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Psychotherapy by definition is idiosyncratic to each case, but there are always two things present in a treatment that works: a patient willing to show her real needs and a therapist who can meet her where she is.
-- Gail Hornstein, To Redeem One Person Is to Redeem the World: The Life of Frieda Fromm-Reichmann
We need some guidelines about how to provide . . . love in a way that has some hope of helping [a patient] to find the secure and coherent center she so badly needs, and without straying from the field of therapy into a deeper and more unconscious enmeshment.
In my view, Heinz Kohut’s "self psychology" articulates those guidelines. Essentially he provides three principles. (a) The precondition for the work is an intense, lop-sided rapport between the nascent self of the patient and the coherent self of the therapist, in which the latter is accepted as a kind of substitute self or "self-object" that provides vicarious stability to the patient. (b) The work itself begins by gratifying the patient’s need to be taken seriously through clear-sighted "empathy" that discerns and articulates ("mirrors") the emerging self of the patient as well as the emotional chaos that surrounds, confuses, and fragments him. (c) Most effective, however, are the necessary "frustrations" the therapist must give to the patient’s inevitable demands for "inappropriate gratifications" -- but "empathically," sorrowfully and with full emotional awareness of the desolation being caused ("optimal frustration").
Kohut has, in effect, described the nature of parental love in nuanced detail. What they longed for as children was to be seen for who they are, seen with the heart as well as the mind, valued, and enjoyed. But they also wanted to be corrected and shown their limits, with a compassion that is willing to share the pain as well as the joy of their inchoate struggling personhood. Parents express these things as they feed, bathe, and cuddle their infant, while a therapist is limited to seeing, feeling, and talking.
What adequate parents do spontaneously -- for it is simply the way one loves an infant -- the therapist needs a theory to justify. She has to be more conscious than the parent of her own feelings and those of the patient; and she has to be able to find the words, gestures, and tone of voice to convey what is going on "inside" the patient and within the therapeutic [relationship]. Therapeutic love for a self-in-becoming amounts to parental love that has been "schematized" (consciously understood in detail and as a whole).
-- John Ryan Haule, The Love Cure
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