Therapeutic action: A new theory

Abstract

This article introduces a new clinical construct: "Interaction structure." Interaction structures are recurrent, mutually influencing patterns of interaction between therapist and patient. The experience, recognition, and comprehension of the meaning of such repetitive interactions are a fundamental component of therapeutic action. This bipersonal or dyadic model attempts to bridge those theories of therapeutic action that focus on insight and self-understanding and those that emphasize the patient's experience of the therapist. In this model, insight and relationship have complementary roles, since psychological knowledge of the self can develop only in the context of a relationship where the therapist endeavors to understand the mind of the patient through the medium of their interaction. The interaction-structure construct and its associated theory of therapeutic action are based on empirical research. A single-case research model is described that shows that process and outcome in psychoanalytic treatments can be studied within individual treatments in a way that is scientifically persuasive. Three case studies illustrate how each patient-therapist pair has a unique interaction pattern, and how these patterns are linked to therapy outcome. The essential place of formal, empirical study in psychoanalytic theorizing and in clinical work is demonstrated.