The Idiosyncratic Nature Of Cure

DONALD SPENCE (1988), SUMMARIZING a workshop entitled "How Does Treatment Help?" proposed the following:

Theories … are all comforting to the degree that they suggest that we know something about how and why treatment works. … They comfort even more because they shield us from ignorance and from the knowledge that we have, at bottom, very little real understanding of the therapeutic process; a meager supply of facts; and almost nothing in the way of cumulative findings. (p. 190)

Perhaps this is an overly pessimistic appraisal of the first century of psychoanalytic practice. However, it does speak to our difficulty in making useful generalizations from accumulated clinical experience. Statements extolling the value of empathy, the mutual untangling of the relationship, the use of countertransference data, or detailed inquiry merely serve as helpful guideposts.

Although we might agree on the kinds of outcomes that make us think that an analysis was successful, it is hard to know what has produced these outcomes without looking at the ebb and flow of specific exchanges in a particular patient–analyst relationship. In conceptualizing the process of change, it is important to recognize that what is mutative is created idiosyncratically by each analyst–patient dyad.

I agree with those theorists (Epstein & Feiner [1979] ; Ehrenberg [1982] ; Schafer [1983]) who emphasize that each analytic relationship is an original creation. As Levenson (1991) writes, "One's response is only called for in a particular way by a particular patient and is responded to in a particular way with a particular patient" (p. 94). But I would go further. Even if we were to control for gender, theoretical orientation, and experience, the nature of the patient's cure might be markedly different if the patient had chosen a different analyst. In other words, it is not only that each treatment process is unique, it is that each treatment outcome will