A Pre-condition for Significant Psychological Change is a Good Match Between Patient and Therapist.
As in all complex relationships combining science and art,the criteria for success in large measure is dependent on the best possible match between therapist and patient. Experience bears out the fact that the most successful relationships are those that are characterized as mutually attuned - resonant. The patient must feel he or she is unconditionally accepted, and in good hands. The therapist must feel he or she is connected with the perceived essence of the new patient and feels challenged and committed to the treatment.

The common denominator in all mental illness is the suffering person who volunteers to come to a particular person for professional help. The patient feels caught up in forces beyond his control which are overwhelmingly painful and seemingly unrelated to any conscious cause and effect logic. These forces appear to have a life of their own which the will can do little to effect. Additionally they are, at one and the same time, as real as a puss-filled wound and yet as mysterious and invisible as electricity.

The new patient seeks cure or at least relief of his psychic agony. He hopes the Doctor has the answer to what has eluded his best efforts to ameliorate. Thus seeking cure at best,or at least relief of his agonizing symptoms, it is common for the majority of new patients to bring to treatment an expectation that the healer is possessed of magical powers that is hoped will be used to the patient's great advantage.

The first page of every book on technique indicates that the therapist is to explain to the new patient that he is not a magician and that treatment is therefore not magical. Then once the therapy commences it is further said that most new patients will try to convince both themselves and the analyst that this disclaimer is not true.

The therapist,if truly objective, freely admits his own personal bias and limits when it comes to his understanding the nature of the particularities of the patient's symptoms and of the particular theory which he uses to make sense of the patient's raw data. He is also willing to admit his prejudices when it comes to selecting a set of techniques which he hopes will eventually result in valued significant psychological changes in the patient.

The selection of a particular theoretical point of view and derived techniques comes out of the total personal experience of the therapist, how could it be otherwise? In all cases, whether the therapist is serious or glib, complex or superficial, careful or careless he will make choices with respect to his theoretical understanding and practical intervention according to the laws of his nature. Therapists differ from one another on a continuum from settling for mere rote on the one hand versus an attitude of ceaseless questing for quality responding on the other. The same goes for the patient. The more a patient works on himself the more he or she is likely to derive from their therapy experience. Put a lot in, get a lot back.

While the Doctor has his theories and techniques, the patient has his too. It is out of mutual respect for the understandings of both Dr. and patient, expressed in the open free dialogue and search for the truth, that the outcome eventually will be decided.

What begins in mystery for both the therapist and the patient should over time become gradually clearer. Over time too, with increasing understanding of the patient's unique 'logic of experience,' there will be small but cumulative changes. If the process works for the patient, the patient will clearly come to appreciate its substantial and cumulative power. The patient comes to appreciate that change is clearly a result of the treatment process which, in the final analysis, might be considered to be an extended dialogue of shared experience focused on trying always to understand the patient in depth and breadth. There is a felt sense of something of importance happening. In my experience significant psychological change is possible but it is slow in coming. And in all cases when it is substantial change, the patient feels as if they have truly been in the most strenuous and protracted struggle of their lives.

The Readiness to Change
Another pre condition for significant psychological change is the key factor of readiness. No one can force anyone to change. No matter how brilliant, clever, experienced, loving and the like a given therapist is, they are unable by themselves to change any patient. To change, the patient must be willing and ready to change. In this light, you can bring a psychological horse to water but you can't make him or her drink.

Research on synchronicities {characterized by quintessential stuck points}demonstrates that change occurs when a person stuck, in what is experienced as an intractable dilemma, shifts their attitude from wishing to be passively rescued {magical intervention}, to an attitude of positive commitment, taking on what ever action is necessary to alter the present set of unacceptable conditions. It is in this state of readiness - I call the realm of possibilities - that a person is most alert to the presence of both internal and external signals signifying potentially beneficial opportunities.

