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Ornstein, A. (1988). Chapter 11 Reflections on Clinical Cases: Optimal Responsiveness and The Theory of Cure. Progress in Self Psychology, 4:155-160.

(1988). Progress in Self Psychology, 4:155-160

Chapter 11 Reflections on Clinical Cases: Optimal Responsiveness and The Theory of Cure Related Papers

Anna Ornstein, M.D.

The contributions of Drs. Brandschaft and Terman are clinically significant, as they both advance our thinking regarding those factors in a therapeutic dialogue that we consider to be potentially curative. I shall first discuss Dr. Terman's chapter. The questions he raises from a self-psychological perspective on the theory of cure are relevant to Dr. Brandschaft's clinical presentation.

Dr. Terman takes issue with Heinz Kohut for having retained the concept of “optimal frustration” as that condition which makes structuralization of the psyche—via transmuting internalization—possible. This, as is well known, Kohut retained both in relation to structure building as he conceptualized this during development as well as belatedly, during psychotherapy and psychoanalysis.

I agree with Dr. Terman that the concept of “optimal frustration” needed cleaning up, but I am afraid he did not go far enough in doing so. His argument, with which I am in full agreement, leaves ambiguities behind insofar as he could be understood as advocating the replacement of the concept of “optimal frustration” with that of “optimal gratification.”


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