What is Effective in the Therapeutic Process?

Psychoanalytic therapy, when it is effective, means the nurturing of a feeling of mutual trust. I believe it is only within the human climate of this ever-enlarging wholeness that the doctor draws the strength with which to further his patient's growth. In time, the relationship between doctor and patient becomes one of the most sensitive and refined expressions of social relatedness. I believe it is largely in the exercise of this basic psychoanalytic process that its effectiveness as therapy occurs.

At the beginning, depending on the depth of his alienation, the patient will have little interest in any of this. What our patient wants, and understandably so, is emergency treatment. For example, he wants our help in the repair of his all-important self-idealizations. It is on the strength of these that he feels that he can live. Without them he feels, “It is unsafe to stay alive.” What is more, he looks only for minor repairs to be done because, overtly or secretly, he believes his way of life to be fool-proof. He cannot know that what he takes for strength lies in a design which makes him emotionally out of step and, as in psychoses, ultimately impervious to life itself. When this happens the patient will complain of feelings of inner deadness. Living with the fullest range of feeling is the only source of our strength; if the patient is deprived of this source what impetus does he have left with which to grow?

Our patient wants corrections to be tacked on. He wants rules and formulae and what amount to new innoculations against life itself. Life is becoming for him his greatest obstacle, and overcoming it his deepest passion. For it is only when he feels he is successful at this that he experiences a transient state of safety. Searching has no place because it would involve him in the possibility of undergoing massive disintegration which would strike sheer terror in him. It is for this reason that our patient is in constant dread whether he faces it or not. This is