This is an effectiveness study of treatment outcome that relies on patients' perception of their mental health during and after psychoanalytic psychotherapy. Ninety-nine outpatients attending the IPTAR Clinical Center (ICC) responded to the Effectiveness Questionnaire (EQ) adapted from that developed by Consumer Reports. Effectiveness is studied from various perspectives. Findings indicated (1) an incremental gain in effectiveness scores from six to over twenty-four months of therapy; (2) an incremental gain with greater session frequency from one to two or three weekly sessions; (3) facilitation of effectiveness by the experience of a positive relationship with the therapist; (4) an interplay between clinical syndrome and treatment conditions. A method giving clinical validity to the quantitative findings is described. Brief summaries of two recorded interviews reveal differential reconstruction of events that had occurred during treatment. The findings are discussed from the vantage point of two hypotheses: cognitive dissonance and internalization of therapeutic experience.

The suggestion is made that emotions organized on a preconceptual level are psychic constructs different in kind, as well as degree, from emotions organized on a more abstract conceptual level. For many people the regressive alteration in ego functioning that gives rise to these emotional constructions represents a characterological way of handling conflict. Emotions organized on a preconceptual level and rigidly maintained through primitive defenses ward off a host of fears ranging from castration to dedifferentiation. The shift from the preconceptual world of sensation to the conceptual world of abstraction complements the resolution of oedipal themes and is essential for free and easy movement between reality-based interactions and the imaginary experience of both self- and object representations in the transference. Structural and dynamic aspects of these emotional constructions are discussed and their relation to a person's experience of reality is explored through transference material taken from different points in an analysis. The problem of the analyst's use of concepts to refer to preconcepts is also discussed, as is the issue of enactments.

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In this article I have argued that the more linear transformations or desymbolized expressions of one's earliest relationships are always a part of psychic reality and represent a unique opportunity in the analytic situation to transform a person's emotional orientation to the world. A necessary condition for this to come about is the analyst's capacity for sustained interest in the patient. This interest, which goes well beyond an intellectual one, can be threatened by countertransference as well as certain assumptions the analyst has about the nature of the analytic process. The analyst's belief in the analytic process, a belief that can only come from his or her own analysis, is seen as crucial in helping the transformational process that occurs in a successful analysis.