The author traces the evolution of psychodynamic theory over the past fifty years and demonstrates how various individuals and schools of thought have contributed to increasing conceptual clarity despite significant continuing differences. Along with these theoretical advances, there have been important changes in analytically-oriented therapeutic techniques. Nevertheless, underneath the wide variance in methodology and in their explanatory terminology, certain common denominators are discernible that explain why such diverse theoretical approaches are able to achieve comparable degrees of therapeutic success. These factors are demonstrable in non-analytic therapies also.
Methods for training therapists customarily are directed to developing cognitive abilities. Using Milton Erickson as a model, an alternate, experiential approach is offered. The "evoking style" of the therapist determines the outcome of the treatment more than the theoretical and clinical methods to which the therapist ascribes.
In the ancient world, the philosopher was a physician of the soul who, employing the healing word (iatroi /ogoi), offered counsel to persons perplexed by problems in living. After the triumph of Christianity, the priest as confessor-counselor replaced the philosopher as rhetorician of consolation. With the birth of psychiatry, and especially since the Freudian revolution, we call helping persons with words "psychotherapy." I shall try to show that without a decisive separation of rhetorical healing from medical healing, psychotherapy as the secular cure of souls is doomed to extinction.
Supervision and therapy are isomorphic processes. What supervision teaches is the process of creating change in people, and the very teaching of this process is itself an attempt to create change in the supervisee. Like families, therapists tend to confine themselves to selected segments of their possible repertory. Thus a major goal of supervision can be the expansion of the therapist's use of self.
The development and function of the self's capacity for intimacy is described through infancy, childhood and adolescence. The normal process of achieving intimacy is outlined. The illusions of intimacy of Disorders of the Self are then described with detailed clinical presentations of each diagnostic category. The therapeutic interventions necessary to deal with these defenses are then outlined.
The focus and re-focus of attention is represented everywhere in psychotherapy; nowhere more pointedly than in hypnosis, meditation and the gestalt concept of concentration. Expanding on these techniques, Dr. Polster offers three options for heightening attention in the ordinary therapeutic relationship: tight therapeutic sequences, the reconstruction of storyline and the spotlighting of selves. Each of these impels attention, helping to create an imbeddedness into previously squandered ingredients of the patient's life.
Focusing is bodily attention, not to mere sensations but to an at first unclear, implicitly complex bodily sense-of a situation, problem, or aspect of life. Therapy deepens immediately with many clients if asked what physical sense comes in the middle of the body in relation to what is being worked on. With half a minute of repeated direct attention, clients can assign a "quality-word," e.g., "heavy," "fluttery," or "tight." Then small steps come to say the crux of the problem. Each brings a slight (later large) "shift" and release, a direct sense of validity, although further steps may again change the whole problem. Without disrupting the hour, most clients who cannot do this, can gradually learn it from small questions now and then, such as "What comes in your body?" "Is it heavy, fluttery or how?" and "Stay a little while with that sense. Can you let it come again?" The bodily sense-of an implicit complexity is not widely known.
For the past half-century there has been a remarkable and continual evolution in the theory and practice of psychotherapy. Now that evolution shows signs of becoming a revolution. Many elements of these changes are, as yet, only scantily represented in the literature, but they are the stuff of bull sessions, the more liberated case conferences and solitary, sometimes fearful, experimentations. This transition comes about from a variety of influences, among which three are particularly worthy of examination for what they suggest about what is likely to emerge a half-century from now. The three are: 1) Developments in our understanding of our own nature as human beings. 2) Experiments with delivery systems for psychotherapy. 3) Great numbers of new entrants into the field, of whom many have limited or nontraditional training.