Over the last 30 years, with the emergence of a two-person relational psychology, there has been a significant shift in the understanding of a person’s psychological problems, from intrapsychic and object relations conflicts to problems of temperament, cognition, affective attunement, cognitive flexibility, and intersubjectivity (the complex interactions of the self, influenced by other persons, detailed in Chap.​ 5). This shift has led to psychotherapeutic interventions that are significantly different than those of a traditional one-person model—the archaeological discovery of an unconscious conflicted buried past. A two-person relational model relies on open bidirectional, here-and-now subjectivities that are continually modified by the reality of both persons—intersubjectivity. As expected the notion of a two-person, relationally-based psychodynamic model of psychotherapy was not received well by all clinicians in the traditional one-person psychoanalytic circles, as it challenged the legitimacy of its tenets. Friedman (2010) reflects, “The chasm dividing classical and relational approaches is both wider and deeper than is acknowledged by psychoanalysts who attempt to either reconcile or minimize the differences between them.”

The two-person relational model has gradually become a concept that most psychodynamic psychotherapists must contend with. Spezzano (1993, 1996) suggests that “the phrase two-person psychology has become shorthand for our recognition that a new paradigm has taken a firm foothold in American psychoanalysis.” This method is widely spoken about in clinical circles, and many clinicians have found the freedom of being “authentic and real” with the patient as liberating from the traditional one-person approach. Two-person relational psychotherapy, in one form or another, is now practiced by a majority of mental health practitioners (Norcross et al. 2002). The two-person relational model has served as an umbrella for several forms of psychotherapies that endorse enactments and self-disclosures that frequently occur unknowingly, although at times can be well timed —mindfulness, dialectic, cognitive, patient centered, etc. Further, in the two-person relational model, the psychotherapist as an authentic and real person may implicitly disclose aspects of him or herself without quite knowing what has been revealed.

In spite of the appeal of the two-person relational model, we have had colleagues who over the years have outwardly moved toward a contemporary two-person relational approach in their clinical work, although in reality they continue to be loyal to traditional one-person theory concepts and technique principles (Chaps.​ 2 and 6). They cautiously share that they do not want to throw out the baby—traditional one-person psychoanalytic concepts—with the bathwater, traditional one-person psychoanalytic technique. We find an example of this dilemma in our colleague and friend, Andrew Gerber , illustrated in his commentary Neurobiology of Psychotherapy – State of the Art and Future Directions (Gerber 2012) in the outstanding book Psychodynamic Psychotherapy Research: Evidence–Based Practice and Practice–Based Research (Levy et al. 2012). Gerber is of the opinion that the intersection of neurobiological research and psychoanalysis “is fertile and growing…. That would have delighted Sigmund Freud.” He proposes four unifying principles. In the first, he suggests that the description of psychopathology lies in a set of continuous trait and state variables representing the content and structure of an individual’s mental life. In the second principle, Gerber asks for a conciliatory stance, inviting the traditional one-person model clinicians to make mend with their own struggles in accepting that “the origins of most psychopathology are understood best as an interaction between inherited/genetic factors that lead to psychological traits, strengths, and vulnerabilities on the one hand and environmental factors, particularly experience, on the other” (italics ours). As such, two-person relational psychologies always include two “one persons.” His third principle emphasizes that psychological processes are best understood as a combination of cognitive, affective, and social categories. Finally, in his forth unifying principle, he seems to plea to the traditional one-person psychoanalytic community to accept their limitations: “The mechanism(s) of action in psychotherapies of all kinds, including psychoanalysis and psychodynamic psychotherapy, overlap more than current clinical theories describe, thus beginning to explain the widespread finding that there are multiple effective ways to treat psychiatric illness with talk therapy” (italics ours). Gerber is implicitly moving the psychoanalytic movement toward a more integrative process—“we now have the opportunity to integrate multiple perspectives in our theory and research”—in line with two-person relational psychology, and concludes with “It is the task of psychotherapy to help the patient find a set of narratives that are most useful for him or her. In psychodynamic thinking, this is often described as ‘co-construction ,’ whereas in cognitive therapy, it may be thought of as ‘cognitive restructuring.’”

