What Constitutes Therapeutic Knowledge and How We Believe it is to Be Attained

Abstract

What we know in psychoanalytically-informed therapy and its relationship to how we know has become the source of heated debate between "classical" and "relational" analysts. There is agreement that a goal of treatment is to make maladaptive unconscious elements of personality conscious, especially in the realm of human relationships, including that with the therapist. However, belief in the quest for objective reality and truth about one's patient and oneself (correspondence) has gradually been replaced with the idea that how and what we know involves construction of coherent and pragmatically satisfying narratives from consciously and unconsciously interacting subjectivities (coherence, narrative truth). The debate has generally been conducted on philosophical grounds having to do with the nature of reality. It is more fruitful to examine how the mind works and whether different but equally valid kinds of knowledge emerge from different but equally valid ways of knowing. Objectifying epistemology is heavily influenced by secondary process thought, whereas relational epistemology is tilted in the direction of primary process expression. Each epistemological perspective relates to qualitatively distinctive aspects of unconscious mind, and it is a particular challenge for the therapist to find a way to give both their due.