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Editor's note. This article was published in the Journal of European Psychoanalysis, 12-13, 2001. It is a commentary on Lawrence Friedman's "Ferrum, ignis, and medicina: return to the crucible". Journal of the American Psychoanalytic Association, 1997, 45, 21-37. It is followed by a rejoinder by Friedman.



The logic of the therapeutic relationship



Tullio Carere-Comes




Friedman pointed out that "Freud did not design a treatment: he discovered one". It means that psychoanalytic therapy is a robust phenomenon, endowed with an inner logic or an essential structure of its own. Two elements of this structure are highlighted by Friedman: the "hunt for objective truth" and the "adversarial attitude". The Author builds on this basic core to extend it in two directions. Firstly, he contends that the essential structure pointed to by Friedman is not a property of psychoanalytic therapy alone, but is shared by any genuine psychotherapy, ie any treatment that does not dissociate the tactical objective of symptom relief from the strategical objective of personal formation. Secondly, he locates the two Friedman's factors on the two orthogonal axes—the uncovering and the remaking line—that define the field of psychotherapy. On these axes, connecting each two cardinal therapeutic positions, the two Friedman's factors are doubled to four, ie two couples of opposite therapeutic factors. This doubling, which transforms Friedman's linear logic into a dialectical one, is deemed necessary to overcome the unilaterality of the former. In a dialectical approach truth is not just hunted or conquered, it is also received or generated; and the resistances are met with an adversarial, as much as with a reassuring and validating attitude. A balance is to be struck moment by moment between hunting and receiving, as between wrestling and reassuring, as a function of the demands of the process.




"Freud did not design a treatment: he discovered one". If it were not so, as Friedman points out, therapy would be an arbitrary venture:


If I am wrong in my assumption—if treatment is just the application to patients of whatever analytic theory happens to be knocking around at the moment—then my method is pointless.


Analytic psychotherapy­—and I would add psychotherapy tout court—is not in its essence a construction. It is something that happens and is observable in the treatment setting: It is a robust phenomenon. This is equivalent to say that the treatment has an inner logic of its own, which determines the observable structure. One can even start from hypnosis, as Freud himself did. But if one is guided by the logic of the process, and not by the wish to get at something (like repressed memories, catharsis, or whatever), the relationship reveals an essential structure, that is a set of properties that any genuinely therapeutic relationship must feature. Two points of this structure are highlighted by Friedman: the hunt for objective truth and the adversarial attitude.

            One can dispute whether the elements of the process being hypothesized by Friedman are the only elements, or whether they are the most basic among others. One can point out a contradiction between the willingness to be guided by the logic of the process and the decision to take into account, in the study of its components, only "Anglo-American, Freudian analysis". One can object that every therapy, inasmuch as it is a cultural product, is also a construction depending on some premises and worldviews. All this, however, does not detract from the substance of Friedman's observation. In fact, if an essential core, or an invariant structure, did not exist in every genuine psychoanalytic or psychotherapeutic relationship, all discourse on psychoanalysis or psychotherapy would fall into meaninglessness for lack of a real referent, and the psychoanalytic/psychotherapeutic theories could not be distinguished from the myriad of cults competing on the market for the care of the souls.

            Quite often, in the attempt to define this essential core or structure, the term "psychoanalysis" is employed for the genuine therapy, while the term "psychotherapy" is applied to a generic container for all merely symptomatic, suggestive or manipulative practices. This distinction echoes of course the one made by Freud, between the gold of psychoanalysis and the copper of suggestion. The same terminological distinction is also used in the attempt to separate "psychoanalysis" as a search for truth or a way of personal liberation from "psychotherapy" as a technical-scientific profession similar to medical practice. In both cases the distinction seems inadequate. It is true that symptomatic,  suggestive and manipulative practices, as all sorts of "short term therapies", do exist: but in all these cases it seems more appropriate to speak of "bad" psychotherapy. Even inside the medical paradigm a therapy that only aims to eliminate the symptoms is just a symptomatic therapy, while a good medical therapy acts as much as possible on the cause of the illness. Besides, the statement that psychoanalysis, unlike psychotherapy, can bring about a radical transformation, has never been convincingly demonstrated and still remains today a mere petitio principii.One can agree with Contardi when he says a propos of psychoanalysis that "therapy does not occur without subjective formation and this proceeds producing therapeutic effects"—save that this can be said of any good psychotherapy, not just of psychoanalysis. Indeed no psychotherapy can be deemed good, if the tactical objective of symptom relief is set apart from the strategical objective of personal formation or growth.

