relationship aside from the countertransference aspect mentioned above. It is difficult to see

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how we could with impunity ignore the potential of self-correcting processes which, as many patients tell us, often go on successfully outside the therapeutic relationship~with their friends, for example. This raises the question: just how available can we make our person to the patient? This question receives much attention, for example, in the copious literature on countertransference as a therapeutic tool. To quote just one opinion which seems to support our point of view, "a professional facade--in therapeutic fact, a fictional facade~will not misguide or deceive the patient very l o n g . . . The psychoanalyst who plays the role or enacts the persona of expertise, in effect interposes an egoic or interpersonal boundary between his creative inner resources and the problems of his patient's psychology, and in so doing, also pushes the patient's creative inner resources one more step backward into himself. ''36 The T r e a t m e n t Process

This is a summation of what was said above, emphasizing the sequence of the problems. Treatment as discussed here has a chance to utilize the great natural potential of the intuitive self-correcting process. However, the patient must be able to hear us and hear himself, and often he is unable to do so. In an originally reparative effort, the patient has distorted the only way in which he could become aware of himself---i.e, the ability to be close. He often deludes himself that he is in a situation of closeness by transforming others, via transference mechanisms as defined above, into his neurotic "alteregos" or by internalizing the whole process, while "talking to himself." This establishes the first treatment priority. Communication becomes treatment along the lines described above. Whether we wish it or not, it starts with the very first contact with the patient and does so with considerable intensity and rapidity, as people communicate with their entire personalities. This places a stringent requirement on the therapist, but it also offers an opportunity. As soon as the patien t gets a response to one of his attempts at communication (some of which have been mentioned), he will get the only reassurance valid in therapy, and that is a feeling that his problem can be grasped by another personY This is a solid basis for the therapeutic relationship. While this takes a number of sessions, the image the patient has of the analyst in his future will emerge. In the situation of transference as described above the patient's pathology will come into play. This is a crucial point in treatment, when another priority emerges. While the traditional pathology-oriented approach induced the analyst to remain passive so that the pathological self-image could come out unhindered, in the proposed frame of reference, the therapist will be equally concerned with the possibility of pseudocompliance on the part of the patient, who often will be willing to trade an unlimited number of hours in therapy against the terror of

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personality fragmentation connected with the prospective loss of the personality model. This terror occurs as the change is first perceived as inevitable but not really possible, when the outline of the future is still insufficiently clear. Should the analyst be able to help the patient to sense an image of his future self, united in time perspective, he will aid him in a strategically crucial foothold in reality and make it a turning point in treatment. Not only will awareness of pathology be more rapid because it will be more genuine, but a liberation of healthy forces of the personality will occur parallel to its unification. Case 6. An attractive 33-year old professional woman came for help in extreme anguish following the breakup of a 21/2-year love affair, her first emotional involvement in a number of relationships she had over the years. She had grown up in a family dominated by a very controlling father. Needing affection himself, he really did not believe in it and was only able to feel loved when others were absolutely obedient to him. The patient's mother, a very dependent woman, accepted those terms, as, on the whole, did the patient, her father's pet and the darling of the entire clan. The patient never lost the memory of her pain when her father suddenly died when she was eighteen. An early assessment of the dynamics when the patient started treatment could have been that of Oedipal fixation. The patient had long been anaesthetic in her love affairs; when she finally selected a partner to become emotionally involved with, he was in many respects like her father. However, it soon became apparent that she was so attached to her father because she shared his pathology. Like him, she had an insatiable need for affection; but whereas her father was only able to try to accept it in terms of absolute obedience, for her the proof of love was to be loved unconditionally, especially after she rejected her partner. This indeed was happening in her relationships, but never to a satisfactory degree. She responded to her last lover because he seemed to understand her fully. She thought him strong, as he was able to resist her; his eventual yielding, of which she was sure, was that much more precious a thing. She felt that both had a deep understanding of the nature of each other, which would assure perfect happiness. In fact, her lover needed as much reassurance as she did, though in a different fashion, and, just like herself, tried to get it at the expense of his partner. Both felt that the ultimate reassurance was just within reach; she, when he stayed with her despite her moods, the reason for which she made a point not to explain; he, when she stayed with him despite his having affairs on the side. Yet, the magic breakthrough never arrived; on the contrary, they kept lacerating each other more until he dropped her for another woman. The patient suffered so acutely that in treatment her first concern was to find out what was wrong with her that she ruined her life so. However, it seemed that she had many personality assets and that she could try from the outset to

