An Outline of the Basic Therapeutic Model
Presented in Stockholm on Friday, 15th, and Saturday, 16th April, 1994
by Dr Robert Gordon
"It is an uneasy lot, at best, to be what we call highly taught and yet not to enjoy; to be
present at this great spectacle of life, and never to be liberated from a small, hungry, shivering self."
George Eliot, Middlemarch, 1871 - 1872.
First of all, as an
introduction to our frame of reference, Craigie Macfie and I will
outline the principal elements of our theoretical model, which is self-psychological.
I shall lay down some of the important elements of the model, and Craigie will elaborate on them.
We, of course, shall not be able to give you more than a basic outline of the model, but
I hope it will be enough to clarify our position and the direction, that is our frame in supervision,
which follows from it.
elements of the self psychological model
The self-psychological model has a number of basic elements:
The centrality of the concept of the self
The concept of the primacy of subjective experience
The centrality of the concept of empathy
The selfobject concept and selfobject transferences
The recognition of disjunctions, or therapeutic errors, and the bilateral work
between patient and therapist, of reparation, to reconstitute the self
The transference-like states of idealising selfobject experience, mirroring selfobject
experience and twinship selfobject experience - and the relevance of function pertaining to each
First, let me say a little about the relationship between therapist and patient, and what I
call the form and shape of psychotherapy. Craigie Macfie will expand on it further.
In my opinion, there is always a real relationship in psychotherapy. There is humanity,
sensitivity, patience and the continuing concern of the therapist, and there is the growing commitment, curiosity and trust
of the patient.
There is also the frame in psychotherapy; consisting of the contract, the consistency,
in terms of time and space, the continuity, in terms of the repeating of number of sessions per week
and year, and the concept of care or, what Winnicott termed, the 'holding environment'.
These elements are the bedrock of psychotherapy and they sustain the
process - often when all else is failing.
Paul Ornstein suggests, and I would support his view, that the important element in the process of
psychotherapy is the development of a curiosity about the self by the patient. To do so requires a process
which, to my mind, must centre the concept of subjective experience and subjective, reflective
style, as the focus of attention through an empathic mode of listening. This subjective experience
has been shaped and coloured by early childhood experience with a relevant other, and the
vicissitudes of early developmental life, and perhaps even later developmental processes.
immerse and validate
The importance of the therapist's ability to validate subjective experience and to immerse himself
within it, to maintain this immersion as much as possible, and to recognise the disjunctions when
this immersion has failed, are also key elements of the model.
the concept of empathy
Empathy, as defined by Basch, is an affective communication going beyond the self referential.
Heinz Kohut has defined the concept of empathy as 'vicarious introspection' and defines it as
'a data gathering tool', thus lifting it out of the realm of sympathy and morbid curiosity.
One allows the patient to play on one's internal 'musical instrument'. The therapist picks up
the reverberations and attempts to recognise the 'melody', particularly the 'emotional melody',
and makes a suggestion as to the 'words and music' heard. The therapist's sensitive resonance
to the subjective experience of the patient, and his attempts to recognise and understand 'the music'
made, bring about 'a sense of feeling understood'. To Kohut, feeling understood is the symbol
for 'being held' in a psycho-physiological sense.
The work of empathic immersion in the patient's state brings about an expansion of self experience;
'instruments' of the personal self begin to play and resonate to, or harmonise with, the basic
melody. With growing strength and harmony 'the symphony' of the functioning and organised
self begins to emerge and a personal 'piece of music' is created.
But first the primary musical instrument, that of the therapist, must be available and
appropriately tuned to the hushed notes and tentative tunes of the patient.
To my mind, empathy is central to all therapies that work, but the centrality of empathy
as a data gathering tool, and the significance of this, can be attributed to the genius of Kohut.
His genius was also the one to recognise the concept of a 'therapeutic error',
or disjunction, when the therapist's empathy fails, when the musical instrument of the therapist will not
resonate to the subjective experience being played by the patient, the music ceases and some
other activity commences. The therapist must be sensitive to this failure or disjunction, recognise its
symptoms of disharmony in the patient, and take the necessary steps to replace 'the patient's fingers
on the keyboard', and 'to tune the therapist's instrument'.
