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Restoring Reciprocal Empathic Responsiveness (RER) as an Individual- Couple Therapy PRESENTED AT:

8th World Congress of the International Family Therapy Association (IFTA) July 1996, Athens, Greece.

SARA IWANIR, Ph.D.

Marital dysfunction is viewed in the RER model from an integrative interpersonal - intrapersonal perspective, synthesizing concepts of self psychology and system theory into a process of change. The systemic theoretical perspective gives meaning to the way the couple organizes itself as an organic unit to preserve its balance at moments of threat triggered by some intra-psychic event, and clarifies how the couple's interactional behaviors are structured into rigid patterns. The therapeutic procedures are theoretically based mainly on concepts taken from self- psychology, particularly the self–self-object matrix (the leading conceptualization is detailed in the theoretical introduction). The following therapeutic model deals with several types of distress that signal failure in the couples’ mutual empathic responsiveness. The major intrapersonal difficulties that the partners will encounter in such a relationship are: unclear boundaries between self and non-self, problems in dealing with frustration, childish and unrealistic view of the mate, as if s/he will always be able to satisfy one’s needs. And there is also an anticipation of disappointment. In such cases, most partners feel a great deal of anger, and Sara Ivanir, Ph.D.

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hostility bordering on aggression towards themselves and/or the other. They perceive their mates as objects for the fulfillment of their own needs and are unable to accept the principle of mutuality. Balint, in his paper "On love and hate", calls this type of relationships "the primitive object relation", meaning a relation in which "only one partner is entitled to make demand" (1951, p. 357). People who suffer from failure in their capacity for empathic responsiveness cannot bear the frustration and normal depression brought on by the realization of mutuality, where one must give something in order to get something from the other. Their capacity for self-regulation by soothing, encouraging self-talk, looking for other internal or external resources, is very poor. They tend to activate the partner into regulating their own inner stresses or anxiety. The couple's behavioral-interactional problems or symptoms may be: an increase in bitter quarrels, sexual dysfunction, a variety of conflicts on widespread issues such as financial difficulties, upbringing of the children, life style, etc., which become problems that the couple feels unable to cope with. It becomes difficult to decide on anything together. Among couples in this predicament, the level of criticism and aggressiveness will be high; they may be highly offensive towards each other, unaware of what they are doing as individuals. The high level of personal need on the one hand, and the fear of rejection and abandonment on the other, may lead to the emergence of patterns of conflict avoidance. Such cases lead to the creation of patterns of triangulation by involvement of a third issue, such as problems with children, an extramarital affair, over-involvement with the family of origin, addictions to work, alcohol, etc., which indeed decrease tension and restore an often temporary feeling of balance, but do not allow the partners to experience the full satisfaction of intimate love and empathic responsiveness. Failure in empathic responsiveness prevents the mates from being good selfobjects to each other in happy experiences or stressful events, or in facing unconscious threats of a stressful episode about to take place. They are unable to provide each other with mature self-object experiences and are left Sara Ivanir, Ph.D.

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with the distress and the expectation of still another unfulfilled archaic selfobject experience. The RER model has two purposes: a. The couple therapy centered on the theoretical concepts discussed above seeks to transform the archaic demands and experiences of the self-object into mature self-object experiences. The specific goal of the RER therapeutic procedure is to restore and promote mutual empathic responsiveness. To achieve it, each partner is asked to act as a potential facilitator and adopt the position of self-object for his/her mate. As facilitator, this partner enables, facilitates, mirrors the other, always in the context of empathic responsiveness and affective attunement, which are the components of the self-object function. b. To reinstate the mandate for personal cure and growth to its natural psychological sphere, namely the couple/marital bond. For me, the purpose of "alternative couple therapy" is to remove the mandate for the cure of emotional interaction problems and promotion of personal growth from the exclusive domain of the therapeutic 'dyad' or 'triad', and restore it to the natural adult psychological dyad, the couple relationship - reestablishing in the process the partners' capacities of mutual healing. The traditional position of the "all-knowing" couple therapist is replaced by a position of not knowing. The therapist will now trust the partners' natural healing power and will approach problems as part of a natural ongoing process of growth. A central strategy in the RER procedure consists of placing one mate, (the facilitator), for a specific period of time and a specific subject, at the service of his/her partner, (the self-in-focus), so as to facilitate the other (the self-infocus) with his/her (of the facilitator) attentive and attuned presence in order to promote an opportunity to restructure the partner's fragile self through him/her. The RER procedure is best suited for a population of committed couples not threatened by divorce or ongoing infidelity, who already experience minimal emotional separateness or, in other words, whose level of reactivity enables Sara Ivanir, Ph.D.