My analyst once said " the despair about changing is a life long battle between self interest versus regression (an id resistance). Growth takes {as Jefferson said about democracy} "eternal vigilance" and honesty with the self. To change takes effort. You have to be clear about which direction you are headed: north or south; adulthood or childhood? To change means to stop acting like a child."

How Change Looks From the Outside In
A Psychoanalytic Criteria for Assessing Psychological Change
Personal Communication with Frank Lachmann, Ph.D.

1 The Relation Itself - between therapist patient. It's unique focusing on the person in an accepting way in the spirit of an alliance {doing something with the patient and avoiding a manipulation of compliance in which the therapist does something to the patient.}

2 Transference Analysis - The patient brings distortion (in the here and now) into sharp relief. Seeing things in this way provides new information resulting in a new way of perceiving the self, the therapist, and the past (i.e. seeing one's parents associated and colored by various developmental phases.)

3 A New View of Childhood - Enables one to see themselves in a new light.{ Examples: In objectively viewing reality the patient may come to see that it was easier to split himself up thereby diminishing his realistic powers rather than have access to all of his powers but feel a crushing sense of depression correctly acknowledging the terror, and horrendous sense of isolation that is associated with being hated and abused.}

4 The possibility of redoing the past - in the transference with the therapist that is in turning passivity into activity in the service of ego mastery.

5  Releasing Developmental Restriction - (undoing fixations)

Change as Steps in a Process: Selected Raw Data of Experience Processed Through Psychological Structures

1. A balance that has been upset initiates a felt need to restore the balance. (The following story will illustrate the above).

...Two fish heard that a great man who could perform miracles was in a certain place. They swam to the brook where he was instructing a crowd of people and swam near to him. They saw him come to the water's edge, scoop some into his hands and say how water was a great creation of God. It was cleansing, purifying, essential for life. It was in fact God's greatest gift. The fish touched by the teaching looked at each other and both said: I wish we could find some water.

"If one knows the laws of nature - he is able to change the environment (atmosphere) and rearrange the context." {Clifford Bias}

2. There has to be a shift from a passive wish for rescue, in the form of magic, a break, etc. to a commitment to actively searching for a way to restore the imbalance. This part of the process might be conceived as a state of readiness (on your mark, get set) and release (go).

Two Types of Patients
There are essentially two types of patients seeking psychological treatment.

(l) those seeking to minimize their pain and

(2) those seeking to maximize their pleasure. The first group typically feels as if they are drowning in an ocean of intense feelings and emotions. Change for them means to be able to find a way to survive. The second group can survive but for them it as if they were in a forever circling row boat unable to stake out and follow a specific direction. Change for them is harnessing their powers, allying it with their will and directing it towards the attainment of meaningful challenges.

Building a Container: The Creation of a Cohesive Self - From Reactive to acting from within - Being Precedes Doing
Creating personal order out of one's idiosyncratic chaos is a process of consciously and unconsciously straining content through the sieve of structure.

For those who lack structure, significant change for them is the construction of structure. Structure in this light is what is known as the cohesive self. The operational definition of a cohesive self is something solid at the core of one's being that is felt to endure in the midst of internal and external confusion.

Significant change in the form of palpable structure spontaneously comes about to the degree to which the patient is induced to bear increasing dosages of frustrations and other so called negative (and sometimes positive) affects.

Changing The Awareness of Content: Making the Unconscious Conscious
Significant psychological change in therapy comes about when a patient is able to experience that which has previously been repressed {forgotten}. Once the unconscious is made conscious - the patient then can choose to act out the once repressed feelings, or suppress them. For example before a patient had knowledge of the scope of his feelings he used to cringe when a surly shop-keeper was hostile to him. Feeling attacked, instead of panicing and withdrawing; he instead, experienced a mixture of wonder and anger,plus a new found ability to hold his ground. In this new psychological frame of mind he challenged the store owner by asking him a pointed organizing question:"Is that an observation or a criticism?"

