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I FREQUENTLY HAVE THE IMPRESSION in reading the relevant literature that we are often involved in conceptualizing our concepts rather than conceptualizing the therapeutic process. That is, the abstract nature of the conceptualizations seems remote from my experience of the therapeutic work.
Another related observation has to do with hearing of people's experiences in analysis with other analysts whom I know personally, or whom I've heard speak, or whose writings I've read. I am so often surprised by a discrepancy between what I hear from the patients or ex-patients and what I would have expected on the basis of the analysts' formal or informal presentations. I now feel it's a very risky business to try to predict how analysts actually work. Incidentally, I assume the same is true of me.
All of this tends to confirm Clara Thompson's observation that the therapeutic relationship is like a marriage in that it's very difficult to convey to someone outside the relationship what the experience of being in it is really like. And yet, to advance our understanding of the process, we have to keep trying. Here's the way I think about the therapeutic process—most of the time, but not all of it. My orientation is, as with good therapy, to present my thinking concretely—that is, to reduce the level of abstraction as much as possible.
Psychoanalytic work takes place essentially between two poles—that of victimization and responsibility. That is, people become patients because they experience themselves as victimized. They feel victimized by other people, by their families past and present, by the circumstances of their lives, by their jobs, by the world and by themselves. They feel victimized by their emotions, their thoughts, their desires and their actions. They experience themselves existing