Therapeutic Actions

This distinguished group of authors has offered us a great deal of food for thought. Having seen the other contributors' essays as issue co-editor, I would like to discuss Paul Wachtel's work with Louise through a different lens, by focusing on the role of therapeutic actions. Customarily, we use the term “therapeutic action” to refer to the process or processes through which structural change is achieved. That might emphasize developments set in motion within the individual patient, describe what occurs between patient and analyst, or both. My interest here is with patients' new and constructive actions—that is, with “therapeutic actions” taken by patients—that both result from and contribute to therapeutic action (in the term's customary usage). I will consider the analyst's role in promoting, as well as the patient's in undertaking, such actions. These new behaviors may occur in session with the analyst or outside of sessions, with others.

I have written about this topic in depth (Frank, 1999). I do so again to mark the time when, historically, our acknowledgment of the role played by behavior and behavior change in psychoanalysis, and especially our use of influence in shaping behavior change, seems to have reached a turning point. In fact, I will show that there has developed a critical mass of opinion, at least among relational analysts, suggesting that a reversal of an earlier bias has occurred. What better forum in which to underscore this point than here, showcasing the clinical work of Paul Wachtel, the individual who undoubtedly has contributed the most to analysts' appreciation of the role of behavior and behavior change (Wachtel, 1977, 2008)?

Over the years I have heard many stories about analytic supervisors' criticizing their supervisees for interventions they regard as

“nonanalytic” because they address change at the level of surface behavior. Remarkably to me, I recently spoke to an “old-school” analyst who forcefully took a related position—that hi