            The articulation between tactical and strategical objectives, on the other hand, cannot follow a fixed scheme. Sometimes the former, other times the latter, are at the forefront. A symptom-centered work can bring about an important personal transformation, just as the work on deep conflicts can cause the resolution of a symptom. However, it is the more likely that such things happen, the more the other side of the coin, even if implicit, is kept in mind. It very often happens instead that the more tactically oriented treatments (the "psychotherapies") do not pay enough attention to the strategy, while those more strategically oriented (the "psychoanalyses") neglect the tactics, ie the treatment of the symptoms with apt techniques. They both do a bad service to their patients, when the protection of the identity of the therapist is privileged to the detriment of the patient's needs. When on the contrary the attention to these needs prevails, the psychoanalyst becomes a psychotherapist (one who does not disdain the use of many cognitive, behavioral, and experiential techniques), and the psychotherapist becomes a psychoanalyst (inasmuch as they carry out an ongoing monitoring of the experience of the relationship on both sides­­or, if one prefers, they analyse the transference and the countertransference). With the consequence that the difference between the two becomes almost irrelevant.

            As a consequence, the words "psychoanalysis" and "psychotherapy" can be used as synonyms in most cases. Instead of looking after uncertain and improbable distinctions, it could be more useful to define what is essential and structural in any genuine therapeutic relationship, whatever one prefers to call it. With this aim, the two basic attitudes indicated by Friedman seem to be a good point of departure. Here is the first:


The analyst could press his own case without entreating the patient and without manipulating the patient because the patient's ultimate response was guaranteed, theoretically, by a third presence—objective truth, truth undistorted by the analyst's and patient's preconceptions and wishful thinking.


These words define the basic attitude not just of psychoanalysis, but of every relational therapy, because the incapacity or unavailability to neutralize one's personal or school preconceptions is the hallmark feature of all practices of manipulation or indoctrination. It is hardly questionable that the suspension of all analyst's and patient's preconceptions is the very foundation of any genuine psychotherapy, whereas on the attribute objective for the substantive truth one cannot be equally sure. Benvenuto has for instance observed:


hermenutic criticism has reminded us modern folk, insofar as we are all (fatally) "enlightened", a bitter truth: that it is impossible to know something without interpreting, and that it is impossible to be definitively "objective".


Everyone interprets on the base of one's personal or school myths. The crisis of the Freudian interpretation (no longer revealing an objective truth, but just a myth among many) is, however, healthy, "insofar as it reduces a chronic tendency in much of psychoanalysis towards interpretive omnipotence". This crisis means that we are now aware that one can never fully bracket out the myths (prejudgements, preconceptions) that are at the root of one's interpretations. This crisis can pave the way to positions of relativism or radical constructivism, where everyone is wrapped in one's own myth (or one's own theory), and can communicate only with those who share the same premises. Truth disappears from this horizon, being "functionality" the only boundary left against chaos.

            Once the illusion that interpretation reveals objective facts has been abandoned, what will save us from nihilism, dangerously courted by Nietzsche ("facts don't exist, only interpretations do")? How is it possible to distance oneself from the old naive, dogmatic certainties, without falling into the opposite extreme of postmodern constructionism; how can one avoid the trap, in other words, of the false alternative between scientism and skepticism? If the identification of reality and objectivity is the trap, the way out will be the separation of these two notions, for reality to be traced back to the ontological or noumenical foundation that is lost in any objectivation.

            Only what is is real: the ontological referent, in itself unknowable, of every knowledge . Every knowledge (K) is a transformation of the thing in itself (O). When we try to know a thing, we unavoidably transform it. What we know is the result of that transformation, not the thing as it is in itself, independent of our action. But the transformation can both reveal and conceal the thing. What shall we know then of its truth? We can first of all apply the classic criterium of conformity (adequatio rei et intellectus): the validity of a knowledge depends on its adequacy to the ontological referent. This criterium of course is not usable in the constructivist perspective, from which the ontological referent has disappeared. If we recover it—as we must do if we want to get rid of the dilemma between scientism and skepticism—we also recover the criterium of conformity, but its application requires the clarification of some premises.

            To begin with, as hermeneutic criticism has reminded us of the impossibility of being definitively objective, we have to give up the simple and naive objectivity of scientism, but this does not sanction the denial of any space and value to the object and to the scientific activity that produces it. As biology allows us to know some aspects of the living being, those aspects that the theoretical-technical apparatus of the biologist cuts out from the reality of the living world (ontological referent), which is incommensurably vaster than the cut out part (objective knowledge), so psychology allows us to know what its instruments cut out from the reality of the psychic world, this too incommensurably vaster than the part that has been cut out. Biology and psychology are nothing but theoretical-technical activities, and the objects produced by them. If the procedures are correct, the objects that are the result of these procedures are adequate to the referent, ie they allow us to know some partial aspects of it. But only the correspondance to the referent, established by repeated and controlled comparison with the investigated reality, will allow us to ascertain the quality and the measure of such adequacy.

