Patients’ Experiences of Change in Psychoanalysis in relation to their personality orientation

What is it about?

One of the most famous quotations credited to Freud is that, when asked what he thought a psychological healthy person should be able to do, he had said: “to love and to work.” A central goal in psychoanalytic treatment is to bring about changes in basic, mostly unconscious, mental structures. The aim of this study was to investigate, applying inductive thematic analysis, the experiences of anaclitic and introjective patients, respectively, of change after psychoanalysis with regard to the domains Love and Relationships and Work and Achievements. Analyzing patient interviews, we identified a third domain of experienced changes, The Self, which refers to increased self-understanding, self-acceptance and self-care, rather than improved dynamic balance between love and work. All patients experienced several positive changes in their lives during and after psychoanalysis. We also found distinctive patterns that appear to be closely linked to the patients’ initial personality orientation on relationships or on achievements. Generally, the patients described symmetrical, but opposite, broad change processes within the two specific domains Love and Work. For the anaclitic patients, this indicated a movement inwards in the domain of Love (from an excessive preoccupation with issues of relationship to others toward more distinct self-boundaries and increased agency) and outwards in the domain of Work (from unenterprising towards becoming more outgoing and daring). For the introjective patients this pointed to a reverse movement outwards in the domain of Love (from an excessive preoccupation with issues of autonomy towards increased responsiveness to others and desire to be establish close, mutual relationships) and inwards in the domain of Work (from an excessive orientation on achievements toward increased becoming more grounded in their own feelings, needs and desires). In conclusion, patients in both groups have experienced a reduced preoccupation with issues related to their initially predominant personality dimension (relatedness or self-definition) and increased receptivity to needs typical for the complementary dimension. These changes seem to be mediated by changes in the domain of The Self. Our study suggests the clinical relevance of focusing the therapeutic work on fostering a better and more dynamic balance between love and work, relatedness or self-definition.

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Why is it important?

The idea of a balance between love and work is central to several influential theories of psychological maturation and well-being. According to Blatt’s two-polarities model, psychological health presupposes a mature balance between relatedness (anaclitic configuration) and a sense of autonomy (introjective configuration). Our study focuses on the initially anaclitic and introjective patients’ experienced changes after psychoanalysis. We found a symmetrical, but opposite, pattern of changes in the two patient groups. The anaclitic patients experienced a movement from relational vulnerability towards more distinct self-boundaries and improved enterprising. The introjective patients described a turn from excessive need of autonomy and performances towards mutual relationships and self-understanding. Patients in both groups have experienced a reduced preoccupation with issues related to their predominant personality dimension and increased receptivity to needs typical of the complementary dimension. These changes in the domains of Love and Relationships and Work and Achievements seem to be mediated by increased self-understanding, self-acceptance and self-care in the domain of The Self. Some patients could experience that the price for positive changes was loss of emotional excitement or of high ideals. These findings might contribute to our deeper understanding of the complexity and dynamics of change, as experienced by patients in psychoanalysis.

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