How Psychotherapy Works

Book excerpt: In the landmark volume, THE PSYCHOANALYTIC PROCESS, Joseph Weiss presented a bold, original theory of the therapeutic process. Now, in HOW PSYCHOTHERAPY WORKS, Weiss extends his powerful theory and focuses on its clinical applications, often challenging many familiar ideas about the psychotherapeutic process. Weiss' theory, which is supported by formal, empirical research, assumes that psychopathology stems from unconscious, pathogenic beliefs that the patient acquires by inference from early traumatic experiences. He suffers unconsciously from these beliefs and the feelings of guilt, shame, and remorse that they engender, and he is powerfully motivated unconsciously to change them. According to Weiss's theory, the patient exerts considerable control over unconscious mental life, and he makes and carries out plans for working with the therapist to change his pathogenic beliefs. He works to disprove these beliefs by testing them with the therapist. The theory derives its clinical power not only from its empirical origin and closeness to observation, and also from Weiss's cogent exposition of how to infer, from the patient's history and behavior in treatment, what the patient is trying to accomplish and how the therapist may help. By focusing on fundamental processes, Weiss's observations challenge several current therapeutic dichotomies--"supportive versus uncovering," "interactive versus interpretive," and "relational versus analytic." Written in simple, direct language, Weiss demonstrates how to uncover the patient's unconscious plan and how the therapist can help the patient to carry out his plans by passing the patient's tests. He includes many examples of actual treatment sessions, which serve to make his theory clear and usable. The chapters include highly original views about the patient's motivations, the role of affect in the patient's mental life, and the therapist's basic task. The book also contains chapters on how to pass the patient's tests, and how to use interpretation with the patient. Dr. Weiss also provides a powerful theory of dreams and demonstrates how dreams can be utilized in clinical practice. This distinguished volume is a major contribution that will profoundly affect the way one conceptualizes and practices therapy. Theoreticians, investigators, and clinicians alike will find it enlightening reading.