            Being the result of the theoretical-technical procedures applied, the object is always an interpretation of the subject. On the other hand, as the procedures are bound to the ontological referent, the result will not be arbitrary, but will describe the aspect of reality that is defined by the selected criteria—the more rigorously the procedure has been applied, the more faithfully this aspect of reality is described. The recovery of the ontological referent therefore permits us to overcome the distinction between hermeneutics and science, or between natural and human sciences, whose artificiality has been pointed out by Holt. In this sense psychoanalysis—interpretive discipline par excellence—is a science in its own right, provided that it rigorously defines its theoretical and technical apparatus. The same is true for every form of psychotherapy.

            If, on the one hand, the link to the ontological referent allows us to grant a status of objectivity to the interpretive procedures, this on the other hand is no bullwark against the unlimited multiplication of perspectives, leading to the proliferation of schools and psychotherapeutic languages. Every paradigm is entitled to revenge its own scientific foundation, though remaining incomparable and incompatible with the others. Thanks to the specificity and originality of its means,  it is as though every approach highlighted a particular sector of the "thing" (or of the therapeutic field), providing us with a valid and objective knowledge of that sector, though incomparable with the others. As a matter of fact the very loyalty to a given paradigm warrants on one hand the rigor of the procedure, while on the other it insulates the sector defined by it from all the others, defined by rival paradigms.

            If the pluralism resulting from the multiplication of perspectives can be welcomed as a step forward in respect to the monolithic ideologies, it is not an acceptable outcome for psychotherapy. The surrender to the pulverization of schools and methods would mean indeed the resignation to the impossibility for the therapist to transcend the theoretical frame that orders his or her world, thus sanctioning the impossibility of communication among adherents to different paradigms, and the definitive illusoriness of a genuine listening. Such a "postmodern" outcome could be accepted if only aesthetical values were at stake, which is not the case in psychotherapy—a discipline that, as was pointed out above, is different from indoctrinating or manipulative practices inasmuch as it is systematically and constantly grounded on the capacity and will to neutralize all personal and scholastic preconceptions and wishful thinking.

            We started with the observation that the corner stone of psychotherapy—neutrality—is contradicted by the hermeneutic criticism that "it is impossible to know anything without interpreting". The retrieval of the ontological referent allowed us to return a relative validity to the objectivity of interpretation, but only inside a given paradigm, whereas the choice of the latter remains completely up to subjective preference—it is out of the question that one could ever "objectively" demonstrate the superiority of, say, a cognitive paradigm over a Lacanian one. If this were the point of arrival of our investigation, we would face here an insuperable contradiction between the basic assumption of genuine psychotherapy and hermeneutical critique, inasmuch as what the former demands the latter denies. Should we then give up one or the other?

             Many conflicts that seem insuperable as long as they are addressed from the standpoint of linear logic, are no more so in a dialectical perspective. If we recognize the value of either enunciated principle, it will suffice to renounce the pretence for the one or the other to be unilaterally valid, to see that the contradiction relates to the two terms of a dialectical polarity. The first step has been done—the pretence of a perfect neutrality, if we ever harbored it, was swept away by hermeneutic criticism. The second step must be in the opposite direction. Hermeneutic criticism, which left to itself bolsters the anarchic proliferation of interpretations, must in turn be moderated by the call of neutrality, in search of the balance without which the therapeutic operation is unconceivable.



The dialectic of interpretation and neutralization has been described, albeit in different words (assimilation and accommodation), by Piaget. In the course of normal development the child firstly tries to assimilate all new data to her available cognitive schemata, ie she interprets them in the light of preexisting models, myths or theories. Piagetian assimilation substantially corresponds to hermeneutic interpretance, an ongoing, structural attitude of the human being. However, the healthy child does more than assimilation. Facing contradiction, she does not insist on trying to force reality into her schemata, but she finally suspends those schemata, stepping back and letting the new data enter into her horizon. In so doing, the child does not interpret, but sees something new, thanks to the suspension of the assimilative attitude. Instead of assimilating the data to her schemata, she accommodates her perceptive apparatus to the reality in front of her. The child's accommodation is the first embryo of phenomenology's epoché, in which the bracketing of expectations and preconceptions permits her to receive what appears in that opening. And it is only for this systematic neutralization that her schemata are modified and enriched.

            The same dialectical movement is found in the hermeneutic circle. Any interpretation starts with a precognition, as Heidegger pointed up. Reevaluating prejudgment as a source of understanding, and denying the possibility of a neutral interpretation, Heidegger lucidly illustrated the general condition of interpretation. In this emphasis of understanding through interpretation, however, one intuits the wish of the disciple to emancipate from his master Husserl, who in an equally unilateral way had insisted on neutrality. More balanced than either one of these is Freud's position, which is "Heideggerian" in the prescription of the Oedypal mythology as the base for the production of meaning in the analytic narratives, and "Husserlian" when he suggests to proceed free of expectations, facing whatever happens in an open-minded way and without preconceptions.

