Rethinking Therapeutic Action: Finding Commonalty in Diversity

Abstract

Understanding what the therapeutic action of psychoanalysis and psychoanalytic therapy have in common with other forms of therapy helps us identify essential elements of therapeutic change. Several processes that cut across diverse psychotherapy approaches are outlined, based on clinical empiricism, theory, and research. A model of therapeutic action is considered that places emotion schemas at the center of therapeutic change across modalities; to modify these memory structures, diverse therapies utilize overtly different, if complementary, methods. These shared processes are drawn together into a common, coherent change model that is further informed by the role of neuroplastic memory reconsolidation. Although the model seeks to explain and to link multiple transformative therapy approaches, and in that sense, is a general model that applies to many therapies, for the purposes of this paper, the case example applies the model to psychoanalytic therapy. Paradoxically, the case illustration brings into sharpened focus what is important and often underemphasized in psychoanalytic therapy, while also opening and extending customary forms of psychoanalytic and psychotherapeutic thinking and methodology.

Keywords:

• Psychoanalysis
• Psychotherapy integration
• Emotion schema
• Memory reconsolidation
• Therapeutic action

This article responds to:

“Mismatch” in the Search for “Effortless Permanence”: Discussion of “Rethinking Therapeutic Action”

Representations, Schemas, and Living-in-the-World

Notes

¹ Digging down, personal qualities of the therapist (articulateness, interpersonal perception, affective modulation and expressiveness, warmth and acceptance, empathy, and focus on the other, for example) (Novotney, 2013) cannot be minimized in forming a therapeutic bond and in therapist efficacy. However, this topic is beyond the scope of this paper.

² Most comparative research finds EMDR superior to CBT for PTSD, but CBT also has respectable results (Khan et al., 2018). Other methods like SE, SM, and IFS also are positively regarded by many trauma clinicians, but these approaches have not yet been subjected to comparable systematic study. At times, these approaches may be used supplementally in analytic therapy (Frank, in press, for example).

³ I have discussed the advantages, limitations, and relational evolution of Alexander and French’s view of corrective emotional experience elsewhere (Frank, 1999).

⁴ Bucci framed such interactions as the bidirectional communicative centerpiece of her referential process (Bucci, 2011a; Bucci, Maskit, & Murphy, 2015).

Additional information

Notes on contributors

Kenneth A. Frank

Kenneth A. Frank, PhD, is Co-Founder and Board member of the National Institute for the Psychotherapies, where he is also Founder and Co-Director of its Psychotherapy Integration Training Program. He is formerly Clinical Professor in Psychiatry (Part-time), Columbia University College of Physicians and Surgeons, is Senior Consulting Editor of Psychoanalytic Perspectives and has published more than 60 articles, chapters, and books, many on psychoanalysis and psychotherapy integration. He practices in NYC and Bergen County, NJ.