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Finn, M.G. Sperling, M.B. (1993). Therapists' Representations of Psychotherapy—Special Patients. Contemp. Psychoanal., 29:343-351.

(1993). Contemporary Psychoanalysis, 29:343-351

Therapists' Representations of Psychotherapy—Special Patients

Mark G. Finn, Ph.D. and Michael B. Sperling, Ph.D.

THE HISTORY OF MODERN DYNAMIC psychotherapy has been characterized by an unceasing evolution in the language of theory and technique. One of the sub-texts of this history is the story of how particular therapists working with particular patients came to creative understandings that have become the texts of our field. Some of these pivotal patients are themselves part of the story of psychotherapy; none more so than Freud's patients. Anna O. and Dora have become objects of scholarly interest almost unto themselves. More recently, Kohut (1979) has described the paradigmatic change in his work in his two analyses of Mr. Z. from a classical analytic to a self psychological point of view. Semrad said that the patient was the only text a young therapist needed to read (Rako & Mazer, 1979). It is the thesis of this paper that, on a significantly less epoch-making level, every therapist has patients who come to be the reference points in their development as clinicians. It is these patients that one may experience as particularly "special" because the work with them is incorporated within and facilitates changes in the therapist's representational model of psychotherapy.

This incorporative dynamic within the therapist may be understood as similar to that characterized by Bowlby (1969) in his discussion of "internal working models, " or mental representations, of attachment. Such models are further defined by Main, Kaplan and Cassidy (1985) as "a set of conscious and/or unconscious rules for the organization of information relevant to attachment and for obtaining or limiting access to that information" (pp. 66–67).

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