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This paper illustrates how I have incorporated and translated Hoffman's dialectical constructivism within my own theoretical and clinical framework—a broader context that combines our shared existential thinking with my own evolutionary perspective generating a view of analysis as a highly reciprocal process of mutual change.
The clinical story of Sarah and her son, Noah, illustrates how Hoffman's dialectical, clinical sensibility operates in the existential context of a child's mortal terror, parental love, self-love, deception, and self-deception in the ordinary good-enough family. Hoffman's dialectical tensions and constructivist process are seen as universal features of the human condition—adaptations that may have evolved, precisely, to regulate the inherent ambiguity and self–other conflict embedded in culture and human relating. The fallible “probing” for deep, reciprocal connection in Noah and Sarah's developmental interaction is viewed as a fundamental human capacity that operates in the treatment relationship and shapes the therapeutic action.
In this larger existential-adaptive context, dialectical constructivism is seen as calling us to a kind of radical empathy: a sometimes painful, challenging openness to being seen for who we are as we re-enter our own struggle to make meaning around the same universal, human issues that torment our patients.