The Whole Patient In Therapy

We deeply regret that Karen Horney cannot be here to contribute to this symposium. While I feel greatly privileged and honored to be asked to present her psychotherapeutic viewpoint and methodology, I do so with some misgiving, since Horney herself, despite her prolific writing,1 gave us no volume specifically on psychotherapy or psychotherapeutic methodology. I think this was largely because she so keenly appreciated the highly personal nature and unique quality of every therapeutic relationship.

The only way I can do justice to Horney and to this symposium is, first, to indicate briefly what I think psychotherapy in general has derived from her viewpoint and, then, to show what I personally have derived from my analysis by her and from my fifteen years of close association with her.

Foremost, we have the optimism that stems from Horney's rejection of instinct theories, with their implied fatalism, and her basic premise that we are not passive agents victimized by immutable instinctual conflicts, but rather that man with his culture carries the responsibility for initiating, aggravating and perpetuating his own disruptive inner conflicts and, at the same time, carries the capacity to change.

The patient is approached, not as being innately a cannibalistic and “polymorphous perverse criminal” but as a crude, integral part of the social body at birth, with some inborn sense of order and rhythm, and the potentiality to contribute uniquely to the orchestration of the social body, i.e., self-realization. On this premise all authoritative attitudes toward the growing individual stem from love and respect, and not from fear and the imperative need to repress and sublimate something thought to be instinctively antisocial.

Horney worked in terms of basic anxiety initiated in childhood by inimical cultural influences, and described by her as “feeling alone and helpless in a hostile world.” Henceforth, the individual is driven compulsively and automatically in indiscriminate and