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take a larger view, namely, what shape her healthy future could be. After I became convinced that we were able to communicate adequately, I began to refer to her in terms of her future self to the extent that I was able to sense it and she was able to conceive of it. At first, there seemed to be little to work with. There were some incidents of rebellion in her past; e.g., when, upon starting school, she tried to have her friendships based on a loyalty different from the one that tied her own family together. At that ti me, this did not work out; there was no one to show her the way, and her school years were spent in tight cliques run on a strict quid pro quo basis, where loyalty was measured strictly by what was advanced by the other party. She later remembered her daydreams as a teenager. At that time she imagined herself being loved in a different, exciting fashion. No secrets were to be kept between her and her imaginary lover. She fantasied talkingto him by the hour of the most intimate things. All this was forgotten when she started dating; against reality it all seemed like childish dreams. And yet, as she now began to remember, her daydreams were not really forgotten. Her years were filled with a burning curiosity as to what could be going on between a couple, or for that matter among whole families that seemed so happy with the feeling which appeared to unite them. It was all so different from the frantic warfare-like relationships that were the only thing she knew. Other people were so calm, so inconspicuous, as if they knew a secret which was denied her. They rarely talked of love; she bitterly suspected that this was so because they did not have to. They knew what love is, while she did not. In those years when she was deeply unhappy most of the time, she did try her best to find out. She went with some boys who, she thought, were of that different kind. Yet nothing came of it, and finally she decided that it was she who must have been right, and "they" must have been wrong; that "they" were ninnies, do-gooders who deceived themselves; and that the whole of life is war, and that love must be war too. These old repressed thoughts and feelings were what we could work with. When she now talked of her recent affair, by degrees she began to view it from the point of view of "how it cou Id have been." She began to sense that these "other" people of her early girlhood must have had the kind of feelings which she came to call "long-circuited ones" in distinction from the "short-circuited," "hand-tohand" transactions she was accustomed to. But what was all that good for? She struggled with the concept of healthy closeness for a while. Initially, it felt so foreign to her that, as she later admitted, when I first used the word "healthy dependency," she really for a moment thought me insane. But the feeling picture of her future healthy self began to form in her in a way that was too complex for me to have observed in all the details. The first sign of it seemed to be the fact that she started to cry bitterly during sessions. This astonished her, as she never was able to cry in the presence of others. It was so, because she was afraid that this might open the gates to her utter despair. Now she knew

