According to Dr. Padnick, recent research and clinical investigation focuses on identifying the active ingredients leading to successful treatment outcome. Reviews of hundreds of studies point to the strength of the “therapeutic alliance” or “working alliance”—the purposeful, collaborative partnership between patient and therapist—as the single strongest predictor of positive therapeutic success. This critical partnership is facilitated when a patient works with an experienced, highly trained therapist, skilled in emotional understanding and communication, and comfortable exploring all aspects of the therapist-patient relationship, itself. On the other hand, according to Dr. Padnick, research suggests that therapeutic outcome is negatively impacted by therapists who are rigid, tense, distracted, hurried, distant or critical, in addition to using techniques such as overly structured sessions, excessive or inappropriate silence, excessive self-disclosure, or dogmatic interpretation of patients’ feelings, behaviors and experiences.
In modern psychoanalytic treatment, the emphasis is on building a strong, collaborative working alliance as a foundation for the therapeutic process. The modern psychoanalytic treatment approach promotes “progressive communication,” rather than interpretation, as fundamental to success. Finally, according to Dr. Padnick, advances in brain research over the last decade demonstrate the relationship between treatment focused on verbalizing thoughts, feelings and impulses—“saying everything”—and measurable neurological changes in the brain. The process of verbalizing primitive urges and impulses, which are functions of the lower brain, allows the cerebral cortex to mitigate potential destructive behavior. Specifically, it appears that successful treatment results in the development of new neural pathways being laid down, producing the potential for new and, hopefully, better choices and directions in life. So, 120 years later, Freud’s first psychoanalytic patient, “Anna O”, is prophetic in coining the term “talking cure.”