Therapeutic Action: An Introduction and Overview

Our idea for this collection of essays had been percolating for some time before NIP's annual conference in May 2009: “Clinical Dialogues on Therapeutic Action in Psychoanalysis.” When Paul Wachtel, who presented case material there, agreed to participate in this issue of Psychoanalytic Perspectives, sharing the same generative clinical work as he had at the conference and proposing to write the conclusion, it became eminently clear that we would have the corpus of a valuable document.

Conference panelist Jim Fosshage and chair David Brand likewise signed on, agreeing to write papers formulating their views for this issue and using Wachtel's work as the common clinical example. In addition, we were pleased to extend the discussion by inviting Darlene Ehrenberg, Donna Orange, and Sandra Shapiro as contributors. Their unique voices, we felt, would add diverse and important perspectives. Ehrenberg has been an ardent advocate of authentic exchange. Orange's background in philosophy always adds a valuable dimension to analytic discussion. And Shapiro is among the most knowledgeable people on the professional scene on the subject of trauma. They did not let us down.

Finally, Kenneth Frank, spurred by the forming discussion, felt the desire to add some of his own thoughts. Emphasizing the action dimension of the therapeutic exchange, which he has discussed elsewhere as an important element of therapeutic action, he outlined that dimension as central in Wachtel's work (Frank, 1999).

So what constitutes the therapeutic action of psychoanalysis? How does this practice we engage in with our patients work to effect positive change? In our pluralistic age, it's virtually impossible to respond with anything like consensus. Such questions are in keeping with the nature of the “monster” we call psychoanalysis, as Lewis Aron tells us (Aron, in Safran, 2009) Citing Laurence Friedman, Aron characterizes psychoanalysis as monstrous, meaning