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AN ANALYSIS OF THERAPEUTIC ARTFULNESS
WALTER BROMBERG
Am J Psychiatry 1958;114:719-726.
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Abstract

The common factor in all psychotherapeutic relations is admittedly the emotional relation between therapist and patient. In scrutinizing this factor, we encountered artfulness, the application of scientific technology which involves certain psychologic overtones of extra-technical nature operating within the therapist. The elements constituting artfulness involve, on one hand, the psychology of the therapist, and on the other, the psychology of the therapeutic process itself. The operational complex, identified with artfulness, resides in the application of a skill, i.e., is extra-technical and applies to all healers whatever their original postulates, premises, or theories of psychotherapy. This complex involves essentially conative impulses and insinuates a sense of assurance to the therapist which invades his critical judgment toward the efficacy, the "science," of the theoretical foundation of his method.Successful therapy is initially recognized as dependent on the technology stemming from the scientific hypotheses advanced. Judgment concerning the scientific hypothesis which underlies every method of psychotherapy lies under the shadow of the operational complex which has been identified with artfulness. Later the efficacy of a treatment method diminishes: that degree of success, not attributable to the specific scientific theory and its technology, is recognized as due to artfulness. The intrusion of the conative influence and other unconscious forces—magical thinking, omnipotence fantasies, narcissistic satisfaction, symbolic expression, etc., bears on a scientific judgment of the method in question, e.g., the verification of interpretations in psychoanalytic treatment. To explain how therapy works at all in successful cases, one must accept the extra-technical elements involved. This is suggested as the most plausible way to explain successful therapy when conducted by workers who point to the most diverse scientific theories and formulations as a valid basis for their accomplishments.

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