Concerning Therapeutic Symbiosis

In 1958 I postulated that symbiotic relatedness constitutes a necessary phase in psychoanalysis or psychotherapy with either neurotic or psychotic patients, and introduced the term “therapeutic symbiosis” for this mode of patient-analyst relatedness (Searles, 1959a). In 1959 I stated that what the analyst offers the patient which is new and therapeutic, in this regard, is not an avoidance of the development of symbiotic, reciprocal dependency with the patient, but rather an acceptance of this (1959b). My several subsequent discussions of this subject have included mention of the role of symbiotic relatedness in healthy, adult living (1965, 1967).

The present paper is the third in a series of reports on what I have learned in recent years concerning autism, symbiosis, and individuation. In these papers I am concerned not only with patients suffering from schizophrenia of varying degrees of severity but also with, for example, the subtle autism that emerges in the course of the neurotic patient's analysis. The first two papers included these passages:

The categories … of pathologic symbiosis, autism, therapeutic symbiosis, and individuation depict what I regard as successive phases of ego development in therapy. Whether any one patient needs to run that whole course will depend upon the level of ego development he has already attained at the beginning. He may already have achieved, for example, a strong capacity for a therapeuti-cally symbiotic relatedness, in which case the first two phases of ego development would be relatively little in evidence in one's work with him [Searles, 1971, p.70].

I have described it as characteristic of this phase of transition between autism and therapeutic symbiosis that the analyst now begins to find it feasible effectively to make transference-interpretations. This is in contrast to the earlier, autistic phase, during which he has had to adapt to long stretches of time during which