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them to listen to each other for at least a short period of time. Such couples will want to improve the relationship and already have a certain commitment to the therapy. There should be no extreme educational or cultural hang-ups or gaps between the partners. RER can be introduced to suitable couples in the initial sessions or at a later stage of couple therapy. The procedure can be used in every session, or intermittently, combined with other approaches. When I introduce a couple to RER I prefer to use the method frequently until it becomes a natural pattern for dealing with pain and anger.

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The RER consists of four therapeutic steps: 1.

Identifying the therapeutic issue: Redefinition of the problem from

interpersonal conflict to intrapersonal self-owned distress Although the event (the change event) indeed occurs at this stage, we must bear in mind that the therapeutic procedure began before and continues throughout this phase with the process of ‘nest- building’, which seeks to create a safe environment and an atmosphere of trust. This stage calls for the therapist's full involvement, by both presence and intention, as silent observer of the people before him/her. The therapist listens and notices the complaints or conflicts presented by the partners, and waits for something to resonate within him/her - by way of his/her own feelings, associations, images, memories, metaphors, and so forth, waiting for some expression of a hidden cry which, through empathy, to connect him/her with the anguish of one or both mates. After a few minutes the therapist decides with whom to stay and address the conversation. The first session involves several important therapeutic decisions that include whether or not to practice RER-CE, who will be the self-in-focus and who will act as facilitator - mainly based on sensing who of both mates might be best suited for this role. The therapist will then turn to his/her mate who is in the role of self-in-focus. Once a complaint is stated, the therapist will empathically clarify it until s/he senses that the issue is fully in focus or, in other words, until the person who is being addressed by the therapist clearly confirms that this is exactly what s/he feels. The mutually redefined issue is a translation of the couple's interpersonal problem, mostly their mutual accusations, into an intrapersonal self-owned distress. In this phase of the procedure both partners have the opportunity to understand the interactional nature of their conflict: that there is no good or evil, white or black. Synchronizing with this, the therapist, through delicate attunement to the precise and specific feelings at hand, reassures both mates that their needs for response are being heard, seen and felt by him/her, that they are validated and will be met.

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Example: The wife was very angry and complained that her husband refused to speak to her and showed no desire to know what was really troubling her. I addressed the husband (after deciding on the basis of previous knowledge that he would be the self-in-focus that day), and asked him whether he also felt something that he didn't quite like about talking things over. His angry response to this was, "She's the one who really doesn't want to speak to me; she only wants to educate me and always be right. Most of the time she judges me for anything I say, rather than accepting, so what's the sense of talking". The therapist responded to the husband's accusation by asking him, "What do you think would have happened if I hadn't interrupted the exchange and addressed you, would you put up a fight for the right to be heard without being judged?" His answer was that he had given up on his wife, although with other people he had learned to be resolute. I then asked him just when had he decided to give up on the significant relationship with his wife. He confessed that the relationship had always been difficult for him, particularly in the past 6-7 years (a time when his wife suffered a serious life-endangering health problem). I interpreted the husband's predicament by saying: "I understand how hard it’s for you to uphold your right and determination to be heard all the way and be accepted. I see that this is particularly difficult with your wife." (The conflictual issue is defined in terms of personal distress within the interaction.) At this point (assuming this is the first time), the partners receive a brief explanation of how the procedure works. The therapist adds the following statement: "I invite each of you to assist the other as you explore your personal pains and longings. Today we will work with X's distress, who will be the focus of attention, and Y. will assist. These roles will be reversed in future sessions. I assure you that I will guide and assist whoever is in the role of facilitator." 2.

The Initiation Phase

This step consists of an 'initiation ritual'. The therapist asks the person who will act as facilitator: "Do you agree to commit yourself to your partner, to try and help him/her understand him/herself better concerning this particular Sara Ivanir, Ph.D.

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issue? I will of course be here and I will assist you". If the facilitator agrees, the self-in-focus is asked whether s/he agrees to the partner's assistance in exploring and clarifying his/her feelings on the specific issue. This phase has two aspects: firstly the ritual, which is achieved by creating an atmosphere of emotional intensification, and secondly the contractual, which aims to check the well-known tendency of mates to preserve their mutual relational boundaries and oppose their partner's attempts to change them. 3.