Although we mostly agree with Gerber’s principles and efforts for further dialogue among the divergent forms of psychotherapy, we caution his efforts toward an overly conciliatory stance with traditional one-person psychology clinicians as it attenuates the differences. The traditional one-person clinician believes that psychotherapy is effective when the inner conflicts of the child or adolescent are discovered and understood: through recognition of maladaptive ego defenses, the presence of transference manifestations (i.e., remembering and repeating), or by discovering object relations conflicts, which are amenable for being worked through by verbal insight-oriented suggestions or interpretations. Although the two-person relational psychology has built on the traditional one-person model, it has evolved to an approach that relies on the nonverbal, implicit cocreation of new experiences in the form of enactments and self-disclosures that frequently occur unknowingly, although at times can be well timed, to move along the psychotherapeutic relationship. The result of this is providing new and healthier nonconscious relational neuronal pathways in the here and now with the active and genuine psychotherapist—corrective emotional experiences—and later implicitly used when interacting with others (Fig. 3.1). Gaines (2003) suggests promoting new, more adaptive relational experiences, saying the “thoughtful use of therapist self-disclosure is an important tool for child and adolescent.” In two-person relational psychology, the terms “cocreate ” and “intersubjectivity ” are sine qua nons to the theory and technique. They reflect the active participation by both patient and psychotherapist in the encounter, with continuous and novel moment-to-moment changes due to each other’s subjective experiences.

Altman (1994) masterfully captures the differences between the two models: “As I argue, child psychoanalysts of all schools has been moving in the direction of a relational, two-person or multiperson psychoanalytic model in response to the difficulties encountered in work with children on a drive theoretical basis. However, child analysts have done so while avoiding a clean break with drive theory. The result has often been a collage of one-person and two-person elements, which results in an internally inconsistent theoretical model with confusing implications for psychoanalytic technique. Specifically, a drive-based, one-person model directs attention away from the impact of the here-and-now interaction on patients.” As Hoffman (1994) states, “there is a feeling of ‘throwing away the book.’” We believe that is better stated as “let’s not forget that the original (one-person) book also has a second (two-person) part.” The mechanisms of therapeutic action may be different, but they still rely on an interaction of one and two person factors.

In Chap.​ 6, “Deconstruction of Traditional One-Person Psychology Concepts,” we take a bold approach that we believe is much needed but cautiously avoided by most. In that chapter, we discuss in detail the steadfast terms from traditional one-person psychologies, followed by their deconstruction when viewed through the lens of a two-person relational psychology. We then further clarify the reasons why these everyday traditional one-person concepts have transformed to terms that attend to discoveries from developmental research, neuroscience, attachment, and temperamental theories to the clinical work of a contemporary two-person relational psychotherapist.

Freud began with a small and closed group of colleagues loyal to his psychoanalytic theories and formed the Wednesday Psychological Society, which later became the Vienna Psychoanalytic Society. Among some of its members were Wilhelm Stekel, Paul Federn, Alfred Adler, Otto Rank, Sándor Ferenczi, Ian Suttie, Karl Abraham, and Carl Jung. Over time, conflicts aroused, and Adler, Jung, and Rank broke away from Freud’s drive theories and formed their own societies. This was followed by the departure of Ferenczi, Stekel, and Suttie, who introduced the idea that the analyst needed to be a real and active participant in the process in order to help the patient feel understood. Though their progressive ideas had the potential of extending the psychoanalytic movement to greater scientific inquiry, they instead were ostracized from prominent psychoanalytic circles for questioning Freud’s psychoanalytic theories and advocating changing neutrality to an empathic bidirectional relationship that allowed for gratifying the patient’s wishes in certain situations. The early dissenters provided the seeds needed to give birth to what later became two-person relational psychology.

In the United States, there also were some dissenters who broke from the mainstream of Freud’s drive theory and the restrictive psychoanalytic techniques, specifically the emphasis on analytic neutrality and psychic determinism (Chap.​ 6). The dissenters founded the William Alanson White Institute (WAWI) in 1946. The WAWI was strongly influenced by the work of Ferenczi, and its members included Harry Stack Sullivan, Clara Thompson, Erich Fromm, Frieda Fromm-Reichmann, David Rioch, and Janet Rioch. Currently, WAWI is one of the leaders in the advancement of two-person relational psychology and has among its faculty member’s distinguished writers Philip Bromberg, Jay Greenberg, and Donnel Stern.