Chapter 4 The Optimal Conversation: A Concern About Current Trends Within Self Psychology

Self psychology is witness to an ongoing conversation that addresses the question: “What is optimal in the clinician's response that will facilitate the hoped-for cure?” The persistence of this troublesome question, despite 100 years of psychoanalytic study, suggests that the central curative elements of analytic treatment remain unclear, or at least they remain in dispute among and between the various psychoanalytic camps. Kohut, in the provocative title of his posthumously published book, How Does Analysis Cure? (1984), posed a variant of this perplexing query. Kohut's seemingly straightforward question is not so simple when one realizes that the “how” of his question can be read either from the perspective of therapeutic process, in which case the query asks, “By what process does analysis cure?” or it can be read in terms of therapeutic action whereby the query asks, “By what action does the analyst facilitate the analytic cure?” The former reading asks the developmental—theoretical question, while the latter gives voice to the technical-clinical question. I believe that the current conversation in self psychology has become mired in the untenable predicament of separating its clinical technique from a rational underlying developmental theory. This separation is evident in the very form of