The Facilitated Introspective Phase

Here, the therapist guides and encourages the facilitator in the task of helping his/her partner expand awareness and expressions of any emotion, positive or negative, within the framework of the redefined issue. The therapist assumes the role of coach and asks the facilitator to be attuned to the other, by asking questions, listening silently, mirroring, etc. - in other words, to find his/her own ways to stimulate and promote the partner's inner exploration and self-disclosure. Throughout this phase, the therapist encourages the conversation by empathic attunement with the facilitator and the situation. The therapist must be extremely attentive and sensitive to what is needed and by whom. (The therapist will do his/her utmost to empower the facilitator's position, unless an acute response by the self-in-focus shifts the therapist's attention to address this partner first.) It becomes clear in this phase that the position of self-disclosure within an intimate relationship and the position of facilitation are actually one inseparable experience. This is what the proponents of the relational system (Storolow, Atwood & Brandchaft, 1994) mean when they claim that psychological phenomena are crystallized and experienced continually and mutually, only in a mode to ‘co-create’ and ‘co-shape’. Storolow, Atwood and Brandchaft suggested that from the perspective of the new paradigm, namely the relational system, the observer and his/her language are grasped as intrinsic to the observed. The new experience in this phase must be experienced as formed. For Storolow et al. this is "at the interface of reciprocally interacting worlds of experience" (introduction p. 10).

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This phase allows the self-in-focus the opportunity for good experiences of self disclosure, for revealing inner feelings, thoughts, wants, dreams, or past experiences, where the content does not matter. Lichtenberg, Lachman and Fosshage (1996) specified that the person who can more fully experience affects and moods, both positive and negative, gains a sense of selfauthenticity, of being in touch with his/her needs, wishes and desires, and thereby gains an enhanced cohesion (1996, p. 122). Partners who can empathically perceive this affective fullness with all its 'highs' and 'lows', will gain a sense of "involvement and participation in a vitalized and vitalizing experience and thereby an enhanced cohesion" (p. 122). Throughout the process the mates can learn the extent to which one is similar to the other. They can use this quality of ‘twinship’ to promote self-disclosure. Waring (1990) wrote that through self-disclosure one could understand the other's needs and the extent to which s/he accepts or deviates from this profound knowledge The central theme is that the therapist coaches and empowers the 'facilitator' to consistently maintain the empathic position, staying close at all times to the other's subjective experience. Throughout the phase, the therapist will support and direct the facilitator who, via the therapist's empathy and resonance, can shed his/her own needs and fears to be fully available for the other. The therapist remains alert to any difficulties that the facilitator may encounter, by remaining in the position of his/her self-object. The analogy for this coexperiencing of the therapist and the facilitator can be seen in my own recent experience with a young mother of a 7-month old baby girl. The mother feared the baby and felt that the baby hated her and cursed her. She was unable to touch the baby, and when she tried to take her in her arms, both bodies became tense and rigid; the baby had trouble breathing and became very agitated. In my frequent visits I would sit on the floor and place the mother between my legs calmly and gently. In this position the mother was able to hold the infant. Sometimes she would merely look at the child silently, or amused her by playing with her hands or with a toy, or would put some food in the baby's mouth. The experience of being held safely and the experience of providing safety to the baby gradually blended together and became one Sara Ivanir, Ph.D.

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nourishing and cohesive experience. A person must feel that s/he receives for her/himself before being ready to cooperate and nourish the other's needs. The therapist is of course acting as a behavioral model for the facilitator, teaching him/her how to enter into and remain in empathic communication with the other. A woman who had acted as 'facilitator' said at the end of one particular event: "It was difficult for me to liberate myself from my own feelings and theories about my mate, but at a certain stage I began hearing myself less and, instead, I entered into his story. I said to myself, "This is a different issue", and from that point on, I could listen to him in an unprejudiced way." The task of the facilitator is extremely difficult. Being within the range of affect and mood demands sensitive listening and a level of involvement that is not easy to attain and preserve. This is more so when listening to one’s partner's deep and intense emotions, sometimes of anger and negative feelings toward him/herself, which escalate easily to a sense of fusion and create reactive behaviors. Typical facilitator behaviors that derive from this situation are frequently expressed in this phase and often block the couple's dialogue. When listening to the partner's self-disclosures, the facilitator's most frequent responses are in terms of wanting to be ‘right’, blaming the other or taking the blame, accepting responsibility, providing explanations that will soothe the self-in-focus, or arguing, suggesting solutions, asking forgiveness, starting to negotiate, or behaving in a conciliatory mode. Such behaviors signal that the facilitator has moved away from an empathic introspective position and is now speaking for him/herself. When such behaviors persist, the therapist can perceive them as distress signals from the facilitator who is in need of help before s/he can move on. The contents of 'self-exploration' can vary. They may relate to thoughts, feelings, memories, dreams, or physical sensations - in fact, to any subject matter that 'surfaces' spontaneously or intuitively, or that 'feels right' to the self-in-focus. There is no right or wrong or, for that matter, no objective reality`- what counts is the subjective. Perception testing can come later but Sara Ivanir, Ph.D.