            The hermeneutic circle can function in the mode of vicious or virtuous circle. In the former the theory or myth is the same at the departure and at the end of a movement in which the conclusions regularly confirm the premises. It is the way of all orthodoxy, and the reason for the well known—and for this reason just—exclusion by Popper of psychoanalysis from the scientific field. In the virtuous circle the implicit presuppositions are firstly employed for a preliminary understanding of the data, and then suspended for a fuller understanding, inclusive of whatever the initial presuppositions could not grasp. The figure of the circle is apt to describe a movement in which the point of arrival (the fuller understanding) is brought to bear onto the point of departure, which allows for the theory to be constantly modified and enriched.

            There exists one more possibility, a third and more insidious mode of hermeneutic circle which is neither openly vicious, nor clearly virtuous. It happens when the initial assumption is suspended as a function of the expectations of the other. What is lacking here is a true neutralization. The subject does not suspend his or her assumptions in the name of truth, but just comes to terms with, or negotiates a solution acceptable to both parties. As the mediation is not in the name of truth but in that of compromise, the process leads to a reciprocal adaptation which is not in the maturative direction, but in that of a false self à deux. In the relationship between a couple, between the leader and his followers, or even between analyst and analysand, each party tends to consciously or unconsciously adapt to the knowledge of the other (theories, models, phantasies). It is necessary to distinguish this pseudo adaptation—in fact, a reciprocal collusive manipulation—from a true adaptation to reality. The true accommodation is not a negotiation of knowledge, but the correction of a preexisting schema which follows the suspension of all knowledge: the jump into the void that Bion pointed to with the formula Faith in O, which means entrusting oneself to the unknowable origin of all knowledge.

I will try now to show the dialectic of the hermeneutic circle as it unfolds in the writings of Benvenuto and Napolitani. Benvenuto holds a prudently intermediate position between those who exceed either in a scientific or in a hermeneutic sense, ie on the side of the object or on that of the subject. On the one side one "aims for the objectivity of something elementary, for a primary cause which, in so far as cause, has no meaning... This love for the term 'elementary' is always the indicator of a reductionist attitude: the objectivist runs from the complex (the olon), and seeks peace or a safe haven in the elementary". On the other side, "the resignation of analysis to an hermeneutic game—ie to elaborate interpretations that only History will be able to judge—is a sign of its crisis... Those who discredit psychoanalysis think in fact that it deals only with interpretations, and never really with something real—that the analyst is not a witness to some thing (das Ding) that the subject discovers, but a manipulator of the subject's beliefs".

In the search for a real that is not reduced to an elementary, meaningless objectivity, nor dissolved in an endless flight of interpretations of interpretations, Benvenuto finds a track in the "affect of truth" that is "certainly the result of the analyst's likely historical-hermeneutic re-constructions which reveal the subject's interpretive defense: but on the horizon, this affect of truth points out to the subject—finally perceiving herself as something other than what she believed herself to be—the possibility of interpreting herself otherwise, and opening herself to that otherness that dislodges her". The real is therefore defined by contrast to the imaginary: It is other than what the subject imagines to be, it is what she finds before herself—what she has to come to terms with—when she uncovers the self deception in which she had taken refuge or had been trapped. The affect of truth is the liberating feeling which signals the exposure of the self deception, and at the same time points up to the reality that the deception concealed. The analyst pushes the subject to become permeable to an otherness that Benvenuto exemplifies as "biological drive, trauma, demands and interpretations from without": an otherness that has the quality of an inevitable given, or a given that is only avoidable at the price of a self segregation into a neurosis.

However, according to Diego Napolitani , "every 'discovered truth' is a deceit, ie a fanciful approximation to 'how things really are'". If "there is no objective reality, no encounter with the world, which is not a hybrid, that is the result of a violence (ubris) of individual preconception on perceived data", then even what Benvenuto identifies as "real" (drives, traumas, demands from the outside world) can be nothing but the product of the same violence that constantly tries to pass off its own constructions as real. Does it mean that there is no way out of one's epistemological cages or shells? One way does exist, says Napolitani, and it consists in recovering "the naked gaze of the child", that is "a way of seeing which does not presuppose a single aim, therefore surprises, open to comprehension and uninterested in the explanation, not caught up with the shapes on our side of the horizon, because it sees that which is beyond sensible limits. The gaze of the mystic, of the poet".