The signals of a disjunction are:
Shift of affect, usually of a negative kind
Disorganisation of thought, through confusion,
or a breakdown of speech - such as stammer or broken sentences
Linearity of thought
Development of a cognitive style of communication
Perseveration or rumeration
Fragmentation of the self
These fragmentations, according to Kohut, can take the shape of panic, rage reactions, empty depression,
hypochondriasis, perversions and addictions, somatasation disorders, and suicide.
Behavioural patterns driven by intense affect states than dominate, and there
is 'a cacophony of sound'. The behaviour does not appear to make sense, and can in fact be 'mad'.
The importance of repairing this error cannot be overemphasised.
The therapist must recognise the disjunction or error and bring it to the notice of the patient.
Asking the patient to return to the point where the disjunction appears to have occurred, for either the patient
primarily or the therapist.
By the therapist recognising the part he has played in the disjunction,
and the therapist and patient reappraising the 'moment of experience' where the disjunction is likely to
have occurred (both from the point of view of the content of the material and the affective experience
that was probably not recognised by the therapist), and then reorientating to the material, and its
background music, in the light of the patient's elaboration of the experience of the disjunction, through
this replay of the misunderstanding by the therapist's experience, brings about a reconnection of
empathy to the patient's subjective experience.
It is through this process that Kohut's concept of 'transmuting internalisation', is brought about in
microscopic shifts in the self's capacity to function. A new form of functioning is slowly internalised
by the self to allow for more competence in dealing with the environment and personal experience.
The model of self psychology differs from other models because of this therapeutic process.
The microscopic repair to self structure, cohesion and functioning through this process, places it
apart from other theoretical models, and defines the shape and direction of self psychology.
the concept of the selfobject
Kohut, Wolf and Ornstein have conceptualised the concept of selfobject as 'objects' which are
experienced as a part of, or support, the functioning of the self. Expected control of them is closer
to the concept of the control which an adult expects to have over his own body and mind.
Such an object is related to only in terms of the specific phase-appropriate needs of the developing
self, without recognition of the separateness of the object and its own control and initiative.
My definition would be: the experience generated by relevant others in a self 'in need'. This
experience is that of providing a capacity to function in the 'area of need' of that self.
These needs may be those necessary for:
making sense of previously fragmented experience or behaviour or combinations of
In my opinion, to learn to function using affective resonance, self reflection and environmental
responsiveness brings about an efficacy, confidence, and competency of the self, which builds
self-esteem and permits further elaboration of the innate creative self.
The concept of competence is central here. The self searches for competence and competence
builds the self. Brandshaft proposes that borderline personality disorder is brought about by
the experience of a fragile self in a failing selfobject environment, and suggests therefore that the
borderline experience may, in fact, be iatrogenic when an unempathic therapist is in the presence
of a precarious self. An interesting proposition.
This concept of selfobject is another of Kohut's contributions, and highlights the relevant capacity
of the primary care giver, both in her ability to tune to, recognise and resonate with the child's early
affective 'statements' and experience.
This early empathic resonance by the primary care giver allows for what I call 'embedding' of the
emerging self in the matrix of the self and primary selfobject, experience. It is here that the self
becomes 'rooted' or embedded in the experiencing state of the relevant other, and determines
whether the individual can go forward to elaborate the core self or begin the long torturous and
painful task of the 'false self' system of Winnicott's. Or what I have termed the reverse mirroring self.
The reverse mirroring self proceeds to elaborate in response to the failing primary selfobject
function of the mother, her own vulnerable self, and the need for the child to be the selfobject
of the mother, rather than the mother functioning as a selfobject for the child.
Most commonly, there is a slow, progressive, and selective deterioration of certain affective states
and their relevance, a shrinking of self state and a lowering of self-esteem, with a progressive
vulnerability to self fragmentation. In essence: there is a failure of the child to 'emotionally' thrive.
What then, you say, are these functions that the primary selfobject provides for the child?
I shall use the concepts of Daniel Stern to organise my ideas.
These concepts are:
The emerging self which occurs between zero and two months of age
The core self which progresses from two to six months of age
The subjective self which emerges at seven to fifteen months of age
The verbal self that becomes apparent from sixteen months or so onwards
The narrative self which develops around the third or fourth year of life
During the phase of the emergent self, the primary function of the maternal selfobject is nurturing,
soothing. All in the process of allowing this emerging self to embed in what Kohut has termed
the 'self-selfobject matrix'.
