The family physician as a "therapeutic instrument".

The doctor-patient relationship is the matrix of the family physician's diagnostic-therapeutic activity. To enhance the curative potential inherent in this relationship, the physician has to be able to make contact with the person in the patient. To achieve this, the physician must develop his potential for empathic observation, empathic listening, and introspective self-awareness. The use of these skills in a non-judgmental, non-condemning, and non-manipulative climate creates an optimum therapeutic setting. Rather than focusing upon the body of knowledge available in the behavioral sciences, or upon the pursuit of learning "psychiatry" or "psychotherapy," the family physician should first develop his own personal skills. He should then apply them to his own patients, in his own setting, in order to discover the therapeutic approaches appropriate to this patients and their problems. The psychiatrist, psychologist, or any other behavioral scientist can be most helpful to the family physician if he is prepared to aid him in his own discoveries rather than attempt to teach him the accumulated knowledge from his own field.

The bipolar self in the psychoanalytic treatment process: clinical-theoretical considerations.

This study of "The Two analyses of Mr. Z." compared and contrasted the different clinical and theoretical approaches to the understanding and explanation of the patient's psychopathology and the significantly different outcome of each analytic experience. The conclusion was reached that viewing Mr. Z.'s emerging psychopathology in the transference as defensive against a central, oedipal transference neurosis, precluded the full mobilization and working through of Mr. Z.'s self-pathology in the first analysis. This approach has thus led to limited therapeutic results, mainly through the patient's compliance with the analyst's expectations. The recognition of essentially the same clinical data, as expressions of a mirror transference first and of an idealizing transference later on--the core elements of the new theory--expanded the depth and breadth of the second analytic process. This approach has led to: (1) more accurate genetic reconstructions, (2) a better grasp of the nature of Mr. Z.'s psychopathology, and (3) more profound therapeutic results via transmuting internalizations in the working-through process of the selfobject transferences.

Formulating interpretations in clinical psychoanalysis.

The psychoanalytic psychology of the self led not only to a theoretical expansion of our central concepts of transference and resistance, but it also led to a decisive, dual shift in the manner in which we formulate and focus our interventions, irrespective of the nature of the patient's psychopathology. What we have described here as the empathic, reconstructive-interpretive process, and have exemplified with a clinical vignette, bridges within the psychoanalytic process the often still prevailing sharp division between conflict-based, structural psychopathology and deficiency-based, primary self-pathology. The utilization of a predominantly empathic mode of listening and responding (as contrasted with a predominantly inferential mode) is of particular significance in unifying the psychoanalytic approach to the various forms of psychopathology. Empathic reconstructive-interpretations encompass both transference repetitions and new experiences. Such interventions, therefore, responded to the total self of the patient, rather than to isolated, single elements in his associations and thereby lend them their broad therapeutic leverage.

On the conceptualisation of clinical facts in psychoanalysis.

After defining 'facts', 'clinical facts' and 'psychoanalytic clinical facts' the authors describe their conceptualisations of these facts from experience-near to experience-distant levels. They maintain that psychoanalytic clinical facts are jointly created by patient and analyst and are to a great degree dependent on the analyst's mode of observation and theory. They illustrate the various levels of conceptualisation within the broad outlines of self psychology with three detailed clinical vignettes from the analysis of Mr K. A starting central question in the authors' minds arises out of their focus on the patient's selfobject transference (in this instance a mirror transference), hence on the function they serve for the patient in this transference; the role he assigns to them in the restoration and maintenance of the cohesiveness of the self. It is the recognition of this function that serves as the basis for their conceptualisation of the patient's psychopathology as well as the curative process of his analysis.

The Clinical Impact of the Psychotherapist's View of Human Nature.

As psychotherapists, we rarely examine the implicit or explicit notions about human nature that are built into our theories and treatment approaches. Aside from the controversial question of whether a scientific conception of human nature is now tenable or not, our unexamined views (including our unrecognized biases) hold powerful sway in our clinical activities as well as in our theoretical discourse. As a consequence, our unexamined views of human nature may adversely affect our conduct of psychotherapy. Comparing Freud's view of human nature with that of Kohut, we can recognize their respective impact on the treatment process and its outcome.

Conceptualization and treatment of rage in self psychology.

This article presents a self-psychological understanding and treatment of anger. Angry reactions are based on various types of injury to self-esteem, and on disappointments in those one holds in special esteem-such as early caretakers and later important others. When these injuries and disappointments are massive--traumatic--the ensuing angry reaction is especially intense and often destructive. Treatment addresses the patient's vulnerability, the soil on which all these forms of anger arise, through an empathic entry into the subjective inner world of the angry or enraged individual rather than through direct confrontations. Empathic entry leads the therapist to the sources of anger, often precipitated by inadvertent, unempathic responses in the therapeutic encounter. Accepting nonjudgmentally, understanding uncritically, and explaining patiently the meaning and origin of the anger may lead to the amelioration of the vulnerability that gives rise to the anger.

On the interpretive process in psychoanalysis.

The concept of interpretation and its function in the psychoanalytic process is updated by emphasizing the analyst's contributions to the psychoanalytic treatment process through his interpretations of resistance and transference. By incorporating Kohut's recent contributions to the psychoanalysis of narcissistic personality disorders into our general considerations regarding the process of interpretation, we have been aided in our effort to unify the theory of the psychoanalytic treatment process. We offer a broadened definition of the interpretative process and stress the added "interpersonal" dimension of resistance and transference, namely, those elements in the development of both, which are affected by the analyst;s personality and the manner of his interpretive and noninterpretive interventions. This makes the artificially sharp dichotomy between verbal and nonverbal interpretations or between interpretations and noninterpretive interventions unnecessary. The recognition of the "self-object" role of the analyst in the narcissistic transferences not only lends more precision to our understanding of archaic narcissistic experiences (whishes, demands, fantasies, etc.), but makes their interpretation within the transference our preferred analytic response. The need to foster the so-called "real relationship" between patient and analyst and the need to deal with such "nontransference" aspects of the relationship noninterpretively is thus replaced with interpretive interventions. To underline our emphasis on the analyst;s contributions to the analytic process, clinical samples and brief vignettes illustrate the manner in which interpretations may retard or promote the analytic process.