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not before the emotional meaning of the issue for the self-in-focus has been grasped, acknowledged and validated by the person and by his/her mate. Typical steps that the therapist may take at the appearance of such signals can be: to remind the facilitator to 'hold back' emotionally, remind her/him of the issue that is troubling the other and of how much s/he wants to support the mate, both for the sake of her/his own personal growth as well as for the joint relationship. The therapist may ask the facilitator to express his/her cognitive understanding of the problem; relating cognitively to an issue promotes emotional distance, neutrality and objectivity that enable empathic understanding and validation. It is important that the therapist constantly praise the facilitator and assure her/him that s/he is doing excellent work. The phase continues until the self-in-focus feels satisfied and relieved. The experienced therapist becomes more and more discriminating as to the quality of emotional response required for change to occur. As Johnson & Greenberg (1995) put it, "The superficial discussion of emotion is ineffective, as is the indiscriminate ventilation of reactive emotions" (p. 131).

The

therapist learns to evoke vivid and intense emotional experience by "being skillfully" with the client rather than simply being skillful (Kempler, 1981, in Johnson & Greenberg, 1995, p.131). 4.

The Appreciation Phase

The therapist turns to the self-in-focus and asks him/her to tell the partner what in his/her behavior was most helpful in the process of exploring and disclosing him/herself. After this, the facilitator is asked to express his/her appreciation to the other for the way s/he explored and disclosed her/himself.

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Case illustration Due to ethical considerations, names and other identifying details have been omitted in order to protect the privacy of the clients. Furthermore, I have chosen to present a very condensed account of this case study, concentrating only on aspects relevant to the four steps in the development of RER-CE as they transpire in several significant emotional episodes, which I consider crucial to couple therapy, in an attempt to clarify and demonstrate the dynamics of the mechanisms of change at work in this approach. Step 1: Identification and Redefinition Mr. and Mrs. R. have been married for 26 years and are the parents of four children. Mrs. R. is a very vital, sensual and volatile woman. Mr. R. is self-contained, intellectual, serious and reserved. They have suffered several acute marital crises during their married life. They came to therapy seeking to sort things out among themselves and improve the marital relationship. In an early session Mr. R. angrily described his wife's dreadful behavior the previous evening: “I had cardiac cramps after your horrible attack on me. I was almost certain I was going to have heart attack and I couldn't sleep. I cannot bear this any longer. I refuse to live with such an explosive situation”. I responded to his grievances by reassuring him and redefining what he had just said: “I understand that you cannot bear the feeling of being attacked and I can see your suffering on not being able to bear this feeling”.

Mr. R.

accepted what I had just said by nodding his head. Step 2: Initiation I then turned to Mrs. R. and asked whether she would like to help her spouse by encouraging him to explore his unbearable feeling of being attacked. I assured Mrs. R. that I would be there to assist her at all times, and asked her: “Are you willing and ready to assist and facilitate your husband to explore and understand himself better concerning this unbearable feeling of his?” After Mrs. R. agreed, I again turned to her husband and asked him whether he was willing to accept his wife's assistance if this would help him understand himself better and be able to cope with those unbearable feelings of being attacked. Mr. R. nodded again in a gesture of consent. Sara Ivanir, Ph.D.

