Therapeutic processes. A longitudinal view

1. Psychic equilibrium serves work, love, and play. 2. When such equilibrium is disrupted, symptoms occur. 3. Psychotherapy is effective when the equilibrium is restored. The restoration of such equilibrium may be a unifying feature of many psychotherapies. 4. The actions undertaken to restore the equilibrium may be viewed within an operational framework or an intrapsychic one. 5. The operational framework is more readily inferred from observable features. It describes the relationship the patient and doctor make with one another in pursuit of their avowed aims. It highlights technical features. 6. The intrapsychic framework attempts to describe and explain what goes on in the mind of the patient as the treatment proceeds, and what goes on is often very different from the avowed aims of either participant. It highlights individual structure, organization, and meanings. 7. There may be a class of patients who very easily restore their psychic equilibrium within a therapeutic setting, independent of the theoretical assumptions of the therapist or the avowed goals of the treatment. They are people with compelling synthesizing, integrative, and organizing capacities used in the service of development, mastery, and control. There may also be a class of therapists with similar capacities who apply them in conjunction with their authority in order to facilitate such a restoration. The restoration of stability is a valuable treatment goal for many children and adults. 8. Attention to these capacities may be useful for furthering clinical work and for appraising various theories of therapeutic action, especially those theories that rely heavily on positive clinical results for evidence. It may also be one of the starting points to distinguish the treatment process in analysis from the treatment process in other therapies.