Action, Insight, and Working Through Outlines of an Integrative Approach

Action and insight form an essential dialectic within the psychoanalytic process. Yet many recent psychoanalytic formulations, while emphasizing integration, have continued to view psychoanalytic and action-oriented techniques dichotomously. It is reasoned that certain behavioral-cognitive techniques that promote adaptive behavior can become an active part of an in-depth analytic experience, providing material for an exploration that results in new ways not only of relating but also of experiencing the self and others. Such an approach, while at times helpful to certain patients, can be counterproductive for others. An integrative approach is compatible with many recent psychoanalytic frameworks emphasizing a two-person psychology, but not with a one-person vision of the psychoanalytic situation; in the two-person view, it is reasoned that an integrative approach is capable of maintaining the integrity of the analytic process. The outlined technique reflects a relational psychoanalytic orientation emphasizing internalized object relations, with the use of action-oriented techniques organized by the superordinate goal of modifying psychic structure, conceptualized principally in terms of self- and object-representations. Reasoning that this approach is congruent with certain theoretical contributions from Gill, Mitchell, Sandler, and especially Wachtel, among others, I state underlying assumptions of the approach, preliminary technical guidelines, and illustrative case material.