Optimal Responsiveness: How Therapists Heal Their Patients

A generation of dynamic therapists is starting to look at what actually heals the patient, in contrast to the classical Freudian vision, according to which interpretation is the essential contribution of the therapist and insight is its chief therapeutic effect. There is a growing awareness among practitioners of what patients have always known - that the successful therapeutic experience derives not only and probably not primarily from the insight rooted in interpretation but rather from a relationship of optimal responsiveness. Ferenczi, Alexander, and such object relations theorists as Balint, Winnicott and more recently Kohut, anticipated the idea of optimal responsiveness, which legitimizes a range of psychodynamic behaviours (emphatic attunement, confrontation, support, self-disclosure, validation or invalidation), except where they interfere with the therapist’s personal tolerance or professional functioning. Optimal responsiveness implies recognition of the therapeutic process as a reciprocal system for each therapist-patient dyad. Reciprocity in turn implies reconceptualization of what is known as countertransference. Howard Bacal illustrates both principles and applications of optimal responsiveness in 17 chapters informed by emerging understandings in self psychology and intersubjective relational perspectives.