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Paul A. Dewald, MD

Arch Gen Psychiatry. 1978;35(5):535-542.

Abstract
• The patient in psychoanalytic psychotherapy experiences a variety of psychological and emotional responses during the treatment process. These are described and conceptualized as related to the structure of the therapeutic situation, the therapeutic relationship, the mobilization of conflict, the experience of affects and drive derivatives, the phenomenon of reinforcement, and the working through of the termination phase. The distinction between "core" and "derivative" psychic functions is developed, permitting a conceptual understanding of how this form of psychotherapy can produce significant and lasting intrapsychic change. Some of the differences between psychoanalytic psychotherapy and psychoanalysis are described. The general concepts are illustrated by clinical vignettes from a case of successful psychotherapy.

Author Affiliations
From the St Louis Psychoanalytic Institute and St Louis University School of Medicine.

Footnotes
Accepted for publication Aug 16, 1977.

Reprint requests to 4524 Forest Park Blvd, St Louis, MO 63108 (Dr Dewald).

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