During the core self period the primary maternal function is the progressive naming and validation of affective expression -
it is so-called 'affective attunement'.
During the subjective self phase, when the earliest signs of the representational
self (with its capacity to recall and then to compare a memory with present experience) arise,
the primary maternal function is the naming, the validation and the assimilation of affect and affective experience.
In the later phase of this subjective
self, the concepts of Furer's 'emotional refuelling' and the 'practicing subphase' component of self elaboration
(described by Margaret Mahler) become evident - as well as the concept of
intersubjectivity: the experiencing of 'two minds in harmony or disharmony'.
These affects colour and, further, shade experience. They elaborate the 'social style' of the
During this period, the maternal selfobject function is to name, to validate and to help organise the
assimilation of social and personal experience.
The progressive role of cognition complicates the picture. What was once obvious
self experience exhibited on the face and in body movements now becomes elaborately reorganised
in response to the primary care giver, the family and the developing social environment.
The interplay of the instruments
of the self slowly evolves into a personal symphony where each instrument becomes less and
less evident yet continues to play its part in the final expression and experience of the personal self.
During the period of the narrative self somewhere around the third or fourth year of life, the
concept of time begins to become more and more part of the self state, and the relevance of
past, present, and future makes its presence felt.
Stories have become more and more relevant, and the recognition of a history of self and its
future further expand the self state.
In therapy, the 'self in need' responds to the empathic immersion
of the therapist by forming transference-like interactions, and by calling upon functions from
the therapist, to respond to previously wilted affective self experience or what I would
call 'overmodulated' affective self experience, or on the other hand, to 'undermodulated' affective intensity.
As well, the yearning for competence, self-esteem, and goal directed behaviour also calls upon
functions of the therapist to redress past 'failed' self-primary selfobject experiences.
The therapeutic self-selfobject experience brings about these transference-like states of, the
needs for idealising selfobject or mirroring selfobject or the twinship selfobject experience.
The important contribution of the therapeutic selfobject is to provide a capacity to function in
such a way that the self reverberates to, not fragments with, the 'containing' environment.
These 'self-therapeutic selfobject' transference like states require a response from the therapist:
(a) In the mirroring self-selfobject experience, the need of the self is for a mirroring
response which works towards the building of self esteem, self assertion, goal directed
behaviour, and personal fulfilment.
(b) the idealising selfobject requirement, is that of internalising a soothing function
which leads to a stability of the self and a move towards ethical standards, cultural activities,
morality, and perhaps creativity.
(c) In the twinship of self and selfobject need, the therapist is required to provide a sense
of belongingness in a familiar and cultural matrix, a sense of oneness with one's cultural, traditions,
and societal values, 'a being part of the human race and of the human experience'.
Failure of the primary care giver to provide these responses brings about a lack of cohesion of
self, a low self esteem, a diminished sense of vitality, and a functional disharmony deteriorating
from a sense of order to that of a chaos. There is a lack of self validity, a disavowal of certain
affective self experiences, a limitation of the participation in certain environmental experiences,
a diminution in initiative, a lack of goal directed behaviour, which involves initiative, purpose,
ambition, and assertion, the inability to be alone, the lack of a cultural self, and the creative self,
the lack of ability to organise productive 'organisation' behaviour, the failure to be empathic, a
failure to organise time, space, money, and purpose, a failure in appreciation of one's emotional
states and their affects, a failure in oedipal maturation, a failure of adolescent separation
behaviour, a failure to grow and mature with time, and more pathologically, if there is more
pathological than all the above, the fragmented states either acute or chronic of the narcissistic
state and borderline personality and behavioural structures.
A few words on the emotional development of the self.
I have referred to Daniel Stern's work about the phases of self development, but I would like
here to return to the work of Charles Darwin and Silvan Tomkins to suggest that there is clear evidence
of genetically programmed neuro-physiological substrates of affective experience, and that
these genetically endowed signals permit the individual to recognise and respond to external
and internal experience.
Silvan Tomkins proposed that there were nine primary emotions: interest, pleasure, surprise,
distress, anger, fear, disgust, contempt, guilt and shame. Subsequent researches have further
elaborated this concept, such that the emergence of these affects along a temporal continuum
can be appreciated.
