What is Effective in the Therapeutic Process?: A Round Table Discussion

I feel honored by the privilege offered me to moderate this Round Table on the vitally important and significant topic, “What is Effective in the Therapeutic Process?” We do not intend to negate other sources from which a distressed person may gain help. However, this panel of psychoanalysts is specifically concerned with the kind of help which leads to effective therapy. True effectiveness would be reflected in personality change and growth. Can we arrive at tentative formulations regarding the forces which are derived from our clinical data? Can we clarify what actually transpires during the therapeutic process which results in a positive contribution toward the patient's becoming healthier? How can we more effectively communicate our experiences to each other? These questions are of paramount importance for the present and future consideration of each one of us, both as they relate to the welfare of our patients and of psychiatry.

In a general review pertaining to this subject, I was struck by the variety of factors which were considered of primary importance in their contribution to effectiveness in the therapeutic process. Some therapists emphasize mainly the doctor-patient relationship; others give centrality to the personality of the therapist, stressing the influence stemming from his philosophy of mental health and neurosis which determine the character of his participation and interest in the whole of the patient. Others put the activation of the constructive forces in the patient in the foreground; still others give predominance to the working toward diminishing the destructive forces. Some attribute the weight of importance to the development of insight through helping the patient understand his dreams, relive his childhood memories and the timely use of valid interpretations. Some regard effectiveness as a reflection of a successful process of reeducation. Then there are therapists who correlate effectiveness with helping the patient achieve a greater to