From Ego Psychology to

The ways and means by which psychoanalysis achieves meaningful change remain as poorly understood today as they did two decades ago, when Fonagy (1982) made a similar observation. Although we have been able to systematically show that psychodynamic psychotherapy is effective, despite difficulties in disseminating those facts (Shedler, 2010), we have had more difficulties in understanding the therapeutic action by which either psychodynamic psychotherapy or psychoanalysis achieves its effects. In an issue of The Psychoanalytic Quarterly, devoted in its entirety to the question of therapeutic action, Smith (2007) drew attention to the fact that therapeutic action is often discussed at different levels of abstractions making comparisons between different schools difficult. On one level are our theories of pathogenesis; on another are our theories of how the mind works; then there are a number of ideas about what the analyst does; and still at another level is the role of the analyst as a person effecting change.