But what is the relation between the interpretive violence and the naked gaze? Violence belongs to the Freudian unconscious, meant as "the space of the repressed, the 'totally already known' which makes itself present, beyond a critical awareness, as an a priori law, the law of the defunct, the moral conscience". If experience is governed by the law of the defunct, of the already known, its categories will be confirmed in an endless repetition. But if the defunct is evoked, as in the old psychagogical ceremonies, "in order to conclude the time of his death... his heir has the possibility of not remaining confused with him, of taking that reflective, critical, aesthetic distance in which he can minimally affirm his originality... originality does not imply the impossible being beyond one's own history, but a singular way of taking up once more one's own history (one's own origins) not to repeat it, but to transform it". The naked gaze corresponds then to "the negative capacity already formulated by Keats and then by Bion. It is the capacity to tolerate change and it is founded on the shifting of the existential center of gravity towards the future and becoming. The mind which does not reject its own conception has faith... in its ability to find itself once more, grown in its own continuity, beyond change". This faith allows the jump into the void, the  abandonment of the certainty of the already known (though unconscious), to entrust oneself to the generative matrix (the unknown).

Benvenuto and Napolitani have a point in common, but then their ways diverge. This base is also common to all those, like Jacques-Alain Miller and Jean Laplanche, for whom "the interpretation  is above all that of the unconscious, in the sense of the subjective genitive: it is the unconscious that interprets".  The interpretation is seen as a primarily defensive operation, which protects from something that is pointed out as the true, the real, the unknown, the thing-in-itself. The primary objective of psychoanalysis therefore is to unmask this operation, uncovering the interpretations to which the identity of the subject has remained stuck, to bring her back to whatever she has repressed by means of those interpretations. How is it possible that from this common ground one arrives to divergent or seemingly opposite conclusions, as in the case of Benvenuto and Napolitani?

My answer is that the opposition is only apparent, if one considers that Benvenuto and Napolitani have highlighted respectively the two terms of a dialectical polarity, the one that Bion refers to with the letters K and O, the actual and the potential, the phenomenon and the noumenon. In the K vertex the analyst confronts the subject with those real data that are like unavoidable stumbling blocks on her existential path. Heavy data, biological, biographical, or environmental, with which one has to come to terms, if one does not want to remain stuck to them. There is a "real in K" which is made up of these concretions, ie of the material, familiar, historical, social conditions of the existence of the subject. The human being, thanks to his "neothenic" unachievement, is different from any other animal for his extraordinary capability of ongoing transformation of the conditions of his existence, in which he breaks the material or epistemological shells that imprison him, to reconceive and rebirth himself in ever new and unforeseeable forms. In the O vertex of the therapy field, the analyst and her patient, "bound by a common evocation of their own 'deceased' (of their own history, ideology, common sense, theories, psychoanalytical knowledge)" continuously dissolve and recreate the forms of their existence.



We have passed from Friedman's "hunt for objective truth" to the set of operations on the line connecting the O and K vertex of the therapeutic field. An initial concept of objectivity has been examined: the one that exists inside a given paradigm, the object being inseparable from the theoretical-technical procedures that produce it. Because genuine (non manipulative) psychotherapy happens only insofar as all pretence of imposing one's own personal or scholastic paradigm is suspended—the space of therapeutic dialogue opens thanks to this suspension—the criterion of objectivity, though not alien to the truths that are discovered in psychotherapy, meets here with a problematic application. In the first place the self-interpretations in which the identity of the subject has remained trapped must be  brought to light, furthering the encounter with the real that they screened. One is guided, in this part of the work, by the "affect of truth" (as Benvenuto conveniently calls it), more than by the procedures commmonly employed when the aim is to establish the objectivity of a proposition. But once we find ourselves in the face of that real that the alienating interpretations concealed, the question of its objectivity appears in a new form.

            It is a question that we do not have to face, if we stick to the Lacanian definition according to which "le réel est l'impossible". Indeed, if the real that one finally encounters is nothing but the impossibility of the desire (of true love, of immortality…), then the surrender to this impossibility is the price to pay to stop the endless flight into neurotic interpretance. But this would be an ethical task, not a scientific venture. If then, beyond a stoical acceptance of the unavoidable, we make out the possibility of getting rid of our interpretive cages, towards a reinterpretation of existence that is no more neurotic, but creative and regenerative, the space that opens wide in front of us is that of the art of living, which has little or nothing to do with science. Psychotherapy is certainly a complex operation, inseparable from an ethical and philosophical committment. What, in its scope, could still claim a scientific foundation?

            If such a foundation is indeed to be claimed, it will no longer suffice that a school of psychoanalysis or psychotherapy defines its theoretical-technical apparatus, self-limiting its own pretence of objectivity to the objects that this apparatus cuts out in the real. Even if in so doing a partial aspect of the thing is described, the self-referential withdrawal on one's own objects (practice, rites, language) observable in most existing schools is incompatible with the minimal demands of the scientific discourse. This in fact requires that instead of the necessary comparison between different and competing hypotheses being used as a key for identifying followers, forwarding careers and marginalizing heretics (as happens nowadays), any theoretical assumption be viewed as an hypothesis to be verified or falsified in the ongoing public confrontation with experience. This confrontation is not possible if the object under investigation is generated by the theory through which it is investigated (in which case self-referentiality is unavoidable), but only if the real referent to which all theories are bound is neutral in respect to the theories themselves—if it is "transtheoretical" or "metatheoretical".

