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.
Bacal turns our older shibboleths on their heads and comes up with a new psychotherapeutic model in his summation of the post-modern trajectory of self psychology, intersubjectivity, and relationalism. If optimal frustration was the principal feature of the clinical approach in the hey-day of drive theory, facilitation significantly extends our therapeutic reach in a more positive, humanistic direction. Optimal responsiveness epitomizes a turning point in how we understand and conduct psychotherapy today and supplies the overarching human dimension to a technique that has become mechanical, its sterility obvious. Bacal and his contributors challenge and relieve us at the same time. -- James S. Grotstein, M.D. What, at heart, is it that heals in psychoanalytic therapy? Therapeutic change stems not from such negative strictures as analytic anonymity, neutrality, or basic frustration emphasized in the classical tradition, but rather from the positive aspects of the experience of intersubjectivity between patient and therapist working with feelings honestly together. Bacal authoritatively sets the stage, and then each of his seventeen colleagues, all leading self-psychologists, engages about one aspect of the technique such as sharing, enactments, or management of disruption. Nowhere else has this theory been put together so comprehensively. With plenty of good clinical material, the book is inspiring and unputdownable. -- Eric Rayner, Ph.D. The term optimal responsiveness, like Oedipus complex, primal scene, and selfobject, has great evocative power. The reader is helped to follow the multifaceted discourse, which begins at the core of the two-person clinical exchange, by Bacal's careful grouping of papers and his easily comprehended introductions. The book retains its intimate connection to the question of what helps people (patients and therapists), and the reader comes away with a sense of the profound evolution of the psychoanalytic approach and our understanding of it over the last quarter century. Intellectually stimulating and extremely useful to the practicing professional. -- Joseph D. Lichtenberg, M.D. Bacal's concept of optimal responsiveness provides a powerful lens to assist us in rethinking the analyst's role in the therapeutic process, which has moved from a one-person model to one of mutual influence. Outstanding contributors elucidate their listening and experiencing perspectives and their views of transference and empathy, among other issues, to help us reassess what we as therapists do to facilitate our patients' development. -- Peter Lessem, Ph.D. Optimal Responsiveness is about the therapeutic process-what it is that actually heals patients. The answer that emerges is that the specificity of fit between the understanding and response a patient needs and a therapist can provide is central to effecting change. This is a gold mine of clinical wisdom that stands at the leading edge of our expanding knowledge; it illuminates and richly illustrates the relation-systems view of therapeutic transformation. -- Robert D. Stolorow, Ph.D.