Reflections on the Therapeutic Process

This issue has a dual focus, and so will my contribution to it. On the one hand, the series of papers here represents an attempt, by a range of psychoanalytic clinicians, to convey their understanding of the nature of therapeutic action in psychoanalytically oriented therapy. On the other, it represents as well, in most of the contributions, a set of more specific reflections on a sample of my own clinical work that was shown and discussed at a conference on therapeutic action sponsored by NIP. Since I have written fairly extensively in the past on my general understanding of therapeutic action (e.g., Wachtel, 1997, 2008, 2011a, 2011b), I will mainly in this paper address the larger set of issues by responding to the comments made regarding my session with Louise.

A number of the commentators have emphasized that this was a one-session consultation with Louise rather than a session drawn from or reflecting a more ongoing therapeutic process. In some instances, especially for Darlene Ehrenberg, that distinction has been an act of generosity, a way for the commentator to throw me a lifeline or offer an “excuse” for how I proceeded in the session, which, through the commentator's eyes, would be highly problematic if this were how I conducted “real” therapy. For others, the main aim was simply to contextualize the discussion, since understanding the exact nature of the contact the session represented and the assumptions with which each of us entered the session is crucial for understanding the interaction between us and its meanings and implications. I do, of course, understand and agree that a one-session encounter is different from an ongoing therapeutic relationship, and I will address the implications of this for what I did with Louise as I proceed. But as grateful as I am to be

offered the “out” that of course I would practice quite differently if this were a sample of “real therapy,” I must resist taking hold of that particular lifeline and try to swim to shore o