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This paper is based on my participation, together with my esteemed colleagues and good friends Jody Davies and Alan Schore, at the NIP Annual Conference on May 2, 2009. As the issue co-editors have delineated, the three of us were discussants of a videotaped consultation by our esteemed colleague Paul Wachtel. Our task was to present briefly our theories of therapeutic action, followed by our discussions of Paul Wachtel's consultation involving a close tracking of the therapeutic action in the clinical exchange. Since our presentations were extemporaneous and are now converted to the written word, I maintain the fluid conversational tone, especially in my discussion of Wachtel's interview.
I characterize my approach as emanating from a relational self psychological psychoanalytic perspective. I will first delineate very briefly my theory of therapeutic action and follow it with a detailed focus on the clinical material.
I have proposed two fundamental pathways of analytic change (Fosshage, 2003a; 2003b, 2005; 2011a). The first occurs at an explicit level and involves the explicit exploratory/reflective avenue to therapeutic change. While this corresponds with the traditional psychoanalytic focus on interpretation and insight, relational approaches at large emphasize a more collaborative exploratory process that expands reflective awareness. Exploratory/reflective processing enables us to become aware of organizing patterns (patterns of construction) that have been established on the basis of lived experience (Wachtel, 1980;
Hoffman, 1983, 1991; Stolorow/Lachmann, 1984/1985; Fosshage, 1994; Lichtenberg, Lachmann, & Fosshage, 1996). Awareness of how organizing patterns (for example, negative self percepts or self-with-other images) develop out of relational experience undermines their “felt truth” and gradually empowers us over time reflectively to intercede and deactivate problematic thematic patterns. Being free from the grips of a negative patte