What is Therapeutic Change

This article describes a model for experiential learning that provides a cognitive reorganization. The experience of a good therapeutic relationship will in and of itself lead to cognitive changes. Ultimately, these new therapeutic experiences provide a new perspective on the client's difficulties. This experiential learning becomes especially meaningful when painful affect is aroused that is related to the earlier faulty learning. What is the nature of therapeutic change and how can it be brought about? These, to me, have always been the basic questions psychotherapeutic research must seek to answer. In a searching article, poignantly titled "Are all psychotherapies equivalent?" Stiles, Shapiro, and Elliott (1986) review the available literature in which they find considerable support for the Dodo verdict. I shall not repeat this exercise but rather attempt to distill from the evidence what I consider salient parameters, drawing on my own experience as analysand, researcher, and therapist. In some respects, the problem is easier than has commonly been believed, that is, we may already have the answers; in other respects, the solution continues to be elusive because, in the final analysis, we are dealing with some of the most fundamental problems in psychology- what is learning, what is the nature of changes in cognitions, feelings, and behavior and how are they achieved? Experiential learning. In the following discussion I shall confine myself to a consideration of psychotherapy as learning that occurs in the context of a two-person relationship. I am proceeding from the assumption that a person (whom we traditionally call patient or client) has, as a result of early life experience, acquired certain patterns of thinking, feeling, and behavior that have proven maladaptive and given rise to "symptoms" that are experienced as a "problem" for which he or she seeks help. Thus, since the person suffers from the ill-effects of previous learning in the context of a human relationship, a new and different human relationship can be used to effect corrections in his or her thinking, feeling, and behavior. Framing the problem in this manner, we quickly arrive at the two sets of "general therapist factors" which have repeatedly emerged in the literature: (l) warm involvement with the client and (2) communication of a new perspective on the client's person and situation (Stiles et al., 1986, p. 172). In other words, the therapist provides a benign interpersonal context in which the client, under favorable circumstances, can modify the products of previous learning and acquire somewhat different patterns of thinking, feeling, and behavior. In short, the client undergoes a corrective experience. To me, this formulation makes a good deal of sense and it articulates well with everything we know about the nature and consequences of early childhood experiences. I am referring particularly to deficiencies in parenting, traumas due to bereavement, abandonment, and the like; the enduring search for the gratification of such basic needs as intimacy and autonomy but also unrealizable and feared fantasies. Since in some instances the impact of these early experiences has been exceedingly trenchant and destructive (due to the child's immaturity and dependency on a primary care-giver), this helps explain the grave difficulties therapeutic endeavors often encounter. Thus, in some cases the effects of early experiences are virtually irreversible; in others, there has been a core of "good-enough" parenting which allows the patient to form a constructive relationship with a therapist. The latter may then meet some of the patient's basic needs and produce corrections in early deficits, thus opening the way to further personality growth. The model I have briefly sketched describes the various forms of psychodynamic psychotherapy interpersonal therapy and client-centered humanistic forms of psychotherapy. Although behavioral colleagues and therapists embracing cognitive models may reject it, I still believe that it has greater pertinence than is generally acknowledged. …