Specificity Theory and Optimal Responsiveness: An Outline.

Abstract

Specificity theory legitimizes the analyst's attempts to tailor the treatment process to improve its efficacy. It recognizes that the analyst's responsiveness effectively draws upon a rich palette of both verbal and nonverbal interventions for therapeutic relating. Dispensing with the notion of analytic neutrality, specificity theory recognizes that each therapist offers something therapeutically unique to a particular patient, which includes but also transcends both theory and technique, encompassing who the therapist is as an individual in innumerable respects. It requires that the therapeutic engagement be continually monitored and adjusted to fit the changing capacities and limitations of the particular therapeutic dyad. The principles of specificity theory are suitable to be used by therapists of different theoretical backgrounds-and further, can be applied as an overarching principle functioning to integrate diverse theoretical approaches.Howard Bacal introduced the term optimal responsiveness in 1985, when it was becoming imperative that analysts make significant adjustments to the psychoanalytic theory of the therapeutic process. The widespread attempts to work with patients who were inaccessible to standard analytic treatment required a theory that incorporated the therapeutic aspects of a more modified analytic technique. In answer to the emphasis of some clinicians on neutrality, insight, and frustration of the patient, Bacal developed an idea that was inclusive of many interventions that were not being formally discussed among professionals. Since then, he has revised and refined the concept of optimal responsiveness and has identified specificity theory as the theoretical perspective that underlies it.In the present climate of increased tolerance and integration of diverse theoretical ideas by the analytic community, the use of optimal responsiveness as an overall clinical posture is especially germane. This is because the principle of optimal responsiveness can be used by therapists who may already be working in similar ways despite coming from

Katherine: A Long, Hard Case

“…In fact, my long relationship with Katherine supports my conviction, as Howard Bacal (see Bacal and Herzog, 2003) so eloquently urged, that every analysis is unique and requires procedures specific to the needs and contexts of the dyad; and, as Donna Orange suggested, we "must hold our theories lightly" (see Stolorow, Atwood, and Orange, 1999, p. 386). I add that sometimes we have to juggle multiple theories for the benefit of our work.…”

Second Hand Rose: Attempting a Difficult Second Analysis as Second-Best Analyst

“…Perhaps I was not up to the task of maintaining a position of empathic immersion (Kohut, 1959) while having my efforts and interventions discarded and denigrated. It is possible that when an analyst feels so dehumanized by his patients, he or she can no longer optimally respond (Bacal, 1998;Bacal and Thomson, 1998;Bacal and Herzog, 2003).…”

The Therapeutic Action of Analytic Love: Commentary on Joye Weisel-Barth's “Katherine: A Long, Hard Case”

“…WeiselBarth invokes Bacal and Herzog's (2003) specificity theory; Stolorow, Atwood, and Orange's (1999) admonition to "hold our theories lightly," and the teachings of the philosopher Levinas (1969) as perspectives that help her place an analytic frame around her relationship with Katherine. I would not dispute the enormous value of these perspectives, but to me they do not do the whole job.…”