"The Therapist's Role in the Disruption and Repair Sequence in Psychoanalysis"
By Steven A. Frankel, M.D.
Article published in Contemporary Psychoanalysis, 33: 71-87 (1997).

Synopsis:
Imagine you are holding the rope that may get you and your companion over this treacherous cliff. You alone have managed to find your way up the face of the rock since you’ve done this before, with years of rock climbing and careful attention to the techniques. But your companion, hundreds of feet below, looks dazed. All she sees is vertical rock with a small tree growing here and there out of its face. She took a short course in rock climbing, but since she is terror-struck she has forgotten all she learned. Cooperation is almost out of the picture. Ironically, your companion is an excellent map-reader and without her you could not have made your way here. Just before arriving, you insisted on following a stream along a canyon. The walls kept closing in, your partner insisted, more violently each time, that you were lost, but you wouldn’t hear. It was only as rain clouds gathered, and you realized how quickly a flash flood could wipe you out, that you even considered listening. But now you both have to get over this cliff and you are the one who knows how.

The canyon was my anger. Marty was driving me crazy with his despair and unrelenting accusation that I was responsible for his suffering. In response I walled him off and protected myself by charging him for a session he did not attend. It was only when our trek looked like it would fall apart, be washed away by a flash flood of emotion, that I took my bearings from him. And then I was in charge.

In most modern dynamic therapy systems the therapist is at least nominally in charge as the two search for explanations of the patient’s troubling experiences and for ways to work together. This picture, which applies in relational as well as traditional Freudian systems, leaves little room for the therapist simply taking over and moving the patient this way or that. After all, his opinions are so rife with distortions based on his own subjectivity that they could hardly be reliable, and the forcefulness of his actions would rob the patient of initiative. And yet, to pretend that therapists do not lead, and deliberately so, is to falsify and debilitate the dynamic therapeutic process. Falsify, because it happens and usually takes up a good deal of therapeutic space. Debilitate, because no patient would want to be in a therapy where the therapist does not lead the way, at least from time to time.

Read the full article here.