Response to Commentaries

The purpose of our target article was to lay the foundation for a comprehensive theory of how the forms and transformations of affect are at the heart of the therapeutic mechanism of change in psychoanalysis. In our view, many important and salient points have been raised by this distinguished group of commentators. We view their comments, for the most part, as raising issues that will need to be addressed as the basic template that we outlined in the target paper gets filled in and then incorporated into mainstream psychoanalytic theory and practice. In the pages that follow, we explain why we hold this position, and what bridges will need to be built between what we have presented and other conceptual frameworks. We believe that this will result in the creation of a comprehensive theory of clinical change, with affect at its core. We begin by making general remarks and then address the specific issues raised by each commentator.

Our starting point for our target article is that the fundamental problems that bring patients in for psychoanalytic treatment involve emotional responses that are out of conscious awareness. We believe that emotional change in psychoanalysis can occur in two ways—with emotional awareness and without it. Our target article focused on the former and, in a secondary way, outlined the latter. The fundamental process of change with insight involves bringing these emotions into awareness, understanding the meaning of these emotions, and then using this understanding to change how one navigates the external world. We wish to emphasize that this fundamental principle was not challenged by any of the commentators. The important issues that they raised involve how one conceptualizes that process and exactly what neural structures are involved as the transformations occur.

The commentators who responded most favorably, and appeared to accept our conceptualization most fully, were Dr. Leslie Greenberg from the perspective of psychotherapy and Dr. Micha