HOW DOES ANALYSIS CURE? Heinz Kohut. University of Chicago Press, 1984. 240 pp.

Edited by Arnold Goldberg with collaboration of Paul E. Stepansky

James Donnelly, DSW, LCSW

Apologia pro vita sua

As introduced by his editor, Arnold Goldberg, MD., How Does Analysis Cure? is Kohut’s final book. Written as a response to criticisms and questions raised by The Analysis of the Self and The Restoration of the Self, the overall tone of the book has the feeling of a tract in defense of the Self Psychology movement. Reminiscent of the European theologians of the Sixties trying to pour new theological wine into old wineskins, preoccupations with issues such as the validity and redefining of an “incomplete analysis”, the valid place of Self Psychology in the Psychoanalytic tradition, the Oedipus Complex redux. etc., surround and distract from the genuinely powerful and useful therapeutic gems that are the core of this book. Fortunately, they are repeated in somewhat of a crescendo pattern throughout the entire book.

There are two major foci of the presentation: an understanding of a core deficit underlying the many varieties of human frailty (including client and therapist) confronted in treatment, and the essential therapeutic attitude (beyond technique) required for a healing response.

The concept that holds, elaborates and integrates these foci is that of the “self-object”. Developed out of Kohut’s understanding of narcissism, the concept of self-object is extremely powerful shorthand that validates both the reality and necessity of dependence in relationships … throughout the entire life cycle. In Kohut’s hands, this seemingly abstract term, self-object, validates the universal need we all have for relationships in order to maintain and balance the inner life of our emotions and sense of self. Self-objects exist only in “self-object environments”, i.e. in relationships. Pathology (deficits in the Self) and health (a flexible and openly defined self vis a vis others) are described in terms of the vicissitudes of our use of relationships; but there is never a time when health means we outgrow them. If one can stick with Kohut, he provides a genuinely refreshing balance to the much maligned and often distorted concept of “co-dependence” in relationships.

The use of the word “object” to describe relationships in the Psychoanalytic tradition is primarily meant to point to the concept of the other that is a real and necessary component of our concept of our selves. Due to the inevitability of less than perfect adaptations between the levels of maturity in our relationships, the “object” always represents some distortion of the reality of the other that is responded to with distortions of the self. The key to health in Kohut is not in the total elimination of these distortions (i.e. the complete “working through” of transference/counter-transference), but in the realization of the valid need and possibility, born out actual experience in a relationship to continuously negotiate the inevitable distortions between us.

The presumption is that those who come for treatment are suffering from deficits in their self resulting from not having had that experience nor having realized that possibility in core aspects of their relationships. For Kohut, the essential capacity to provide an opportunity for “cure” is primarily the quality of the presence of the therapist. That quality is characterized by: “the freedom [of the therapist] to respond with deeply reverberating understanding and resonant emotionality, and the generally calmer and friendlier atmosphere of …treatment.” Although throughout the book, he attests that such a quality of presence is more likely within the theoretical perspective of Self Psychology, Kohut acknowledges that it is present and is the sine qua non of all good therapists … regardless of persuasion. He describes the therapeutic act in two steps: understanding and explaining. However, that the client experience him or herself as understood is essential … even if the explanation is not correct

Reading How does Analysis Cure is a reminder that much of what is “new” is not new; it just needs to be repeated. It is always moving and humbling to witness through the candid struggles of a therapist of the stature of Kohut to reach for it again and again; and to find our own way of seeing it and saying it. Hopefully, that process leads to a better capacity for understanding and more meaningful and effective explanations in our work.

South Garden Press, New York

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