Making Significant Psychological Changes is Hard Work
The reason why a person becomes a patient is often do to a reawakening of traumatic unresolved childhood conflicts. This comes about when a traumatic event in the present, emotionally parallel to the past trauma, threatens to overwhelm the system. When this happens it is often experienced as a psychological short-circuiting the patient's normal routine. This is the state of mind that is commonly referred to as a 'nervous breakdown.' Changing this altered state of consciousness is often like the following example.

Imagine you are a carefree centipede moving your way down the street. Suddenly a gust of wind blows a piece of wood from off a rooftop delivers a glancing blow to your head. You are shocked for a while then realize you have been hit. As you regain your senses you find that you have forgotten how to walk. You have the unenviable task of relearning how to coordinate all 100 legs in just the right way, a behavior that before the trauma had been taken for granted.

Similarly a person suffering a trauma may find themselves having to completely reorient themselves to both themselves and external reality. In such a state there is commonly experienced much confusion, insecurity, vulnerability, fears, anxieties, and other intensely painful feelings.

Subtle Processes in the Phenomenology of Psychological Change

Note the following quotation of William James on extending his consciousness.
"What happened each time was that I seemed all at once to be reminded of a past experience; and this reminiscence ere I could conceive or name it distinctly, developed into something further that belonged with it, this in turn into something further still, and so on, until the process faded out leaving me amazed at the sudden vision of increasing ranges of distant fact of which I could give no articulate account... There was a strongly exciting sense that my knowledge of past (or present) reality was enlarging pulse by pulse, but so rapidly that my intellectual process could not keep up the pace. The content was thus entirely lost to introspection - it sank into the limbo into which dreams vanish as we gradually awake. The feeling- I won't call it belief - that I had a sudden opening - had seen through a window, as it were, distant realities that incomprehensibly belonged with my own life was so acute that I cannot shake it today."

Colin Wilson says James is describing Faculty X which allowed James and others to get on top of the mountain and see his life from a whole perspective instead of from just a worm's eye view. T.S.Elliot calls this: " the intersection of the timeless moment."

In this view - significant change involves a re vision of the past in terms of the acquisition of present knowledge. In other words - significant psychological change as viewed in psychotherapeutic terms means to work through the fog of transference reactions. Transference means viewing the present in terms of the past resulting in either an overly positive or negative perception of a person, place or thing. Crucial in this formulation is that the process of confusing the present and the past is initially unconscious {not verbalized}.

For example: to over idealize or to abandon hope are two states of consciousness that are equally without foundation. Both are illusions.

Ironies Associated with Significant Psychological Change
For many patients there are complex dilemmas that present daunting challenges to be mastered.

For example:

(l) A precondition for effective analysis is that the patient must trust the therapist. This is so because sooner or later, the therapist being human, there are bound to be inevitable disappointments, misunderstandings, and the likes. At such critical points in the treatment these glitches are likely to be experienced as major impasses. Unless there is a sense of good will flowing both ways in the treatment atmosphere it will be virtually impossible for the patient and the therapist to tolerate the often intense feelings accompanying these stuck points. Thus what might be done to effectively engage a patient in potentially effective psychotherapy whose core problem is one of major distrust?

(2) If a patient feels that he has no limits and hates the experience of being pinned down how is he ever to continue to be meaningfully engaged in a treatment process which by it very nature is frustrating and imposes realistic limits? These limits consist of meeting an agreed upon schedule of two to three sessions a week; and agreeing to a request that the patient attempt always to say exactly what is on his mind;meaning, speak his truth no matter what anxieties, fears, shame, guilt, and the likes it might initially induce.

(3) If you need to be able to tolerate frustration, to enable the ego to grow and make informed objective decisions but cannot tolerate frustration how can you hope to be able to have a strong objective ego?

(4) If adult gratification lies in directing libido outward to some love object, but you are too self absorbed to freely give of yourself, how is it possible to love?

