16 Optimal Responsiveness and the Therapeutic Process

Although tacitly accepted as an important element in the therapeutic practice of psychoanalysis, the concept of optimal frustration has received little theoretical clarification. The publication of Heinz Kohut's (1977a) landmark work The Restoration of the Self established optimal frustration as a central aspect of the curative process viewed from the perspective of self psychology. With one of his critics, Kohut (1977b) recognized the problematic nature of the question “What is optimal?,” yet he never arrived at a satisfactory answer.

I intend to reexamine this question in light of the related issue of “optimal gratification.” My purpose is, in part, to demonstrate the significance of the latter, which has until recently been regarded with some suspicion as a form of countertransference acting-in, evoked perhaps by the patient's acting-in in the transference; as a manipulation of the transference itself by the analyst deliberately adopting a role (the so-called “corrective emotional experience” of Alexander, 1956); or, at most, as a useful but temporary parameter to be discarded at the first possible opportunity.

I will suggest that any discussion of the concepts of optimal frustration and optimal gratification becomes inevitably entangled in insurmountable theoretical difficulties and endless debate when separated from the more useful and encompassing idea of optimal responsiveness, defined as the responsivity of the analyst that is therapeutically most relevant at any particular moment in the context of a particular patient and his illness. Empathy or vicarious introspection is the process by which the therapist comes to understand the patient by tuning in to his inner world. Optimal responsiveness, on the other hand, refers to the therapist's acts of communicating his understanding to his patient.

The origin of the term “optimal frustration” is not clear. Although he credits Bernfeld (1928) with its first mention, Kohut (1972) appears to have