The Final Goal of Psycho-Analytic Treatment

Michael Balint read this paper at the International Psychoanalytical Congress at Lucerne in August 1934, and it appeared the following year. He asks whether clinical experience alone, rather than a philosophical, moral or biological ideal of health, can define the point towards which an analysis naturally tends. He starts from re-analyses and difficult cases, which show the obstacles to cure more plainly than smooth ones, and from an observation: in deep analyses the final months bring almost no new unconscious material, yet that is when patients actually get well. Judged against this, the 'classical', structural definitions, all of them Freud's (making the unconscious conscious, lifting the infantile amnesia, overcoming the resistances), are neither necessary nor sufficient. The 'romantic', affective ones are too general or too narrow: abreaction of strangulated affects, the full reliving of the Oedipal relation (Ferenczi and Rank), abreaction of the birth trauma (Rank), the working-off of the repetition factor (Vilma Kovács), and orgastic potency (Reich). Balint develops the 'new beginning' he had described at Wiesbaden in 1932. Near the end of treatment, patients revive long-abandoned infantile wishes and seek to have them gratified. At first they do so timidly, then with an addictive passion. If this is mishandled, it turns into insatiable demands and an inflated narcissism. If patient and analyst persevere, it gives way to a realistic object relation. Because these wishes are always directed at an object, Balint turns to Ferenczi's theory of the erotic sense of reality. He argues that every drive is object-bound from the first and has a passive aim, to be loved and satisfied, which lasts throughout life. Autoerotism and narcissism, like active object love, are detours that frustration imposes. The anal-sadistic and phallic phases are artefacts of uncomprehending upbringing, not normal stages. Neurosis therefore always has a real cause in the environment. Balint presses this point against the stress on structure and constitution in the analysis of his day, taking Melanie Klein's The Psycho-Analysis of Children as his example. The final goal of treatment, then, is that the patient dare to begin loving anew. What must begin again is object love itself, not particular partial drives, and the analyst helps by noticing and protecting these tentative beginnings. Balint admits that patients who can only demand to be loved remain beyond his technique. He closes with the motto 'less sadism and more love'.