If a spinning top becomes consciously aware of endlessly revolving in a circular orbit and wants to seek a unified direction it would first have to come to a complete halt.

"In Between black and white are not shades of gray, but are colors." (R.Wittenberg)

Over and over, session by session, the same sequences occur providing accumulating knowledge of the way the patient habitually reacts to a variety of stimuli. Each session is geared, then, to giving the patient and the therapist a small but significant increase in their combined knowledge of what makes the patient tick - that is deepening their knowledge of the idiosyncratic psychodynamics that constitute the patient's experiential logic.Gradual understanding of the ways in which a patient functions as a complex total individual,often results in inducing significant change.

When significant psychological change occurs what has seemed almost impossible to do, sometime for years on end, suddenly appears to be done seamlessly. When this happens - it is a sure indicator of the presence of significant psychological change.

It is quite common to signal significant psychological change by what is referred to as a pendulum reaction. What is to be changed (e.g. an unwanted attitude or behavior) initially is often felt to be extreme. For example, a hyper conflict averse patient may predictably space out at the first sign of rising anger directed towards someone. As progress is made in understanding the reasons for this gross suppression of natural instincts, the person is likely to swing way over to the other direction. Thus it is not unusual for a patient struggling to overcome a strong aggression inhibition, to one day 'let it all hang out' telling someone off' who provoked them, even if the degree of provocation does not objectively merit an overly extreme reaction. However, typically, sooner than later, the pendulum finds a balance point.

Significant change involves a shift in perception. Data that was interpreted one way before a change occurs is often interpreted from multiple perspectives once the shift in perception has occurred.

For example: a patient who was initially afraid to express his vivid imagination before treatment, could only come to the conclusion that 1 + 1 = 2. As his ' imagination anxiety' reduced he was able to permit himself to play with his now unsuppressed imagination. Thus he was able to additionally view 1+ 1 as 11 and / or 1+1 = 3 {as in Hegelian dialectic wherein a thesis + an antithesis = a new synthesis}.

Changing Often Feels Exciting
Changing often feels exciting is clearly conveyed by B.White and H.White in an article in the New York Post "The Excitement of Change" explaining how great art works to induce significant changes in viewers.

"Great artists are not just people with skills They are people who have the courage to convey very private messages about themselves. They are people who dare to risk a hostile response from stranger and friend ... The throngs of people who respond to the work of Rembrandt ... or Beethoven indicate that the private feelings which these great artists are able to call forth are almost universally present in other human beings . The work of art touches the heart, and the viewer or listener may find his life enriched without all together knowing why.

The artist articulates in his medium that which is preconscious - it is like a good analytic interpretation that joins together two or more associations and finds a common denominator thereby evoking a new meaning which allows what was once a chaotic and nonsensical to reappear ordered and sensible. Old disconnected material is viewed in a new connected alive way."

Significant Psychological Change and Surprise
Significant psychological changes often occur at times in treatment in which the patient has experienced some unexpected event that by definition completely takes him by surprise. Further that the nature of the surprise is one that has dramatic and lasting impact on the patient. In all cases the patient sees the same reality data from an entirely different and illuminating perspective.

One such time was when I was once again despairing that I would never be able to learn to bear frustration at times when it was clearly in my best interest to do so. I said to my analyst that "asking me to change in this area is like telling me to change my breathing." He paused, sat back, put his hand on his chin and said: "But Yogi's change their breathing." The message was that the key to change is reality testing. Thus it follows: " there is a distinction to be made between speculation and real associations. That is that even the strongest feelings and expressions about reality are not necessarily equivalent to the objective truth about reality. The key to unraveling neurosis is recalling memories that have been repressed so they can be given up." {Dr.Rudolf Wittenberg - personal communication}.

Freud on Change in Analysis
"Where id and superego are, ego will be."