Michael Lewis proposed that to the primary emotions of joy, fear, anger, sadness, disgust,
and surprise one may, with the passage of time and the developing presence of a self-reflective self,
progressively add those of embarrassment, empathy, envy, pride, shame and guilt.
These primary affects require maternal responsiveness to each one and require help in
modulating their expression, so that they remain within the realm of personal experience
and do not produce fragmentation.
Perhaps at this point, it is important to state what my use of the word affect implies:
a pre-programmed, genetically endowed, neurophysiological and psychological state which is beyond control or
recognition by the individual, and that only after recognition and appreciation of the affect, does
the concept of 'feeling something' become evident.
I would, therefore, use the term feeling at the point where there is recognition of the affective state
by the individual and an appreciation of what that feeling reflects.
the importance of empathic understanding and explaining
The Ornsteins, in a paper titled "Understanding and Explaining, the Therapeutic Dialogue", make a shift
from the concept of interpretation to that of understanding the subjective experience of the patient
through an empathic mode of listening, and subsequently explaining, that is elaborating, this empathic
By elaboration, I mean when a therapist empathically resonates with the patient's material, and the
experience is shared with the associated affect and feelings underpinning the shared experience,
and is responded to, by the therapist's empathy, it generates a progressive deepening of shared
experience as the therapy progresses, and the emotional resonance more and more deeply understood
generates reverberations into the other realms of personal experience that the patient has probably not
shared in the past or not recognised.
The fact that the state of experiencing is in the present, the therapist anchors
the experience as alive and valid. This elaboration of self experience, this progressive branching of experience embedded in
the affective colouration, forms what I called 'tree of the self'. It is firmly planted in the time and space
provided by the therapeutic hour and the therapist's activities, and it is this elaboration of personal
experience that gives shape, colour and form to a new world of reflective self experience.
Mirroring responsiveness and empathic resonance by the therapist
is the 'facilitating environment' for growth, the 'oxygen and warmth' of the therapeutic atmosphere.
With the passage of therapeutic time, creativity blossoms; first, is the original
imaginative experience, and then, progressively, there is a flowering of personal self components
into original, totally unexpected forms of self-expression, which is the personal 'art' of the self.
supervisory process and self psychology
"Follow the 'Lieder' "
The issue of supervision is not an easy one. Many minds have tried to find the most conducive way
of helping a trainee to learn, and I am immediately reminded of the excellent work of Imre Szecsody,
his very clear demarcation of areas in which a therapist must contain his involvement in enquiry. His
idea of the clear frame in supervision, of the maintenance of the boundaries around the primary task
of supervision, and the use of the P (P-T) T paradigm, where the emphasis is on the supervisor
continuously connects how the P (patient's) personality, conflicts and transference enactments
are expressed in the interaction with the therapist (P-T), and how the therapist (T) experiences this,
reacts to it, and interacts with the patient. His idea of the 'mutative learning situation', the capacity
to step out of his system, and appreciate the unexpected is a very significant contribution to clarifying
our thinking about supervision.
What we ask of our trainees in Sydney is to develop skills in:
Maintaining the setting and contract of the therapeutic relationship.
Acknowledging and respecting the patient's subjective experience.
Clarity about the therapeutic task at any particular point in the therapy.
Attempting to follow the patient's experience and blocks of the full
expression of that experience. This involves:
a) The capacity to attend to disruptions in the empathic connection between patient and therapist,
and to manage this by accepting that both play a part in disjunction;
b) The capacity to listen and tolerate uncertainty, and to appreciate the role of anxiety
in blocking the patient's experience;
c) The capacity to detect when the patient is becoming disorganised by anxiety;
d) The ability to appreciate the relevance of the transferences, as defined.
Putting into words the main experiences the patient has been relating.
Responding to the various layers of feeling in the therapeutic conversation without the use of jargon.
Developing an awareness of the therapist's changing own states during the therapy, and in
particular, appreciating the universal tendency to intellectualise, and to understand its links to the level
of anxiety in a therapist.
Making links between otherwise disconnected areas of the patient's experience, and to utilise
metaphor to expand the experience.