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that she cried not so much for her lover as for all the wasted years of her life. I thought that this was possibly because she now was able to sense some hope for the future. I continued to try to convey to her, to the extent that it seemed acceptable, what l felt this gifted and sensitive person's future could be. The complexity of the exchange of information and emotions that went on makes it difficult to account in detail for the development which occurred in the sixth month of treatment and which seemed to constitute a therapeutic breakthrough. Though she was still not conscious of it, the patient was already aware of her future potential, and this allowed her to fall in love with a healthy man. Previously, this had been impossible, as the patient either found such people uninteresting or else did not believe in their interest, and so she chose sadomasochistic partners instead. Soon after she met this man, the patient acted in her usual pattern. She interpreted something that he did as a rejection and withdrew, waiting for him to come to her without any explanation on her part. The man said, however, that he was ready to love her deeply, but not on those terms. He had had a similar experience before, and would not go through another on e . She must find it in her to be able to trust him, he said, and wait until both of them could see what really happened. The patient went along and, to her astonishment, found herself more reassured than through her previous manipulations. During all this, the patient also came to see her pathology. She recognized her "family recipe" as she called it, for the rather virulent sadomasochistic system that it was, and saw how she grew up to be a part of it. Awareness of her "old model" came to her in colorful imagery. She realized the conflict in which her fantasied picture of herself placed her. On one hand, in her image of what she called "a lion tamer," she allowed herself to be attracted only to a treacherous man because she shared with him the feeling that power is the only worthwhile quality. In the one exception to the rule, however, this man was obliged to let himself be tamed by her--because in the other part of her self image she also was the opposite--an epitome of soft femininity, whose love "conquers all." However, this realization was almost anticlimactic. The patient was certainly concerned with her pathology--after all, this was what she had to deal with mostly in her daily life--but she was much more excited by the vision of the future. After a year-and-a-half she decided to leave her good job, which she never liked (she had not liked any job so far, but this was the area we never had time to explore). She moved away to be with her lover. I felt that she was ready to be on her own. This proved correct, as I saw when she married her lover after another year-and-a-half and came to visit me. Both were happy and seemed to be growing in their relationship. The thing that impressed her, she said, was the way they argued, It appeared that their arguments resulted from

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accumulation of unconscious claims each had upon the other. The quarrel cleared the air by broadening the awareness each had of himself and of the other. To me, it looked like a functioning situation of healthy closeness and love. She contrasted this with the quarrels in her former relationship, in which the goal was weakening and enslavement of the partner as the on ly guarantee of allegiance.

The Results

The results of treatment with the proposed approach were best in the case of those whose habits of abstract thinking and the quality of imagery were high and who had courage to do much of the work on their own. Among the others who did not possess those characteristics, the quality of improvement seemed better in some; yet this subjective evaluation could not be corroborated by objective signs such as shortening of treatment time, changes in personality reflected in changes of life situations, and the like. According to these objective criteria, these patients seemed to have done no better than they would have done with the traditional psychoanalytically oriented psychotherapy. In view of this, it could perhaps be said that the proposed approach might be applicable to the "best" patients, something that is being stated about the candidates for psychoanalytic treatment in general. If so, the proposed frame of reference might still have its usefulness, as the results seem much more rapid; perhaps we have been too timid regarding patients with high potential. However, this evaluation may perhaps remain temporary. Further experience should show whether patients with less potential can be helped by this therapeutic shortcut. For this, its theoretical framework should probably be translated into a wider range of clinically useful patterns. Another area in which future development may occur is that of communications. Patients whose psychic constructs, including that of idealized image, jelled earlier and consist of more archaic material 38might lack the mobility of others in treatment because of their different mode of communication. However, it remains to be seen whether in the forthcoming effort to learn more about human communications we may be able to reach them better than we can now.

References

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30. Ansbacher, H. and R. Social Interest, In The Individual Psychology of Alfred Adler. New York: Harper & Row, 1956. 31. Barnett, J. On ideology and the psychodynamics of the ideologue. J. Am. Acad. Psychoanal. 1: 381-395, 1973. 32. Ludwig, E. Goethe, the History of a Man. New York: Blue Ribbon Books, 1928. 33. Castaneda, C. A Separate Reality. New York: Pocket Books, Simon & Shuster, 1974. 34. Loewald, H.W. Psychoanalysis as an art and the fantasy character of psychoanalytic situation. J. Am. Psychoanal. Assoc. 23: 277-299, 1975. 35. Karen Horney on psychoanalytic technique. The analyst's personal equation. In H. Kelman (Ed.), New perspectives, in Psychoanalysis. New York: Norton, 1965. 36. Wolstein, B. Countertransference: the psychoanalyst's shared experience and inquiry with his patient. J. Am. Acad. Psychoanal. 3: 77-89, 1975. 37. Martin, A.R. Reassurance in Therapy. Am. J. Psychoanal. 9: 17-29, 1949. 38. Metzger, E.A. In Schizophrenia: a panel. Am. J. Psychoanal. 17:114-118, 1957. Address reprint requests to 1049 Park Ave., New York, NY 10028.