ABSTRACT
It is consonant with our newer view of psychoanalysis that we cannot at this time give a very satisfactory answer to the question of how therapy works. Psychoanalysis and, by implication, dynamic psychotherapy now rest upon a series of interlocking partial theories involving drive theory, objectrelations, self-development, structural organization, interpersonal interactions, and narrative construction,at least.Where we once enjoyed the luxury of a single overarching theory that undertook to explain all, or nearly all, of psychic life, we now struggle with competing theories, none of which has yet demonstrated sufficient power or has mustered enough evidence to compel anyone to give up his favorite point of view.While this situation may be distressing to theorists, I believe it is advantageous to clinicians, because it permits, in fact requires, that we examine more carefully what we are doing,under what theoretical aegis, and to what end.This is, therefore, an excellent time to examine what are the active and necessary ingredients of the complicated action called psychotherapy, aware that it is highly unlikely that any single element will be able to claim primacy. I shall, perhaps controversially, treat psychotherapy as a derivative of psychoanalytic theory, employing more openly and in different proportions a large range of technical procedures that are present but muted in psychoanalysis. My perspective is that psychoanalysis and psychotherapy exist on a continuum, clearly distinguishable at the ends of the spectrum and blurred in the middle (see Chapter 8).