            One can deny the very existence of such a theoretically neutral referent, as happens with a postmodern, radically constructivist perspective. If it were true, however, that everyone is unredeemably closed up in one's own theoretical paradigm, not only would any dialogue among adherents to different paradigms be impossible, but psychotherapy itself would be impossible. Genuine psychotherapy is grounded on dialogue, and dialogue is the type of communication in which the presuppositions of those who are engaged in it are as neutralized as necessary to have the logos of the relationship emerge. The assertion of the existence of a logos (a logic, a ratio, an order) in things is certainly a matter of faith, but it is the faith on which every scientific venture is grounded. In particular, it is not possible to think of psychotherapy as a scientifically based operation outside the assumption that psychotherapy is governed by an inner logic of its own, in spite of the virtually unlimited variety of techniques and the unforeseeable singularity of every encounter. In other words, the arbitrariness of theoretical and technical options can be avoided if psychotherapy is anchored to a structure of its own, ie to a set of invariants, regularities or recurrent configurations that structure any psychotherapeutic relationship, independently of the school of the therapist and the preferences of both therapist and patient. The paradox of the Dodo verdict—"all have won, all deserve a prize", the outcome equivalence of the different therapeutic methods—seems to demonstrate that psychotherapy works, but for reasons that are only weakly connected to the technical choices of the therapist. It works because every therapist is persuaded by the inner logic of the relationship to respond to the real needs that are in play in every therapeutic relationship, whether or not they are foreseen by his or her school. With this we return to Friedman's observation from which we started: therapy, in its essential features, is not an invention, but a discovery.         

What do we discover? We discover firstly that the therapy relationship takes the form of an uncovering work. There is a wide convergence to the acknowledgement that a basic feature of every therapy consists in unearthing the interpretations that the subject has given of themselves, their world and their history, and in which they have remained entangled, whatever the form of their interpretations: unconscious phantasies, cognitive schematas, emotional schemes, relational scripts. Though anachronistic and disadvantageous, the subject, as a rule, defends them stubbornly, and vigorously resists any attempt to modify them. They are defended because of their protective function in respect to something which, right or wrong, one is afraid to face—old wounds that still hurt, unsatisfied needs, unresolved conflicts, existential decisions in present life. The "hunt for objective truth"—Friedman's first factor—clearly refers to the inescapable necessity for any therapy to unmask the mental constructions that separate the subject from the reality that is their own.

            The dimension of discovery, however, cannot be entirely reduced to a "hunt for objective truth"—this would throw a vaguely persecutory shade on the relationship. It is not just about uncovering the "real" that the subject shuns, but also the unexpressed "potential" which can be drawn upon to generate new forms of existence. Therapists who systematically faced their patients with the real they escape, without knowing at the same time how to awaken the trust in the healing and regenerative power upon which to draw to transform the real they fear, would probably drive their patients and themselves into a blind alley. The uncovering line of the therapy field can therefore be represented as an axis connecting the K and O poles of the real and the potential, of the known and the unknown, or of the phenomenon and the noumenon. This is the main axis of any genuine therapy, independently of the persuasion of the therapist.

            Therapy, on the other hand, is not just a matter of uncovering. It is an uncovering operation only when, and to the extent to which, a good enough working alliance has been established. But a working alliance firstly has to be created, and secondly has to be sustained. To create and to sustain a working alliance is one thing, to work in the space opened by a working alliance is another thing. These two things can be seen as the two levels or axes of the therapy field. At this more basic level we find the second Friedman's therapeutic factor: the adversarial attitude, meaning the fight against the resistance, ie the unwillingness to face whatever is to be faced. Its necessity derives from the rebellion of the infantile mind to whatever challenges the omnipotence of the desire. This factor was explicit in Freud, when he wrote that the patient suffers not because he does not know, but because he does not want to know. The problem, in Freud's view, is not resolved by communicating to a person what he or she does not know, but fighting his or her inner resistances. The first duty of the therapist, therefore, is not the uncovering of what is concealed, but the fight against the resistance, in Freud's words, or the adversarial attitude, in Friedman's. This concept might be implicit in that of the "hunt for the objective truth", because the hunter knows that the prey will do its best to avoid capture. However, as long as the emphasis is on objective truth, the basic attitude is that of the scientist, who investigates with as neutral as possible a frame of mind, whereas the emphasis on resistance implies a shift from neutrality to a deliberately adversarial involvement:


What I call adversarialness, and what Freud described in similar idiom, refers to the way the analyst sets his face against appeals by the patient, denies bids for validation and reassurance, sternly summons what is most reluctant….