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Step 3: Introspection When both parties had agreed, I said to Mrs. R.: “Go ahead, dedicate yourself to his specific difficulty; enter his experience, ask him questions, help him understand himself better on this issue. It is a difficult task, but I will help you to do it.” After a short pause, Mrs. R. asked her husband, ‘Tell me, what did you feel in those moments when I attacked you?” Mr. R. explained that he felt all choked up and humiliated, totally unable to function, and that this issue could lead to the collapse of their marriage. He then added very angrily, “I feel that what you are doing is an assault because I cannot react. I don't feel I deserve such an aggressive behavior.” Mrs. R. sank into her chair and gasped for air. I gave her a gentle look of encouragement, and she asked Mr. R.: “Do you think it [the marriage] can collapse?” His answer was that he sometimes feels he wants to leave, but the idea that his wife may be crazy worries him, because one doesn't leave a sick person. There was a sudden change in Mrs. R.'s voice when she asked in a practical tone if there was anything that she could do. I sensed that Mrs. R. was very tense and had moved away from the stance of empathic listener. I also noticed that, while trying to be practical, she had blocked Mr. R.'s opportunity to be heard and validated. I calmed her and added that she was doing very well and that she could continue to assist her husband in exploring his difficulties. While answering to another of her questions, Mr. R. recalled an episode when he had been very aggressive towards a worker who was doing some repair in their house, and he had almost hit him. Recalling the event intensified Mrs. R.'s feelings and she began to analyze it in an harshly critical ‘psychological’ manner, and said: “You’re always afraid of your own outbursts”. Sensing the tension build-up, I interrupted the exchange and asked Mr. R. if it was OK with him that I talk to his wife about him for a while. He agreed with relief. I then asked Mrs. R. what she had understood until now. The shift helped her find relief from her own feelings and, with my encouragement, she was able to move on. After a while, in response to another of her questions, Sara Ivanir, Ph.D.

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Mr. R. told his wife that he just remembered how his father, during a violent quarrel with his mother, had taken him by the hand and said, “Come on, let's get out of this house.” Throughout this exchange Mr. R. was very focused on himself, his voice was very soft, at times choked by tears, or filled with affect. Later, reacting to another question, he recalled how his parents had moved to a new neighborhood and how he, a young boy with few social skills and little support from his parents, had been mocked and beaten up by the other boys. He remembered feeling so humiliated at not being able to fight back or protect himself that he had to be moved to another class.

Step 4: Appreciation After this, Mr. R. felt very relieved. I asked him to tell his wife just what in her behavior had helped him reach this disclosure. He turned to her and said, “You stirred memories and feelings connected with these incidents. I felt your empathy and saw the tears in your eyes. I felt how important it was for you to understand me, and this probably helped me to open up.” I then asked Mrs. R. to express her appreciation for her husband on the way he had explored and disclosed himself, and she said, “I was very moved to see how you could recall and speak so openly of these incidents. Never in our 26 years together have I heard you talk about these events so meaningfully. Your ability to reveal yourself kindled my ability to love you. When I cried, my tears were not out of pity but happiness. I admire your courage and feel that I quite understand you. I can again see the light in our relationship".

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Three possibilities for a dialogue situation between the marital partners Scheme 1 presents three possibilities for a dialogue situation between the marital partners. The dot at the center of the circle represents the self as observer (the point of pure self-awareness), or the de-centered self. The changing content of our consciousness (sensations, thoughts, feelings etc.) is one thing, whereas the ‘I’, the self, or center of our consciousness, is the other. The relation between the de-centered/observing self and the content is like the relation between the illuminated area on the screen and the various pictures projected on it. 1/a. - A failed Self - Object Experience

Scheme 1/a. represents a failed self-object experience. Each of the partners is in pain or angry. Each one feels that only she/he is entitled to make demands, and expects that her/his pain will be assuaged or regulated by or through the other (unclear boundaries between self and non self). Each desires a satisfying selfobject experience. But since their previous experiences has led them to anticipate disappointment, they don't reach out to each other and instead feel anger and hostility. As each of them suffers from failure in his/her capacity for empathic responsiveness, they are unable to bear the frustration. Neither of them senses (without help) that she/he has to give in order to receive something from the other in return. The result is increased bitter quarreling, loneliness, and yet another failed self-object experience. The scheme represents a fragmented self opposite another fragmented self. 1/b. – Self-Self Experience (The Buberian "I - Thou" dialogue)

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Scheme 1/b. is a type of dialogue exemplifying the self - self experience, or the Buberian "I - Thou” dialogue. This is an experience of unity, fullness, awakening and flow. Buber speaks of the dimension of between, or the “I Thou”. “A momentarily polarized circuit of consciousness. It neither asks nor answers; it simply connects” (Ferguson, p. 432). This dialogue exists only in the present; each person looks at the other without making any demands. The observing selves momentarily create a wholeness without a division of time, space, or values. The dialogue is not intended for anything but the dialogue itself. It is only meant to be a spiritual event. 1/c. - From Self - Selfobject Experience (The Empathic Responsiveness) towards Reciprocal Empathic Responsiveness (RER)

