Identifying Targets for Treatment
Psychotherapy is a process-oriented, time-unlimited relationship between therapist and client. This process emphasizes transference, or feelings the client has toward the therapist that stem from significant others in their life, and countertransference, or reciprocal feelings the client elicits in the therapist. Comments made by the client during therapy are periodically interpreted in terms of conflicts and defense mechanisms used to cope with these conflicts. Treatment targets are not explicitly defined. The client wants to feel better and the therapist wants the client to improve. This mutual understanding is generally not further refined. If pressed, therapists may indicate that their goal is personality reconstruction. What constitutes such a reformation remains unspecified. Other therapists specify shoring up psychological defenses but little further specification is given. Many therapists resist specifying particular treatment targets on the basis that this equates therapeutic success with symptom reduction, which is not necessarily a good thing. There is some concern over symptom substitution-meaning that if particular improvements were engineered in one area of a client's life, then new problems would emerge in other areas because basic underlying problems have not been resolved. These problems can be stated theoretically but are not easily defined in terms of specific treatment targets. Other therapists resist focusing on specific treatment targets on the basis that the client may take a "flight into health" as a defensive maneuver to terminate therapist inquiry into conflictual material. Again, therapeutic objectives are framed in more general theoretical, rather than specific practical, terms.