The ripple effect: patients influencing others

This paper deals with what seems an insufficiently explored aspect of psychoanalytic practice: the ripple effect of a patient's evolution on the present and future of his or her significant others. Clinical vignettes are provided to illustrate patients' influence on relatives; patients acting as therapists; psychoanalysis by proxy; the ripple effect in psychotherapy; and some countertransference problems. The psychic lives of individuals not in treatment may be considerably affected by their interactions with our patients; seemingly, extraclinical character adjustments may ensue. Sociological findings and plausible psychodynamic explanations are discussed. A psychoanalytic perspective may not only help the analyst understand how therapeutic influence extends beyond the identified patient, but may also help guide interventions that are ripple-effective, even when they depart from classical analytic technique.