The therapeutic relationship and deviations in technique

This paper is a study of the framework and boundaries of the patient-analyst and patient-therapist relationships, and is based on the thesis that the manner in which the therapist manages these ground rules implicitly conveys important information about him to the patient, and influences both the patient's ongoing incorporative identification with the therapist and the "field" or person onto whom he projects his intrapsychic fantasies and with whom he interacts. After a review of the relevant literature, a series of fifteen postulates, drawn from previous observations in this area, are presented; each relates to the boundaries of the therapeutic relationship, and to the consequences of deviations and modifications of these boundaries and of the techniques of psychotherapy and psychoanalysis. The main clinical presentation is drawn from the psychotherapy of a patient whose therapist made several deviations in technique, and this is supplemented by the review of several vignettes from the psychotherapeutic and psychoanalytic literature. In concluding, the following are discussed: the manner in which maintenance of the ground rules reflects the intrapsychic state of the therapist; the consequences of deviations in these ground rules, especially on the patient's incorporative identification with the therapist; the manner in which deviations in technique are antithetical to a sound therapeutic alliance, unless a clearcut emergency exists; the unconscious meanings of unneeded deviations in technique for both the patient and therapist; the technical measures needed to modify as far as possible the consequences of an unnecessary deviation in technique; the need for flexibility and humanity within the basic ground rules of therapy and analysis; and the importance of the actualities of the therapist in the therapeutic relationship.