Turning Points in Psychotherapy. (Volumes I and II).

Abstract

The present study is an intensive, clinically oriented investigation of the interpersonal processes observed in twenty sessions from each of four long-term psychoanalytically oriented psychotherapy cases. It derived its impetus from a review of the theoretical and empirical literature on therapist emotional responsiveness. The primary data of the project consists of (1) casette recordings of twenty consecutive hours from each of four therapy relationships and (2) verbatim transcripts of open-ended interviews with the therapists concerning their responses during this work. The work of two female therapists with contrasting personal styles, each of whom was seeing one less disturbed and one more disturbed patient was studied. Working clinically and intuitively, the investigator isolated and grouped 'turning points' in which marked positive shifts in self-exploration occurred, for three of the four cases. The analysis of the fourth case revolved around a group of critical incidents in which therapist countertransference acted to block patient self-exploration. The main groups of turning points which emerged were labeled (1) empathic, (2) confronting/questioning, (3) interpretation of transference feelings, (4) warm/sharing/appreciation of the patient, and (5) suggesting or inquiring about links with the past. The different distributions of these types of turning points in each of the cases was examined in relation to clinical observations of therapist and patient functioning. Skillful modifications in technique in work with the easier vs. the harder patient were highlighted for one therapist. For the other therapist, a sharp contrast in her effectiveness with the easier vs. the harder case was studied in relation to features of her personal style. In the final section, the five major types of turning points were examined in relation to the debate over the optimum balance of frustration and gratification in dynamic and client-centered approaches. Methodological problems in the selection and judgment of meaningful units of process material and in the reliability of clinical judgments were also briefly considered.