Chapter 3 Problems for a Rational Therapeutics in Self Psychology

Self psychology lacks an adequate theory of treatment. In his posthumously published book How Does Analysis Cure? Heinz Kohut (1984) described the action of psychotherapy, but he did not give a sufficiently comprehensive description. He characterized psychotherapy in broad terms as a reinstatement of development and as a process of structure building via transmuting internalization. These ideas reflect a distinctive set of beliefs increasingly articulated over the course of Kohut's writing, which form a coherent view of psychological health and help and of the essential qualities of human nature.

But Kohut never fully resolved the tension between his new ideas and his wish for their acceptance by the psychoanalytic community. There is a fundamental ambiguity in his description of the therapist's role in facilitating development. This has led to confusion about the basic stance of the therapist and the nature of therapeutic influence. In addition, Kohut's idea that the domain of psychoanalysis is defined by and limited to the information available through empathy and introspection has obscured our understanding of the forces at work in the treatment process.

This chapter describes three different theories of treatment proposed by psychologists interested in the self–Kohut himself, Robert Stolorow and his colleagues, and Michael Basch. I show that each of these theories is predicated on a different concept of self and point out certain problems inherent in each. Finally, I describe an additional