E uno plurus: psychoanalytic psychotherapy in the age of pluralism

Until 1970 the dominant theoretical framework in American psychoanalysis was Freudian ego psychology. Since then a number of additional theories, such as object relations theory (including, but not restricted to, the Kleinian approach), self psychology, relational psychoanalysis, and attachment theory have evolved and compete with contemporary ego psychology in the current marketplace of psychoanalytic ideas. There is considerable controversy about whether it is advantageous to work from one theoretical model and apply it to all clinical situations, or whether to utilize all the available paradigms, making judgments about which model or combination of them is most useful in a particular clinical situation or at a particular clinical moment. The latter approach might be termed pluralistic. Though a pluralistic approach is not without its philosophic and practical difficulties, such a perspective is helpful in understanding the complexity of human behavior and in facilitating therapeutic growth. A pluralistic approach is familiar to contemporary psychotherapists, who must utilize multiple frameworks in constructing biopsychosocial formulations of their patients. A pluralistic perspective is advantageous in promoting a therapeutic alliance, since it lends itself to a collaborative therapeutic process with patients. A brief clinical vignette is presented to illustrate these ideas.