Dissecting the Elements of Therapeutic Change: A Response

Abstract

In his paper "What is therapeutic change?" Hans Strupp argues persuasively that such change occurs when the therapist supplies a "benign interpersonal context in which the client. . . can modify the patterns of previous learning . . ." The key to the benign interpersonal context is the relationship with the therapist. The therapist's interpretations "become maximally meaningful only when one's current experience, preferably in relation to the therapist, evokes the painful affects that are . . . the concomitants of the earlier faulty learning." Strupp also says that the therapeutic context which leads to change cannot be easily dissected into elements or linked to specific techniques. Some of the most effective therapeutic techniques are "spontaneous occurrences in which the therapist "rose to the occasion," "passed a test." Perhaps Strupp is too pessimistic about our ability to dissect the interpersonal context in therapy. Perhaps, also, his argument that interpretations are most meaningful when the relation to the therapist evokes painful affect should be understood in a larger theoretical context which is the result of his own theoretical stance toward therapy. Most of what Strupp says is entirely acceptable to me. I agree that people have early life experiences which tend to promote certain patterns of thinking, feeling, and behaving. I know of few therapists who would disagree with his statement that warm involvement with the client and communication of a new perspective can lead to therapeutic change. Yet, while feeling in general agreement with him, I believe that the model he uses is limited and his language is insufficient. First, let us look at his statement that the client has acquired certain maladaptive patterns from early experiences. I believe the statement is true, but it ignores something. The acquisition of maladaptive patterns is not a passive response to early experiences but active learning. Two people having the same experience need not learn the same thing from it. What we learn from experience is already partly predetermined by the perceptions we have at the time of the experience. In the words of Alfred Adler ". . . everyone is master of the way in which he utilizes his experiences" (Ansbacher and Ansbacher, 1956, p. 212). The child confronted with a newborn sibling may decide to feel dethroned and unloved or may decide to make a significant place for itself as an "older" and "bigger" brother or sister. The roles we choose to pursue, are those that will allow us a sufficient amount of significance in the family constellation. For the therapist, how the client interprets his past is more" significant than the events themselves. It is not that Strupp ignores the importance of the cognitive point of view; it is rather that he seems more wedded to the importance of the affective experience in therapy. Thus, he says, ". . . the experience of a 'good relationship' will in and of itself lead to cognitive change . . ." In the very next paragraph he says " . . . a patient can learn to see his or her assumptive world in a different light and, based on these experiences begin to act, feel and behave differently . . ." He could just as well have said that just as a good relationship can lead to cognitive change, new cognitions can lead to better relationships and thus more clearly show that when we try to divide cognitive from affective we are treating a single dynamic system as if we could affect one part without also affecting the other. I certainly do not deny that many important therapeutic events take place in the analysis of the transference and that interpretations of the transference facilitate important therapeutic change. However, to classify this particular type of patient-therapist transaction as the most powerful, is simply to demonstrate a bias in favor of classical psychoanalysis. I do not wish to depreciate the power of such interpretations, but I wish to broaden our concepts of potent interpretations. …