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Rethinking therapeutic action.

Glen O Gabbard1, Drew Westen

  • 1Department of Psychiatry, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA. ggabbard@bcm.tmc.edu

The International Journal of Psycho-Analysis
|September 19, 2003
PubMed
Summary

Psychoanalytic therapy involves multiple therapeutic actions, not a single mechanism, to facilitate change. This integrated model addresses diverse targets and methods for effective treatment outcomes.

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Area of Science:

  • Psychoanalysis and Psychotherapy
  • Clinical Psychology
  • Psychological Theory

Background:

  • The theory of therapeutic action in psychoanalysis is undergoing revision, with various theorists proposing different change mechanisms.
  • Existing theories often focus on single mechanisms, which may not adequately explain the complexity of psychoanalytic change.

Purpose of the Study:

  • To propose a working model integrating internal and external psychoanalytic developments for a multifaceted understanding of therapeutic action.
  • To delineate the aims of treatment (what changes) and the strategies (technique) that facilitate these changes.

Main Methods:

  • Review and integration of current psychoanalytic theories and related developments.
  • Classification of change-facilitating interventions into categories: insight-focused, relationship-focused, and secondary strategies.

Main Results:

  • Single-mechanism theories are insufficient due to the variety of change targets and methods.
  • Effective interventions encompass fostering insight, utilizing the therapeutic relationship, and employing secondary strategies.
  • Proposed shift in terminology from 'therapeutic action' to 'therapeutic actions' to reflect multifaceted processes.

Conclusions:

  • A comprehensive theory of therapeutic action must acknowledge multiple, interacting mechanisms.
  • The integration of insight, relationship dynamics, and secondary strategies is crucial for psychoanalytic change.
  • Adopting the concept of 'therapeutic actions' offers a more accurate framework for understanding psychoanalytic treatment effectiveness.

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