Introduction

It is both strange and true that contemporary psychoanalysis lacks a full explanation for the therapeutic action of talking. To be sure, we have attributed to language various mutative effects of psychoanalytic treatment (e.g., insight, structural change, expanded mental capacity), but we have not elaborated the specific verbal mechanisms responsible for these effects. To take the most obvious example, we do not have a satisfactory explanation for how the special cognitive-emotional realization known as insight facilitates new ways of living or being. Our primary explanations (e.g., making the unconscious conscious; where id was, there ego shall be) are fundamentally tautological: insight leads to change because self-knowledge sets one free (see Eagle 2011). Given our expanding appreciation for the many forms knowledge can take, such explanations do not tell us why verbalization or even consciousness is necessary.

For those who believe in the power of words, the therapeutic action of language is self-evident. For those who do not, the explanations leave out too much. For instance, many theorists of verbal therapeutic mechanisms do not fully account for various types of relational experience that undoubtedly contribute to therapeutic action; Loewald (1978) and Litowitz (2011) are notable exceptions. Moreover, theorists advocating mechanisms that operate via relational experiences rather than words—and yield change that may or may not be verbally articulated or consciously known—are filling the vacuum of explanation regarding therapeutic action. Importantly, explanations of “nonverbal” mechanisms (e.g., Boston Change Process Study Group 2008) are often well-developed and integrated with findings of systematic research, thereby appealing to wishes for currency and cogency. By comparison, explanations of verbal treatment mechanisms may appear insufficient and outdated, the legacy of a worldview whose relevance is waning. Indeed, we lend credence to this view when we abdicate explanatory power to the “magic” of words (e.g., Freud 1890; see Figure 1). We can and should do better in terms of articulating our understanding of verbal treatment mechanisms, including but not limited to interpretation; we “should be more explicit . . . in step two.”

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Figure 1.

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The time has come for a discussion focused narrowly on the specific and various ways in which the use of language as speech is a mechanism of therapeutic action in psychoanalytic treatment. To that end, I invited Adrienne Harris, Lewis Kirshner, and Alan Spivak to address this crucial question about therapeutic action: How does talking cure? ¹ This question highlights the role of language as speech (talking) and invites consideration of a confluence of relational and verbal processes, rather than a contrast of those processes. The three authors present distinct points of view on the role of language in therapeutic action, illustrated with extended case examples that ground the theories in clinical process. There is great breadth and diversity in the ways the authors understand the therapeutic action of language, as well as much potential common ground. Also included in this section are two discussions of these papers; Ilene Dyller’s examines the papers through the lens of her own clinical material, while mine returns to the titular question to draw out the implications of the three theories for a fuller understanding of the therapeutic action of speech.