The Evolution of Patients’ Theories of Pathogenesis

The author views the patient's theory of pathogenesis as a compromise formation to which both patient and analyst contribute in important ways. Unlike conventional autobiography or case histories, the patient's theory of pathogenesis is an ever-evolving product of the analytic collaboration that is subject to ongoing analysis and self-inquiry. Like any explanatory theory, it both opens and constrains interpretive possibilities. The collaborative attempt to arrive at the best possible explanatory narratives entails both uncovering and joint construction. Explanatory efforts that are anchored in consensually agreed-upon present experiences of resistances and transferences are more closely related to therapeutic action and are more likely to be verifiable than explanatory theories tied to distant past events. The open-ended nature of the life historical and explanatory narratives leads to an emphasis on continued self-analytic activities after termination.