Because we are attempting to train the trainee to hear 'the song' of the patient, we do not feel that
process notes can possibly provide this information. We have, therefore, for some years now, used audiotaped sessions as a method by which to conduct
supervision. This allows both the supervisor and, particularly, the trainee to stand back from the patient-therapist
interaction and to listen to the moment to moment interchanges between the emotional expression of
the patient and the resonance of the therapist's instruments. The trainee therapist, being given the opportunity
to stop the tape and to elaborate upon his experience of the patient, gains a deeper
understanding of his resonances; his appreciation of those moment to moment interchanges
with the patient is enriched and expanded.
The task of empathic immersion can be studied and understood more clearly with tape
recordings and the signal of the therapeutic error or disjunction can only be heard by this audio-taped
method. Of course, video tapes would add even further dimension.
This replay of the therapist-patient interchange gives the trainee a chance to review his
empathic style and therapeutic techniques, and it opens up the field of discussion and
elaboration much more than other methods of supervision I have been involved in.
The fact that the trainee can hear himself speak, can respond to, and we hope
resonate with, the patient's material, enriches his understanding of the therapeutic interchange.
Empathic responsiveness by the supervisor usually permits the therapist to explore his therapeutic
responsiveness in the presence of the supervisor.
As I said previously, the use of audio tapes is not as effective as video taped interviews, but it does allow
for the consideration of much more empirical data than just subjective reporting of the interviews. Audio taping
allows supervisors and trainees to study the same material together and to formulate relatively consistent responses.
It is our opinion that, throughout supervision, the supervisor should follow the
trainee's 'lieder' - should allow the trainee to lead with the expression of his own experience of the
psychotherapeutic experience, should let him move in the direction he needs to go and to make the elaborations
he needs to make. The trainee may then begin to understand himself better - his abilities and
disabilities - in the psychotherapeutic learning experience.
BASCH, Michael. 1985. Interpretation: Toward a developmental model. Progress in Self Psychology, Vol. 1, ed. A. Goldberg. New York: Guilford Press, pp. 33-42.
DARWIN, Charles. 1872. The Expression of Emotions in Man and Animals. London: Murray. Reprinted Chicago: University of Chicago Press, 1965.
ELIOT, George. 1871 -72. Middlemarch, Book 3, Chapter 29, New York and Boston. H. M. Caldwell Company.
KOHUT, Heinz. 1971. The Analysis of the Self. N. York: International Universities Press
KOHUT, H., WOLF, E.S. 1978. The disorders of the self and their treatment: an outline., Int. J. Psychoanal., 59:413-426.
LEWIS, Michael and BROOKS-GUNN, Jeanne. 1982. Self, Other, and Fear: The Reaction of Infants to People.
In Belsky, ed. (1982), pp. 167-77.
MAHLER, Margaret, PINE, Fred and BERGMAN, Annie. 1975. The Psychological Birth of the Human Infant: Symbiosis and Individuation. New York: Basic Books.
ORNSTEIN, Paul and Anna. 1985. Clinical understanding and explaining: The empathic vantage point. Progress in Self Psychology. Vol. 1, ed. A. Goldberg. New York: Guildford Press, pp. 43-61.
STERN, Daniel. 1977. The First Relationship: Mother and Infant. The Developing Child Series. Cambridge: Harvard Univ. Press.
SZECSODY, Imre and MATTHIS, Irene (Editors). 1998. On Freudís Couch: Seven New Interpretations of Freudís Case Histories. Northvale: Jason Aronson.
TOMKINS, Silvan. 1962. Affect, imagery, consciousness. Volume 1: The positive affects. New York: Springer. (1962-92)
WINNICOTT, Donald. 1958. Through Paediatrics to Psychoanalysis. London: The Hogarth Press
and the Institute of Psychoanalysis, 1975. First published as Collected Papers:
Through Paediatrics to Psycho-Analysis. London: Tavistock, 1958.
Also published as Through Paediatrics to Psycho-Analysis: The Collected Papers
of D. W. Winnicott. New York: Basic Books, 1975.
WOLF, Ernest S. 1988. Treating the Self - Elements of Clinical Self Psychology. NY: Guildford.
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"An Outline of the Basic Therapeutic Model" © 1994-2004. Dr Robert Gordon.