You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
The major dynamic in all psychotherapy is the transference relation between the patient and therapist. This element in the therapeutic process has been vaguely recognized even among the ancients and more clearly so in recent years. When Socrates recognized the existence of mental disturbances apart from physical illness, he prescribed “sweet words,” as a cure. We now hear about the “bedside manner” and of the “therapeutic personality.” The fact is commonly recognized that some persons are more able to evoke a friendly response than do others, and that physicians and psychotherapists possess these qualities to varying degrees. In practice one finds patients with whom a particular therapist cannot establish a workable relation at all, while they are attracted almost instantaneously to another.
The initial empathy a patient feels with the prospective therapist is as good a guarantee of success in psychotherapy as one can have. The fact that during treatment there may arise negative feelings and hostility toward him does not detract from the basic soundness of the therapeutic relation. The persisting original sympathetic attitudes of the patient will help buffeting these negative phases.
When the patient comes for treatment he tests the therapist against the unconscious and conscious attitudes he acquired before and during the oedipal conflict. These can be direct reflections of the parental image, they can be a distortion of the real parent, or a negation of him. He may desire the therapist to be fully or partially like his parent, or the very opposite. This preference is determined by how successfully the patient has repressed his incestuous drives toward the father or mother, and whether he has built up supplementary, confirmatory or negative images in later life. He may have added images to those of the real parent that he had for some reason found desirable.
These are among the reasons why some patients readily respond to one therapist and cannot accept another. Rappo