Optimal Responsiveness: How Therapists Heal Their Patients

A new generation of dynamic therapists is taking a fresh look at what actually heals the patient. In contrast to the classical vision, whose essential feature is intervention by interpretation in an ambience of optimal frustration, Bacal's conception of optimal responsiveness legitimizes a whole repertoire of professional behaviors--empathic attunement, confrontation, support, self-disclosure, validation or invalidation. Everything the therapist does or does not do, does or does not say, is experienced by the patient as some kind of response. Because the relational dynamic is unique to each therapist--patient dyad, the therapist's responses can be tailored to meet the patient's needs, enhancing specificity. And because optimal responsiveness implies recognition of the therapeutic process as a reciprocal system, it also implies reconstrual of what we know as countertransference.

Howard A. Bacal, who trained with Balint, Winnicott, and Bion at the British Institute of Psychoanalysis after earning his M.D. from McGill University, has worked with Heinz Kohut and is a leading exponent of the relational/self psychological perspective. He is co-author of Theories of Object Relations: Bridges to Self Psychology.