From Theory-Centered to Patient-Centered Treatment: How Kohut’s Attitudes Impact Contemporary Therapeutic Work

Kohut struggled courageously to proffer many ideas that were opposed to the psychoanalytic theories, philosophy, and clinical ideologies of his day. Not only did he question the way psychoanalysis was practiced, more importantly, Kohut challenged the prevailing Freudian view of human nature; no one since Freud had offered such a radical Weltanschauung, a world view that discerned man and woman in such a disparate light that it precluded self-psychology’s easy integration with other theories. In this article, dedicated to my mentor Paul Ornstein, I will take you on a journey, from the time that self-psychology came unbidden into my life – a time when I was trammeled in the musty corridors of a glum and occluded psychoanalytic world both in my training and my analysis – through its dramatic impact on my clinical attitude toward therapeutic work, to my attempt to preserve and update some of Kohut’s more important attitudes and concepts. I will emphasize the frequently unrecognized clinical consequences of Kohut’s world view – his belief in protecting the patient, his faith in letting the patient teach us how to analyze him or her, his receptivity to permeable boundaries, his capacity to be vulnerable, his transformation of the atmosphere in the consulting room, and his belief in building on health rather than curing pathology. Traveling along this journey we will discover how Kohut altered the therapeutic relationship from one of shadow companions to intimate connections.