therapeutic intent: why we do what we do

An analytic treatment is first established by a clear understanding of the intent or purpose of the analytic endeavor.

Roy Barsness, Core Competencies of Relational Pscyhoanalysis (CCRP)

Relational psychoanalysis – the discipline on which my work signficantly relies – is a historical movement within psychoanalysis that, in part, brings increased suspicion of prescribed technique. By the second half of the 20th Century, the dominate trend in psychoanlysis in the USA was a rigid adherence to technical purity, theoretical orthodoxy, and therapeutic abstinance. While there are certainly other trends in the history of psychoanalysis that challenged this practice (e.g. Harry Stack Sullivan), the dominate approach in America tended to conform to this rigid application.

The relational turn injected a dose of doubt into analytic conceptualization. That is not to suggest that the therapist does not have a mind about what is going on in the relationship and in the treatment. But it acknowledges that the mind of the therapist is as impacted by the patient as the mind of the patient is impacted by the therapist. There is no pure stance, no objective viewpoint that is immune to the dynamics that are unfolding between the patient and the therapist. Any given certainty is conditioned by a mind that is interacting with another mind. The mind of the therapist about the treatment is contextually conditioned by the therapeutic relationship.

Insights from social constructionism, post-structural continential thought, and interpersonal neurobiology all converge to offer psychoanalysis a heaping portion of humility in regards to the possibility of certainty – or even assurance – of knowing what is going on in the consulting room. This uncertainty produces a new freedom to the therapist, even if the cost of that freedom is the (illusory) comfort of certainty. As Steven Tublin states in Core Competencies of Relational Psychoanalysis (2018):

To being with, contemporarty relationalists embrace a radical eclecticism that denies them the comfort of a consensually acepted theory of mind upon which to build a set of technical principles…Whereas the mid-century Freudian faced strict limits in both the theoretical positions from which he might approach the clinical moment and tight restrictions on how he might then engage his patient, the contemporary relationalist has community sanction to borrow from a borad family of theoretical traditions and the techniquest that correspond to them.”

Tublin, S. (2018). Core competency one: Therapeutic intent. In R. Barsness (Ed.), Core competencies of relational psychoanalysis: A guide to practice, study, and research (pp. 67-86). Routledge.

Tublin goes on to describe, in multiple paragraphs, the “broad menu of technical choices that can be exhiarating in its plenitude or panic-inducing in its boundlessness.” (2018). The freedom that relational psychoanalysis enjoys creates a tension between remaining within the relational context of each unique patient-therapist dyad and maintaining a discipline of mind that keeps the conversation psychoanalytic. The remainder of Tublin’s chapter focuses on the tension between freedom and discipline that exists for the relational analyst, and the ways four specific analysts have navigated this tension (Hoffman, Renik, Mitchell and Stern).

I was introduced to relational psychoanalysis through CCRP during my supervision. As a masters level clinician-in-training, and a therapist who did not receive traditional psychoanlytic training in my program, the technical freedom that Tublin describes as either “exhilarating” or “panic-inducing” tended to produce the latter within me. The tenets of contemporary relational psychoanalysis were deeply resonant for me. But I found myself regularly asking, “but what do I do?”. In the face of this freedom, what is the discipline? What makes the extended conversation between patient and therapist psychoanalytic?

Tublin provides an answer. “It becomes psychoanalysis only when it is structured around a coherent theory of therapeutic action that defines the analyst’s therapeutic intent” (2018). It is the therapeutic intent that provides the necessary discipline that balances the technical freedom enjoyed by relationalists.

In the original research that forms the soil out of which CCRP grew, Barsness found that participants “held to a particular belief system and clearly oriented their work toward particular outcomes informed by their understanding of what constitutes change.” By articulating our intent, relational therapists make explicit (to themselves and their patients) the criteria by which they evaluate their therapeutic action within the unique context of each therapeutic relationship.

The competency of therapeutic intent – knowing what we believe contributes to lasting change – provides us a rationale for how to engage our patients. Several purposes of analytic treatment emerged in Barsness’ research, including:

  • Increased capacity to experience and manage multiple affective states and to enjoy the full range of emotion
  • Incrased access to multiple aspects of the self without shame
  • Ability to comfort and soothe oneself and to be self-reflective
  • Ability to accept responsibility
  • Ability to tolerate ambiguity and uncertainty
  • Ability to be more truthful with oneself
  • Ability to think more creatively and openly about one’s past rather than continue to repeat it
  • Relief from internal constraints and rigidities that have become problematic
  • A more imaginative and creative mind
  • Increased capacity to love and to work; self-efficacy
  • To engage in more meaningful and redemptive relationships
  • Hope

By having a clearly defined understanding of what we hope to accomplish and towards what direction we are working, we are provided guidance amidst the freedom of theoretical and technical pluarlism that relational psychoanalysis has produced. While it may not have provided the answer to my question of “but what do I do?” (which is explored more in subsequent chapters of the book and will be explored in future posts on this blog) it does provide the rationale for why I am trying to do anything in the first place.

By way of conclusion, I quote Tublin’s summary at length:

It is intent, not the objectivist-tainted notion of correctness, that should guide the analyst’s participation in the consulting room. An intent-driven conceptualization of technique, while limiting the analyst’s moment-to-moment actions, would force the analyst to be explict about how his communicative acts – his interpretations, questions, empathic expressions, as well as the various jokes, reminiscences, and lexical gestures that establish his unique presence – are meant to drive a therapeutic process…Rendering his intent explicit compels the analyst to know, as much as possible, what he considers essential to a satisfying human existence, what sort of mind he believes allows for the creation of such a life, and what he is capable of doing, via the ritualized application of his craft, to advance that aim.

Tublin, S. (2018). Core competency one: Therapeutic intent. In R. Barsness (Ed.), Core competencies of relational psychoanalysis: A guide to practice, study, and research (pp. 67-86). Routledge.

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