What brings about change in psychoanalytic treatment?

The development of two general points of view regarding what brings about change in psychoanalytic treatment is traced in this article. One set of conceptions emphasizes interpretation, especially of the transference, and historical or narrative reconstruction. The other set emphasizes the experiential and transactional aspects of a new and better human relationship. Various current versions of this difference in emphasis are discussed. Future investigation is needed to distinguish the role of correction of expectations generated out of actual infantile experiences through the new relationship to the analyst, from the role of interpretation of early fantasy activity and reconstruction of how this was generated and congealed in the patient's childhood. The danger of avoiding the analysis of core infantile fantasy activity and its effect on the patient's current perception, thinking, and behavior, by a premature termination of the treatment when the relationships of the patient seem to be more successful, mature, and realistic, is stressed. One must be careful not to utilize self psychology or object relations theory beyond foundational repair in psychoanalytic therapy without considering the consequences. One must ask oneself always if one is utilizing such theories and practices and the interpretations based on them defensively, in a collusion to avoid facing the patient's core unique childhood oedipal and preoedipal fantasy activity and the reverberations of it in the analyst's core fantasy activity. Continuing self-analysis is required in each and every treatment process, which is why the analyst also learns and matures from every case. The openness of the analyst permits insight through interpretation, meliorative noninterpretive aspects of the new object relationship or experience, regression due to the analyst's reliability which gives the opportunity to undo developmental arrests through the analysis of core fantasies, a symbolic holding environment, and the collaborative creation of a narrative, all of which are known to have therapeutic effects and work together to produce change in psychoanalytic treatment.