Reply to Gill, Jacobs, and Shapiro

I am grateful that Drs. Gill, Jacobs, and Shapiro have taken the time and trouble to comment on my paper. I found their remarks interesting and have learned something from all of them.

What I found especially interesting about Shapiro's paper is what can be seen as his metatheoretical perspective on the therapeutic function of theories. Shapiro takes the position that just about any psychoanalytic theory of treatment may equally serve important therapeutic functions such as providing the therapist with a safe haven when he or she experiences confusion and distressing affects. I am inclined generally to agree with Shapiro, although I would like to believe that there are limits to his proposition. That is, it is possible that there are some theories that are so generally off the mark or so inappropriately imposed on, and specifically off the mark with, a given patient that their theoretical content does make a therapeutic difference. Thus, for any given patient it may not be the case that all theories are equal with regard to “fittingness” and therapeutic effectiveness. Ultimately, this is an empirical issue (i.e., whether, to what degree, and in what ways the theoretical persuasion of the therapist makes a difference in therapeutic outcome) that, although testable in principle, would be extremely difficult to investigate in a rigorous way.

I think Shapiro is correct in alerting us to both the usefulness and dangers connected with adopting a particular theoretical position in clinical work. It is inevitable and perhaps even desirable that one work from a particular theoretical position. And yet, there is always the danger of imposing one's theoretical bias on the patient's reports. I suspect that we have all experienced the operation of such biases, observed it, or both. I am aware of the contemporary view that all observation is held to