A good therapist works to make themselves unnecessary. Assagioli maps the therapist patient relationship in four stages, from transference all the way to friendship.
By Roberto Assagioli [1]
Doc. #24089, Assagioli Archive in Florence
Original title: Il Rapporto fra lo Psicoterapeuta e il Malato
Translated and edited with notes by Jan Kuniholm
Editorial Note
The abstract and contextual subtitle in this online edition have been added by the editor, Kenneth Sørensen, to support readability, navigation, and archival consistency. The original wording has not been altered.
Abstract
In this essay, Roberto Assagioli maps four types of relationship that develop between patient and therapist in psychosynthetic therapy: the classical Freudian transference, the therapeutic situation in which the therapist functions as guide and bridge between the patient’s conscious I and their Self, the broader human relationship that unfolds during treatment, and the gradual resolution. He closes by insisting that the therapist’s own inner preparation, including lifelong self-psychosynthesis, is the essential foundation of effective therapy.
In psychosynthetic therapy the problem of creating right relations between the patient and the therapist is made easier, or rather less difficult, by the fact that the therapist not only points out and proposes to the patient, as Jung does, the goal of his “individuation,” but from the very beginning encourages and trains him to use active methods for the acquisition of an increasingly clear self-awareness, for the development of a strong will, and for the mastery and right use of his instinctive, emotional, imaginative and mental energies; in short, for everything that leads him to his independence from the physician.
In spite of the variety and complexity of the relationships formed between patient and therapist, four main types of them can be distinguished, and each is used, directed and regulated for the purposes of treatment and for the good of the patient.
- Transference, in the original meaning attributed to it by Freud, that is, the “projection” onto the physician of the child’s impulses, attachments and emotions toward the parents. These attitudes can be positive, that is, loving, or negative, that is, hostile. Such projections must be analyzed and dissolved. In this psychoanalysis, Jungian therapy and psychosynthetic therapy agree.
- The specific relationship created by what can be called the therapeutic situation. In this relationship the therapist represents and exercises an essentially “paternal” function. He must, to some extent, play the role [and take on] the task of protector, counselor and guide. In dream symbolism, Jung says, [the therapist] not infrequently appears in the aspect of a “wise old man,” and corresponds to what the Indians call a “guru.” This relationship is quite different from the unconscious projection that occurs in transference; it is in fact a conscious, real and actual relationship. In the diagram (depicting man’s psychological constitution) it has been indicated by a “star” that lies outside the subject’s psyche, but which acts as a conduit, a “bridge” between his “I” and his Self. When the “I” cannot become aware of the Self directly, “vertically,” it can be effectively helped by the therapist, who represents for him someone who is in relationship with his own Self, and who thus becomes a “model,” or in a sense a “catalyst.”
- A human relationship develops as treatment proceeds, and creates psychological interaction at various levels, and of different types. A more detailed examination of this is not possible now. I will only say that the delicate, difficult task of the therapist is to maintain that relationship within the right limits — and one might say “at a high level” — accepting its positive or constructive aspects, but resisting attachments, needs, demands, and possessive impulses of the patient. This can be done firmly, and at the same time tactfully and benevolently, making the patient understand how those attitudes, while they may give him momentary fulfillment, are actually harmful to him.
The transition from the second to the third type of relationship is useful, indeed necessary, for several reasons. First, to promote increasing autonomy in the patient, then to eliminate the tendency to lean on someone else, to slough off one’s responsibility, or to be led by the hand, that is based on moral laziness. Also, to prevent the danger that the patient, upon discovering human shortcomings in those who guide and help him — which happens easily, indeed one may say inevitably — may have a disappointment and turn his admiration and even excessive obedience, into criticism and also excessive hostility.
- A critical moment that needs to be regulated wisely is the resolution of the relationship, at the end of the treatment. I have spoken of “resolution” and not of the end of the relationship, first because not infrequently the conclusion of the treatment may occur gradually or almost insensibly. Then, because a positive relationship may continue in some way after the end of treatment, whether in the form of a friendly relationship or even in the form of cooperation. Indeed, not infrequently the healed patient can understand and help other patients better than the so-called healthy ones. In this way, the healed patient — indeed even before being fully healed — can cooperate and maintain a constructive relationship with the doctor. This is related to the current development of group therapy and sociotherapy, in which the less seriously ill, or recovering, or cured, patients can effectively cooperate in the care of the more seriously ill, and their necessary reintegration into family and society.
These relationships with patients, and in general the whole therapeutic process, require adequate preparation of the therapist: not only scientific and technical preparation but also, and above all, human preparation. Jung was well aware of this need, and he expressed it explicitly. Here are some of his statements on the subject: “The recent development of analytical psychology . . . places the personality of the physician himself in the foreground as a factor in healing or in worsening [of a condition], and demands the inner perfecting of the physician, the self-education of the educator.” And elsewhere he says, “Without too much exaggeration, it may be said that almost half of every somewhat thorough cure consists in a self-examination of the physician.”
Therefore, Jung is very insistent on the need for didactic analysis; that is, the need for those who propose to use psychotherapy to first undergo a psychic analysis by another psychotherapist. Indeed, Jung says, “the doctor will not see in the patient what he does not see in himself, or he will be influenced by it in an exaggerated way.” [1]
Psychosynthesis fully agrees with this. However, it is worth noting two things: the first is that when didactic psychosynthesis cannot be implemented, the therapist can subject himself or herself to self-psychosynthesis. I will mention that even some non-“orthodox” psychoanalysts agree in this; for example, Karen Horney has written a book[2] [on self-analysis] in which, however, she stays within the limits of psychoanalysis without entering the field of psychosynthesis, especially without taking into account the higher elements of the psyche. In contrast, in psychosynthesis the practitioner has more tools, more active techniques to apply and to experiment on himself. I would say that each of us, but especially each physician, each educator, can consider himself as a “living laboratory” in which he lives twenty-four hours a day (including dreams).
Moreover, it is not necessary for didactic psychosynthesis, or even self-psychosynthesis, to be concluded in order to begin the practice of psychotherapy. There is such an urgent and extensive need for it that one who wants to devote himself to it should do so as soon as he has sufficient preparation, even if lacking in certain respects. However, it is necessary for him to have the critical sense and humility to recognize his own deficiencies, and at the same time the good will to fill them. In fact, self-psychosynthesis, like education, should continue throughout life!
[1] See C.G. Jung, La Guérison Psychologique, adapted with a preface by Roland Cohen, 1953, Genève, Librairie de L’Université p. 237. —Author’s Note.
[2] Horney, Karen, Self-Analysis, W.W. Norton & Co. 1968 and later editions. —Author’s Note updated by Editor.
[1] Those unfamiliar with psychosynthesis can find a brief mention of it in the article Psychosynthesis – Its Essential Components. An extensive exposition of psychosynthetic therapy is contained in the book Psychosynthesis, a Manual of Principles and Techniques, New York, Hobbs, Dorman & Co., 1965 Paperback Edition – Viking Press. A more general exposition of the various aspects of Psychosynthesis can be found in Creating Harmony in Life (English Edition, Istituto di Psicosintesi, 2022). —Author’s Note Updated by Editor.
