Psychoanalytic Self Psychology, as formulated by Heinz Kohut (1913-1981), was a revolutionary innovation in the field of traditional psychoanalysis in that it placed the individual’s self-experience at the center of therapeutic work. It thus brought into psychoanalytic thinking the values and basic premises of existential-humanistic psychology.

Furthermore, Kohut proposed that, starting at birth and continuing throughout life, self-experience develops and is supported in the context of relating to others whereby the person experiences validation, recognition and soothing of her or his emotional states. When our relational milieu doesn’t offer such experiences, often through chronic and repetitive failures of empathic understanding, our self-experience becomes fragile and loses vitality, cohesion and positive regard. In order to survive emotionally, we then have to narrow our experiencing, our ways of relating, and thus our development, leading to a weakening of our adaptive and relational capacities.

The therapeutic approach, in emphasizing the therapist's sustained empathic exploration of the patient’s experiential world, aims to create a relational milieu which permits the restoration of the process of psychological development. The therapist, in relating to the patient, pays particular attention to their shared experience, and to the disturbances and occasional ruptures which inevitably occur in their dialogue.

Intersubjective Systems Theory is part of the continuing development of this new relational movement in psychoanalysis. It is based on a view of the human psyche and of the personal subjective experience as being essentially interactive and continually embedded in relationships. The therapeutic process is thus seen as being a co-constructed emotional dialogue which occurs at both verbal and non-verbal levels, and through which both therapist and patient attempt to explore the meanings of their shared experiences with the goal of understanding and transforming the patient's painful experiences.

From a clinical point of view, Intersubjective Ssytems Theory is more a sensibility than a technical ability (Buirsky and Haglund, 2001), a sensibility to the inevitable interactions between the observer and the observed (Orange, Atwood and Stolorow, 1997). We are unable to perceive and understand the other's experience without the bias of our own subjective experience. We rather join the other in an intersubjective field in order to co-construct an understanding unique to the two people interacting: "… the therapist’s organization of experience interacts with that of the patient to form a unique and indissoluble psychological system" (Orange, Atwood & Stolorow, 1997, p.9).

The emotional history of the therapist and his explicit and implicit theories inevitably shape, enlarge, and limit both his empathic understanding and his emotional availability. Empathic understanding, embedded in a mutually regulated relational process, requires a particular sensibility in the clinical work —one which can be described in terms of attitudes. First, it entails a sustained self-reflective attitude on the part of the therapist with regard to his own subjective biases and the impact of his subjectivity on the patient's experience. This attitude has been called a "self-reflective awareness in interaction" (Lecomte and Richard, 2006), which awareness is inevitably limited by one’s personal history, as well as emergent in and dependent on the particular present relational context.

This intersubjective view of a co-constructed empathic understanding also inspires an attitude of fallibility in our practice; that is, an acknowledgment that our understanding, at any moment, is only an inevitably partial perspective and thus requires a dialogue in order to become more adequate. This attitude of fallibility leads us to "hold our theories lightly" (Orange, 1995) and keeps us flexible, open to letting ourselves be surprised by what emerges, and ready to learn from our patients and colleagues. This posture of empathic understanding also implies a compassionate humanizing attitude which, Donna Orange (2006) suggests, is a dialogic process in which one is led to "undergo the situation with the other" in order to make sense of it and to open up new experiential possibilities for the two participants.

Such is the nature of a therapeutic understanding which we believe to be effective in healing emotional wounds and in promoting change. But how can we reach or develop such an understanding? If we can't make it into a concrete technical procedure, how can we acquire or cultivate this sensibility? We believe that it is in the lived experience with each of our individual patients, and in our sustained efforts to enlarge our own perspective in order to include that of the patient. These efforts involve inevitable fluctuations, perturbations, disruptions, and impasses in the empathic dialogue, and recognizing these is also an essential part of the process.

• Buirski, P. et Haglund, P. (2001). Making Sense Together: The Intersubjective Approach to Psychotherapy. Northvale NJ: Jason Aronson.
• Lecomte, C. et Richard, A. (2006). Pour une psychothérapie pleinement relationnelle. In: S. Ginger, E. Marc et A. Tarpinian (éds) Être psychothérapeute: questions, pratiques, enjeux. Paris: Dunod.
• Orange, D.M. (1995). Emotional Understanding: Studies in Psychoanalytic Epistemology. Hillsdale, NJ: The Analytic Press.
• Orange, D.M. (2006). For whom the bell tolls: Context, complexity and compassion in psychoanalysis. International Journal of Psychoanalytic Self Psychology , 1(1): 5-21.
• Orange, D.M., Atwood, G.E., et Stolorow, R.D. (1997). Working Intersubjectively: Contextualism in Psychoanalytic Practice. Hillsdale, NJ: The Analytic Press.