This is a very good point. Surely, on many occasions a therapist cannot help but present a stern face and deny bids for validation and reassurance. But is this the only face of a therapist? Are there no other occasions, in which the offer of validation and reassurance is in order? To answer this question, we shoud keep in mind Friedman's warning: to decide what belongs or does not belong to psychoanalysis (or, for that matter, psychotherapy), we should not rely on theory—on any theory whatsoever. Ie, we cannot answer that reassurance is permitted or forbidden, just because our theory foresees or does not foresee it. If we did so, the result would not be analysis or therapy, but scholastic (stereotyped) analysis or therapy. It is not one school's theory that we must interrogate for such an answer, but the inner logic of the psychoanalytic (or psychotherapeutic) relationship. And the inner logic tells us what more and more psychoanalysts realize: insight is not enough. Why is insight not enough? Because if it were enough, the analyst would not need move from the neutral position of the scientist in the first place, which is something they do everytime they take the adversarial attitude—which in turn they must do to fight the inner resistances. By the same token, a parent puts on a stern face when a child tries to shun something unpleasant that is beneficial for them. Indeed, the adversarial attitude is nothing but the basic parental attitude of confronting the child with whatever they are trying to escape. On the other hand, this does not go without the polarly opposite parental attitude of validating and reassuring. These two attitudes make up another basic dialectic, between the paternal-confronting and the maternal-reassuring vertices[1] of the therapy field.



When someone is fully motivated to know and face whatever is there to be known and faced, there is no need for an adversarial attitude, just as when a person is secure of his or her right to exist and to be whatever he or she is, there is no need for a reassuring attitude. There can be moments or whole sessions in which the therapist can remain at least relatively neutral, because the whole work takes place on the uncovering line. But there can hardly exist a therapy in which the therapist will not have to shift from time to time to the remaking or reparenting line, the one connecting the maternal and the paternal vertices of the field. The two Friedman's factors are representative of both lines, but with a distinct male-analytic prevalence. If we correct this bias including the female-synthetic side of the whole, what we get is two couples of cardinal factors (O-K, M-P) and two orthogonal axes (remaking and uncovering) which describe the field of therapy. Friedman's two-factor model is enlarged to a four-factor one that accounts for virtually all therapeutic interactions.

            The widening of the scope is required by the dialectics of the interaction. Too much emphasis on the K vertex, not balanced by the spontaneous and generative interventions of the O vertex, risks giving the relationship an epistemophilic, tendentially obsessive character, which in turn would bolster iatrogenic resistances. If therapy is too much of a hunt, and too little a play, it is all too easy for the patient to feel hunted, especially when one is so predisposed—in which case the predisposition would be confirmed. Similarly, if the therapist's attitude is too adversarial, and not reassuring enough—if the therapist's face is too stern, and not accepting enough—it will be all too easy for the patient to perceive the therapist as a hostile person, and to have their persecutory phantasies confirmed.

            The missing parts of the whole thing have been unearthed by analytic writers. For instance, the reassuring-validating position (maternal vertex) has been re-discovered by self-psychology analysts, whereas the dialectic of spontaneity and technical rigor (O and K vertices) has been explored by relational analysts. However, the development of a fully dialectical therapy has been hampered by two different hurdles. Firstly, although it is widely recognized by now that pure neutrality cannot exist, and every analytic relationship is in fact an interaction, many or most psychoanalysts are still reluctant to allow for any direct and deliberate action, if different from the classical "hunting" and "adversarial" strategies. For instance, one admits that the analytic relationship can host a "secure base", but only inasmuch as it is an effect of the setting, and not of a deliberate reassuring action by the analyst. Likewise, a certain measure of spontaneity is tolerated, as long as it is an unwitting though unavoidable enactment by the analyst, and not a conscious deviation from the neutral position.

            But how are we to decide if the therapeutic process requires or does not require reassuring or spontaneous actions? Is our decision guided by the process or by the theory? The second and most serious hurdle to dialectical therapy is the scholastic defence that makes the therapist theory-responsive instead of process-responsive. The difference is that the dialectical therapist does have a theory (or many theories), but does not depend on it. He or she uses the theory as long as it is useful, and puts it aside when it is not. Real therapy, as real life, cannot be constrained by any theory. Theory is necessary for a general orientation, or as a point of departure; but one should always be ready to be surprised by anything that does not fit in with any given theory, and consequently to modify it in order to accommodate the new datum.

            One could object that the four-factor model I am proposing here is a theory like any other, larger than the two-factor model it is supposed to replace, and smaller than the six-factor model that sooner or later will supplant it. I would reply that, firstly, the four-factor model is dialectical, whereas the two-factor one is not. This makes a great deal of difference, because the four-factor model does not feature just four factors, but more precisely two couples of factors. It means that the unilaterality of each factor is compensated by its opposite, with the result that, for instance, one is not hunted by the hunt for the truth if one also experiences the therapeutic relationship as a place where truth unravels by itself when it is not hunted, but received.