The end of a successful analysis is when the patient can convert neurotic suffering for the acceptance of everyday common misery.(paraphrasing Freud)

"The patient is in need of an experience not an explanation." (Freida Fromm Reichman)

"The patient is in need of an experience and an explanation." (Gibbs A. Williams)

Significant psychological change involves a change in perception of the data at hand. In this view it is a kind of Rashomoning of experience or in John Dewey's terms a reconstruction of experience. Note the following story for the inferred conditions preceding a potential shift in perception.

...Two fish heard that a great man who could perform miracles was in a certain place. They swam to the brook where he was instructing a crowd of people and swam near to him. They saw him come to the water's edge, scoop some into his hands and say how water was a great creation of God. It was cleansing, purifying, essential for life. It was in fact God's greatest gift. The fish touched by the teaching looked at each other and both said: I wish we could find some water.

The Experience of Significant Change and War
It is common for people in the middle of long term treatment to complain (understandably) that they feel worse rather than better. There are many reasons for this predictable set of affairs. Significant change happens by means of understanding but understanding takes a long time to happen. In long term analysis one of the crucial themes to be understood is the history surrounding the patient's need to split their experience of reality, unwittingly initiating their psychological illness. When the pain of realistic limitations (both internal and external) threatens to overwhelm the self - one means of keeping the system functioning {sheer survival} is to split experience - separating feelings from thoughts and/or eliminating one or the other from awareness. This muting of experience has the effect of dulling or blocking out psychic pain. While this defensive action does in fact accomplish its goal, it creates more problems than it solves. Thus, Zombies may be said to function but are clearly ineffectual human beings.

Understanding this state of affairs occurs at a point in treatment when a given patient is capable of standing their ground, so to speak, facing up to rather than retreating from the pain associated with their heretofore overwhelming internal and external realities. But facing rather than retreating means that they have to experience (often for the first time in their lives) the full brunt of the pain that the retreat from reality was utilized to avoid. Thus treatment at this point is often experienced as if the patient was in a kill or be killed war zone - in which his life is on the line every moment. Furthermore, what characterizes the atmosphere of this war zone is little hope for a major breakthrough - like the dropping of the Atom bomb hastening the end of World War II. Instead, what characterizes the nature of the therapeutic war with the self is more akin to the trench warfare of World War I. - twenty trenches ahead, followed by eight trenches in retreat and so on.

Significant change is experienced at this point as if the trucks of war were slogging through mud - or that the patient is tunneling a road through a mountain of granite. Change is measured in small but cumulative increments. When small increments of step by step, meaningful connection by meaningful connection forges links of cause and effect chains that cumulate in an understanding of idiosyncratic psychodynamics, eventually there does come a synthesis of the personality. Just before the shift occurs between situation usual - nothing significantly different seemingly happening - versus, situation definitively different and better - it is apt to say that the patient's experience of the whole sweep of his therapy is often full of doubt as to its overall efficacy. But that once getting over the hump and experiencing significant psychological change in a direction that the patient has longed to acquire - the doubt turns into conviction and the whole sweep of the therapy is aptly experienced as 'it is darkest before the dawn.' Persistence wins the day but no therapeutic victory worth the title is ever accomplished without the patient deeply engaged in an all out battle with themselves struggling with struggle.

Significant Psychological Change is
like Climbing Mountains in Inner Space
The process of therapy as like mountain climbing generally begins with high energy and an all out commitment often taking the form of a rapid thrust upwards. But sooner than later there is experienced the first of many inevitable glitches. The patient stalls or plateaus. One may become discouraged and retreat to the base camp. Perhaps there is a regrouping and beginning once again. The journey is never straight up as resistance dogs the way. Progress in analysis is like the learning curve: ten steps up, seven back, stall, climb, resist, regress, up again and the likes. Additionally the higher you climb the more rarified the air. Persistence wins the day. {Personal communication: Dr. Rudolf Wittenberg}