What is psychoanalysis? Often it is described as "bringing unconsciousness into consciousness" or "getting insight into the resolution of conflict." In other words, through psychoanalysis one comes to understand the existence of psychic pain that was not perceived until then, and that understanding allows the person to begin resolving it. It is essential that the habits of feelings and thoughts (defense mechanisms) that lie behind psychic pain are taken up as resistance in psychoanalysis (in the therapeutic relationship) and are worked through. "Remembering, repeating, and working through" are basic principles of psychoanalysis.

   In the psychoanalysis of defensive states (slightly disturbed personality disorders), the therapist does not encounter difficult situations and treatment will not take a long time if it follows the above-mentioned therapeutic principles. But these basic principles are too vague in the treatment of pathological states (severely disturbed personality disorders) or psychoses. For example, it is necessary to bring unconsciousness into consciousness over and over again. As regards defense mechanisms, here we see very complicated nature of mind that are connected with one another. The therapist also encounters severe symptom formation protruding from defense mechanisms. As the therapist deals with resistance, he/she finds multiple kinds of psychodynamics close together. It is difficult in those situations to judge what and how he should work through them. That naturally increases the frequency of sessions and prolongs the treatment. The therapist cannot assess the future prospects if he/she goes only by these basic principles.

   Through trial and error, many psychoanalysts hace come up with models for treatment in these situations. Those of Otto Kernberg and James Masterson in the psychoanalysis of borderline cases are well known. Also widely known is the "separation-individuation process" of Margaret Mahler, a developmental theory often used in borderline therapy. Another is Heinz Kohut's psychoanalysis (self psychology) on narcissism. Kohut did not clinically deal with pathological states (severely disturbed personality disorders), but he brought forward the concept of narcissistic neurosis, which is different from Freud's concept of classical neurosis. Nowadays, these are generally known as narcissistic personality disorders in defensive states (slightly disturbed personality disorders). By the way, the work of borderline cases and narcissism in fact contributed to some progress in making prognoses in functional mental disorders. The substance of their researches is reflected in current strategies of therapeutic techniques. Because of such work, we know that interpretation is important in the treatment of borderline cases because management of aggression is so central in the therapeutic approach, and that empathy is important in the treatment of narcissistic neurosis.

   Thus, we have made some progress in psychoanalysis, but the ratio of cure in pathological states (severely disturbed personality disorders) nonetheless is actually still low. Certainly advances have been made in understanding mental disorders, but psychoanalysis comes to be more and more put into culture if it is unable to bring about cure of patients. These were the circumstances when I started a study of psychoanalysis. But I was fortunate to be able to study psychoanalysis under the supervision of Okonogi. One of Okonogi's concerns is the so-called Ajase Complex, developed by Heisaku Kosawa, Okonogi's teacher. It proposes two types of guilt; one is the punitive type, and the other is the forgiven type. The latter has its source in a "sense of penitence," which is Kosawa's concept discussed in a paper called "Two kinds of guilt−Ajase Complex" on the sense of penitence (forgiveness). I found the paper very interesting, and although I did not realize it until later, the study on forgiveness inspired a series of discoveries that I made.

   Fifteen years later, my radical treatment of several borderline patients was successful. Finding that forgiveness was the concept that held the key to my success in treatments, I studied the structure of forgiveness (what psychodynamics operated in forgiveness). I came to understand that not only rebellion but also apology is an important constituent factor in forgiveness. As regards the therapeutic technique of interpretation, specialists have studied well how to make effective interpretation, but they lack understanding of the nature behind interpretation. They understand little of how interpretation works as the rebellious object. My borderline patients formed the rebellious self through introjecting me as the rebellious object (not the punitive object) and identifying with it. Patients also introjected me as the apologetic object, and formed the apologetic self, which became the basis of perseverance. This is the formation of the loop of forgiveness. Finally clarifying this, I was able to explain the question of dealing with aggression apart from the topic of narcissism (taken up below), and to improve the borderline theory of Kernberg, which did not clearly distinguish the aggressive system and the fragile system.

Roots of the Integration Theory of Psychoanalysis