            Secondly, I propose a four-factor model because it seems to me that virtually all therapeutic interactions happen within a space defined by two orthogonal axes connecting these two couples of factors, but if I now maintained that only my four-factor model defines the true dialectical therapy, I would indeed be creating a theory like those one typically finds in most psychoanalytic or psychotherapeutic schools. Nothing is wrong with theories, as long as they are instrumental in scientific research. Instead much is wrong, when they become means of identification or power, as so easily happens in psychoanalytic or psychotherapeutic schools. Therefore, if somebody announced that he had found a third axis in the field, which made it hexagonal, a really dialectical therapist would be ready to pass from her four- to the new six-angle field, provided that the data presented were convincing.

            The logic of the therapeutic relationship is not to be confused with the four-factor model (or, for that matter, with any n-factor model). The four-factor model is just the dialectical development of the mainstream psychoanalytic two-factor model, neatly outlined by Friedman. The logic of the therapeutic relationship is a dialectical logic, ie one that differs from ordinary logic inasmuch as it is based on oppositions, whereas the latter is based on identity. For instance, in the passage quoted above Friedman defines the adversarial position (P) as opposed to a reassuring-validating position (M). This is still inside the logic of identity (P¹non-P), in which the opposite is considered only to be excluded. It may be also viewed, however, as the beginning of a dialectical reasoning, in which the opposite partakes in the definition of a thing in an essential way (P=non-M): In a fully unfolded dialectical logic one thing is what it is only in connection with what it is not. It means that it is not enough to say that P is not M—one has to add that P exists only thanks to M, ie the one cannot go without the other, either in the family or in the therapy. This makes explicit the reciprocal belonging that was implicit in Friedman's formulation. While in a classic analytical stance the adversarial factor prevails, and in the self-psychological stance the validating factor is at the forefront, in a dialectical approach neither prevails, but the best synthesis required by the clinical situation at hand is searched for on a moment-to-moment base. Many oppositions that lack a dialectical perspective, thus leading to schisms and to the birth of rival schools, can be understood in this perspective as different polarities of the one therapeutic field.







Agazzi, E. (1994). Tra scientismo e scetticismo. In Il mondo incerto, a cura di M. Pera, Bari: Laterza.

Benvenuto, S. (1997). La crisi dell'interpretazione. Psicoterapia e scienze umane, 4, 53-78.

- - (1999). Eyes wide shut. Is psychoanalysis in touch with the real? Journal of European Psychoanalysis, 8-9, 43-66.

Bernardi, E.R. (1989). The role of paradigmatic determinants in psychoanalitic understanding. International. J. of Psychoanalysis., , 70, 2, 341-357.

Bion, W.R (1970). Attenzione e interpretazione , Roma: Armando, 1973.

Carere-Comes, T. (1999). Beyond Psychotherapy: Dialectical Therapy. J Psychotherapy Integration., 9, 365-396.

Contardi, S. (1999). Therapy in psychoanalysis. Journal of European Psychoanalysis, 8-9, 15-20.

Fonagy, P. (1999), The process of change and the change of process. Psyche Matters,

Freud, S. (1910). Analisi selvaggia. O.S.F., 6. To­­rino: Boringhieri.

- - (1912). Consigli al medico nel trattamento psicoanalitico. O.S.F., 6. To­­rino: Boringhieri.

Friedman, L. (1997). Ferrum, ignis, and medicina: return to the crucible. Journal of the American Psychoanalytic Association, , 1997, 45, 21-37.

Martin Heidegger (1927), Being and time, §32. (New York: Harper and Row, 1962).

Hoffman, I.. (1994). Dialectical thinking and therapeutic action in the psychoanalytic process. Psychoanalytic Quarterly, 63:187-218.

Holt, R. (1962). Individuality and generalization in personality psychology. Journal of Personality, 30, 3, 405-422.

Laplanche, J.  (1995). La psychoanalyse comme antiherméneutique. Revue des sciences humaines. 13-24.

Linehan, M.M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press.

Longhin, L., Mancia, M. (1998). Metodo e verifiche in psicoanalisi: una riflessione epistemologica. In Temi e problemi in psicoanalisi, a c. di Longhin e Mancia. Torino: Bollati Boringhieri

Miller, J.A. (1996). Il rovescio dell'interpretazione. La psicoanalisi. 19, 120-124.

Napolitani, D. (1999). Psychoanalysis has completed the time of its life. Journal of European Psychoanalysis, 8-9, 21-42.

Piaget, J. (1959). The language and thought of the child. London: Routledge and Kegan Paul.


[1] The terms "maternal" and "paternal" do not imply that the respective modes are exclusive of the mother or the father, as in fact each of them can be exerted by both parental figures, as by anyone, as a therapist, in a nurturing position. These terms are chosen, however, because validation is mainly a maternal role, as confrontation is mainly paternal: a child with a validating father and a confronting mother could have problems in gender identification.


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