The Essence of Therapy: What Is Essential for a Therapeutic Engagement and Psychic Change to Take Place and What Model/Models Explain It Best?

Abstract

Two patients in long-term intensive psychotherapy, both engaged at a deep transference level, are compared. The author explores two questions: First, “What is essential for a therapeutic process to take place?”; and second, “What contemporary theoretical models are useful in conceptualizing that process?” Six clinical/theoretical categories are delineated: (1) the quality of attachment to the therapist, (2) the nature of the transference, (3) interpretation, (4) patient and therapist personal attributes and life circumstances that facilitate and inhibit the process, (5) the responsibilities of both patient and therapist, and (6) how to conceptualize growth and what criteria to use to determine whether it has occurred. The final section discusses the self psychological theories that best explain these two patients: Kohut (selfobject theory and the nuclear self); Stern and the Boston Process Change Study Group (implicit relational knowing); Lachmann and Beebe (co-constructed interactions); and Shane, Shane, and Gayles (nonlinear systems theory).