From Theory-Centered to Patient-Centered Treatment: How Kohut’s Attitudes Impact Contemporary Therapeutic Work

ABSTRACT

Kohut struggled courageously to proffer many ideas that were opposed to the psychoanalytic theories, philosophy, and clinical ideologies of his day. Not only did he question the way psychoanalysis was practiced, more importantly, Kohut challenged the prevailing Freudian view of human nature; no one since Freud had offered such a radical Weltanschauung, a world view that discerned man and woman in such a disparate light that it precluded self-psychology’s easy integration with other theories. In this article, dedicated to my mentor Paul Ornstein, I will take you on a journey, from the time that self-psychology came unbidden into my life – a time when I was trammeled in the musty corridors of a glum and occluded psychoanalytic world both in my training and my analysis – through its dramatic impact on my clinical attitude toward therapeutic work, to my attempt to preserve and update some of Kohut’s more important attitudes and concepts. I will emphasize the frequently unrecognized clinical consequences of Kohut’s world view – his belief in protecting the patient, his faith in letting the patient teach us how to analyze him or her, his receptivity to permeable boundaries, his capacity to be vulnerable, his transformation of the atmosphere in the consulting room, and his belief in building on health rather than curing pathology. Traveling along this journey we will discover how Kohut altered the therapeutic relationship from one of shadow companions to intimate connections.

KEYWORDS:

• Connectedness
• empathy
• transference
• relational

Acknowledgments

I would like to dedicate this paper to the memory of one of my most important mentors, Paul Ornstein. Whatever it is that I know about psychoanalysis, I have learned much of it from the writings, teachings, and personal contact with Paul and Anna. Paul’s clinical acumen, friendship, insight, generosity, passion, and wisdom have been a sustaining force in my life for decades. With Paul’s (and Anna’s) help, I have been able to go deeper with patients than ever before; and the combination of clinical and theoretical discussions in which we engaged offer more than a lifetime of learning. For several years, Paul and my weekly discussions around his dining room table reminded me of the Amherst poet Robert Francis’s words as he was just beginning a series of visits to the home of Robert Frost, his journal full of the excitement he felt at having Frost as a mentor. “I thought,” Francis said, “as I came away from his house, that I had been given help of a kind and an authority that I could have perhaps received from no other man in America” (McNair, 2003). Paul brought to psychoanalysis a preternatural facility for capturing and conveying the nature of self-psychological treatment. Sometimes I think that I learned more about analysis and myself in those weekly several hour discussions than I did from my analyses. This perspicacious analyst with the mettlesome intellect—full of spirit and courage—offered his ready insight into, and understanding of, things self-psychological in a way that was contagious. He had a unique way of seeing the dark underside of people with his own soft light. But I also knew that Paul was learning too—that he found our conversations stimulating and enlivening at that particular time in his life. For me, the only way to repay Paul for that lifetime of learning is by passing on to future generations of therapists and analysts what I have learned from Paul and Anna—about clinical work, but also about life, living, the conquering of adversity, and the incredible capacity to remain open to change as we age.

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

¹ This article is an expanded version of my Kohut Memorial Lecture delivered at the 40th annual International Conference of the International Association of Psychoanalytic Self Psychology in Chicago, October 20, 2017.

² Conveying our understanding to the patient is similar to what Anna and Paul Ornstein referred to as a therapeutic dialogue, but here used in a more limited sense to expand the definition of empathy.

³ Obviously, there was more to Steven’s complex symptom, but for the purpose of this article, I am merely conveying one element.

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Notes on contributors

Richard A. Geist

Dr. Richard A. Geist is a founding member, faculty, supervising analyst and former member of the Board of Directors of the Massachusetts Institute for Psychoanalysis. For 35 years he was on the faculty (part time) of Harvard Medical School. In addition, he is a Council member of the International Association of Psychoanalytic Self Psychology.