Communing and Relating: Part 1-Past and Current Perspectives

As theories regarding man's nature have been evolving, there have been concurrent changes in the formulation of the analyst's role in the therapeutic process. Freud spoke of transference and, later, counter-transference. In a definitive manner Sullivan1 emphasized the importance of interpersonal relations in theory and therapy. Horney2 amplified the concept relationship to include relationship to self and relations to others; relationship had intrapsychic and interpersonal reference. In her formulations regarding the doctor-patient relationship she also included what was healthy and neurotic in patient and therapist as determinants in the effectiveness of the therapy. This was in keeping with her holistic viewpoint in theory and therapy.

While Horney was evolving her ideas, and since, Ivimey3, Kilpatrick4, and Wassell5 contributed to our understanding of the doctor-patient relationship. Wenkart elaborated the concept relatedness.6 In commenting on Ivimey's paper on transference, I suggested that the concept of the doctor-patient relationship was more in keeping with Horney's ideas and methodology as of then . As my own ideas on unitary process thinking have been evolving, I began to wonder about the adequacy of the concept, the doctor-patient relationship. In a panel on that topic , to give my comments a contextual background, I began with a definition of the therapeutic situation.7

“The therapeutic situation is a bipolar unitary process. Doctor and patient are the two aspects of this single integral reality, having a subject and an object pole. Subject is used to mean to subject, to influence, to effect, to act as environment of the object. Object means that which objects, which is temporarily and to a degree under the influence of an environment governed by laws heteronomous to the object's nature. From moment to moment, doctor and patient function, now as subject and now as object, for the other.

“From such a concept of the therapeutic situa