What is Effective in the Therapeutic Process?

Using the term “therapy” in its most honorable sense, I believe most of us would grant by now that therapy may occur both within and without psychiatry. While life can be rather inventive in providing therapeutic moments, the sad fact is that most of our patients, rather than meet such a moment, will perversely turn the other cheek. And if we restrict our considerations to the achievements within psychiatry, we are forced to acknowledge that the theories sustaining the therapist may be as various as those of Freud and Jung, Adler and Reich, Sullivan and Klein. So disparate, if not contradictory, are these theories, that they often seem to have no more in common than an abiding interest in the patient's improvement. Still it would be foolish to act, in the face of such diversity, like the anticlerics of the twenties who thought the sheer multiplicity of religious sects disposed altogether of the question of religion. It would be preferable to assume that each system offers its own way of objectifying, if not the patient, at least his psychopathology. And if we add the technical instruction and the rewards of personal analysis, acquired in the training institutes, we can recognize a considerable ground of knowledge or science, which will not necessarily interfere with therapeutic effectiveness. Hopefully, each student will eventually transcend his training, or at least shape his subject as much as his subject shapes him.

What lies beyond theory and training, however, is something we all recognize when we are obliged to refer a close friend or relative for treatment. When our relationship with the patient is casual, we make our referral on the basis of training—or even