Psychotherapy of the Hysterical Personality Disorder*

I begin this presentation with a brief orienting statement of my general approach to psychotherapy. I shall then delineate the main clinical features of those patients to whom the label of hysterical personalities is applied with case examples. I shall proceed to discuss certain problems which arise in psychotherapy with such patients, illustrating this material with clinical vignettes.

For me, therapy is a dialogic process in which I am the participant observer. Although a demanding role, I find it congenial, and it also enables me to employ the learning theory model which I believe accounts for beneficial changes in patients. I appreciate the freedom afforded by Sullivanian theory to bring my own reactions, when appropriate, into the transactional arena without the uneasy feeling that I have violated the rules or am indulging in a parameter. I see the task of the therapist in being aware of the two levels of communication between the patient and himself—the instrumental, reality oriented, purposive level and the more or less unconscious, transference-oriented one whose obbligato underscores and colors (and sometimes dominates) the conscious theme. I place great stress on listening carefully and respectfully. I try to understand what the patient is saying directly; the therapeutic value of this experience for the patient is often underrated in the eagerness of therapists to unravel unconscious content. Sometimes, one might say, there is more on the surface than meets the eye! However, the therapist must do more than just listen—he must listen creatively. He must be able to make wise decisions about when to leave out and when to bring into the context of the therapeutic dialog the subsurface content which is always present, and he must be able to orchestrate the interplay between content and process which to me constitutes the defining characteristics of