title: The evolution of the internal dialogue during the psychoanalytic psychotherapy process.
abstract: This article illustrates curative changes occurring in psychoanalytic psychotherapy by developing the internal dialogue in the mind. By the internal dialogue, I mean the internalization of the therapy process during the recurrent therapy sessions so that the external dialogue between therapist and patient becomes the corresponding internal structure of the patient. In this way, there is a development of the patient's capacity to identify himself and the therapist as separate, sentient, thinking, and reflecting individuals, who have a free internal world of their own. The evolution of the internal dialogue takes place by gradually progressing symbolization achieved through a four-step symbolization-reflectiveness approach. This process is one of the specific curative factors in the psychotherapeutic treatment of borderline patients. The psychodynamics are illustrated by material from one session each of the early and the final stages of therapy, showing a shift from monologue to internal dialogue. The evolved internal dialogue is a central part of the patient's budding thinking capacity, which creates a ground for her subjectivity and autonomy. This study underlines and specifies three factors as cornerstones of the evolution of identity in psychotherapy: symbolization, reflectiveness, and the internal dialogue.
authors.affiliation: Health Care Center for Students, Turku, Finland.
authors.forename: M
authors.initials: M
authors.lastname: Keinänen
mesh_terms: D000328:Adult; D004532:Ego; D005260:Female; D006801:Humans; D007207:Individuation; D007389:Internal-External Control; D010553:Personality Development; D010817:Physician-Patient Relations; D011573:Psychoanalytic Interpretation; D011575:Psychoanalytic Therapy; D013561:Symbolism