When this final struggle to be himself is precipitated and the patient buckles down in earnest, there is a very definite prospect of a successful outcome in analysis. I am firmly convinced that beyond a certain point in a well-conducted analysis the patient gets caught in an irresistible forward-moving current which is irreversible. During this final phase he will have good days and bad days. He will feel identified with his real self, feel more natural, stronger, steadier, more honest. He will stumble temporarily into the old pitfalls of self-glorification and go riding high again. He will succumb to disbelief in and rejection of himself. But he cannot deny or betray his deepest vital interest in the real self once he has been fully awakened from pipe dreams and nightmares about himself.
Radical changes in the theory of neurosis, plus widening of the scope of our observations and a new understanding of the nature and dynamics of therapeutic changes, have led to radical modifications of the pessimistic attitude toward treatment of narcissistic persons. One of the crucial factors in our theory of neurosis is understanding the dynamics of therapeutic changes. Crucial factors in therapeutic techniques are an understanding of the kind of feelings between patient and analyst which actually promote a good human—and working—relationship, and the precipitation of the final all-out struggle between destructive and constructive forces in the patient.