The Kleinian version of change focuses on the working through of paranoid anxieties and the associated defences to allow the patient to reach the depressive position. Change is linked to the development of the capacity to mourn the separateness from the object and to bear the guilt and concern for the state of the object as a result of the phantasised, and real, attacks on it. As the depressive position is established, feelings of guilt and concern contribute to a wish to repair the perceived damage to the objects. The capacity to constructively manage depressive anxieties without resorting to paranoid modes of functioning leads, in turn, to a strengthening of the ego.
One of the main goals of treatment is to achieve greater integration of split-off aspects of the self rather than on insight. This task is said to be largely assisted in therapy by the detailed exploration of transference phenomena so as to help the patient to understand how he manages intolerable psychic states. The interpretation of transference is believed to facilitate a change in the patient's relationships to his internal objects, paving the way for a more realistic appraisal of the significant others in his life. This allows for a greater discrimination between the internal and the external world. Kleinians therefore suggest that change results not from a conscious exploration of the past but from a modification of underlying anxieties and defences as they arise in the therapeutic relationship and are worked through in the transference.
In this view of change, understanding (i.e. insight) and the relationship with a therapist who lends meaning to the patient's communications through an analysis of the jointly evolving interaction are inseparable. The transference relationship is held to be a key to the change process because of its focus on affect - itself regarded as an agent of psychic change - and because the Kleinians subscribe to the view that the here-and-now relationship is an enactment of the past, that is, it is thought to be isomorphic with the infantile past. By interpreting the transference, the therapist is said to be interpreting concurrently the past and the present (Malcolm, 1988). Given this, reconstruction of the past is not regarded as the most significant aspect of the technique; rather, it is the enactment in the present and its interpretation that is the effective agent of psychic change. Linking present patterns to the past is nevertheless acknowledged to offer the patient ''a sense of continuity in his life''(Malcolm, 1986: 73).
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