Paper Session B

9. Kohut’s Understanding and Explaining Steps:
Clinical Considerations Influencing the Need for a
Prolonged Understanding Only Phase

Self Psychology Page | 23rd Conference Program

Overview

Although Kohut recognized that understanding and explaining are an integrated therapeutic unit, he drew the distinction between understanding and explaining steps in the therapeutic unit in order to stress the importance of empathic understanding as a necessary prerequisite for an explanation to be of value to the patient. Additionally, Kohut (1977, 1984) developed the dichotomy between understanding and explaining in order to explicate the clinical necessity of an early (and possibly prolonged) phase of pre-interpretative work with certain patients whose early selfobjects had failed them traumatically. During the first phase of such an analysis, the analyst strives to provide the patient with understanding only; during the second phase, the analyst provides understanding followed by explanations in generic, dynamic, and psychoeconomic terms.

Clinical material was presented from four different patients in order to illustrate the diversity of clinical phenomena which may impact when a prolonged understanding only phase is useful—and when it may not be useful. The clinical material was chosen to demonstrate that patients, even patients with a similar degree of symptomatology or similar level of early selfobject failure, may differ in their experience of their analyst’s efforts to provide understanding only or in their experience of their analyst’s efforts to provide understanding with explanation. Patients who are likely to require a prolonged understanding phase of treatment are patients who experience interpretations as shaming or blaming them, patients who are vulnerable to fragmentation, and patients who feel mistrustful of their analyst’s intentions.

Self Psychology Page | 23rd Conference Program