The Therapist-Patient Relationship: A Holistic View

This paper will try and explicate one theoretical reason for success and failure in psychotherapy. It is based on two interlocking assumptions, which will be presented with some relevant definitions. Evidence in support of the assumptions will follow, and, finally, some case histories will serve as illumination. Psychotherapy is a most difficult enterprise, and many factors-known and unknown-contribute to its success and failure. One such hypothesized factor will be discussed in the following pages.

Assumption 1. Personality is formed, maintained, and changed within a social matrix. Sullivan's22 view is utilized to suggest that human personality cannot adequately be studied or conceptualized without reference to its social origins and maintaining matrices. We can as well, in part, conceptualize our personalities as being comprised of cognitive affective structures12 or attitudes toward self and others. Although these attitudes are intrapsychic, they are directed toward others and cannot exist without their external referents. Such attitudes or structures guide present behavior toward others and, in turn, are affected by the behavior of others toward one's self. The affective interaction of self and others begins at birth and continues throughout our lifetimes.

The more closely we live with esteemed, feared, and otherwise important individuals and social Institutions, the more unchanging our personality. The denser the social matrix-that is, the more involved we are with large numbers of people and institutions-the more stable our personality. The more congruent the attitudes of our social matrix to our own, the more stable the personality.

The more autistic and narcissistic an individual, the more unchanging the personality. Such individuals hold internal dialogues with “introjected” figures13,14 and project their “introjects” and “personalities” onto others, creating their own experienced social matrix. We can add that our own