Scheme 1/c: This is the scheme of the RER procedure. It depicts the RER procedure in a real-time sequential progression. The distressed person (S2) is having a self-object experience from the other. (a) Basch (l995, p. 2) writes that “selfobject is an intra-psychic event” promoted by an experience with an object that functions as a caregiver. The

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selfobject experience occurs in the presence of others who provide self-object experiences that will evoke and maintain the cohesion of the self. (b) This is the intrapersonal event of S2, which has been promoted by the empathic stance of S1. S2 becomes more cohesive thanks to the internalization of the selfobject experience with S1. Now that S2 is cohesive she/he is capable of being the selfobject for S1, and she/he can function as such. The experience becomes reciprocal when one partner meets the other's needs. S1 meets the needs of S2. By now S2 is cohesive and is capable of meeting the needs of S1. As the spouses become more and more able to provide each other with experiences of this type, both inside and without the therapeutic framework, namely in their everyday life, the more they will be able to fulfill the design of the self.

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Scheme 2 - The Transformative Experience. This scheme shows how the cycle of blame transforms into mutual understanding. Content becomes subordinate to context. Regular relationships

The model of RER

Content: "She is driving me crazy"

Content: "She is driving me crazy"

Context: Blame, wish for therapist

Context: Empathic responsiveness,

to be arbitrator

wishing understanding from partner

reciprocal attack and defense

Reciprocal

Empathic

Responsiveness Conclusions and Objectives to be achieved by the RER Procedure Balint has emphasized that what we know as the 'analytic situation' is almost identical to what he called "primitive object love" (1951, p. 360), as in both the analyst is taken for granted, and there is only one partner who is entitled to make demands (p. 357). In the couple event I have just described, one partner can be taken for granted throughout the couple interaction, within a specified frame of time and subject. The expected end-results of the procedure are two: The first is what Balint called "transference to real objects" (1951, p. 361), which means seeing the partner as a person in his/her own right rather than as a frustrating mother or father figure. The second is based on the notion that moments of distress will always occur and may always endanger the coherence of the self. So these events that begin in the therapist's room are expected in future stages of the relationship to become part of the couple's patterns for coping with instances of personal and relational distress. The old negative interactional contents that caused blame

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and anger in the past are transformed into an attitude of renewed curiosity towards the self-disclosing mate, making room for new experiences of mature intimacy and love.

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Bibliography Balint, M. (1951). On love and hate. Paper presented at the 17th International Psychoanalytic Congress, Amsterdam. Basch, M. F. (1983). Empathic understanding: A review of the concept and some theoretical considerations. Journal of American Psychoanalytic Association, 31:101-126. Basch, M. F. (1994). The selfobject concept: Clinical implications. In: Goldberg, A., A Decade of Progress - Progress in Self Psychology, Vol. 10, ch. 1. Hillsdale, NJ: Analytic Press. Basch, M. F. (1995). Doing brief psychotherapy. New York: Basic Books/Harper Collins. Bateson, G. (1979). Mind and nature: A Necessary unity. New York: E. P. Dutton. Battle, C.C., Imber, S.D., Hoehn-Saric, R., Nash, E.R. & Frank, J.D. (1966). Target complaints as criteria of improvment. American Journal of Psychiatry, 20:184-192. Beck, A.T., Rush, A.J., Shaw, B.F., & Emery, G. (1982). Cognitive therapy of depression. New York: Basic books. Beebe, B., Jaffe, J. & Lachmann, F. M. (1992). A dyadic system view of communication. In: Skolnic, N. & Waeshaw, S. (Eds.), Relational perspective in psychoanalysis, pp. 61-81. Hillsdale, NJ: Analytic Press. Benjamin, L. S. (1974). Structural analysis of social behavior. Psychological Review, 81:392-425. Berman-Shapira, O. (1995). Equality in marriage: Definition and its relation to marital happiness. Unpublished master’s thesis, Tel-Aviv University, Israel. Boettcher, R. E. (1977). Interspousal empathy, marital satisfaction, and marriage counseling. Journal of Social Service Research, 1(1):105-113. Boszormenyi-Nagy, I. (1965). A Theory of Relationships: Experience and Transaction. In: Boszormenyi-Nagy, I. & Framo, J. L. (Eds.), Intensive family therapy. New York: Harper & Row. Bowen, M. (1979). Family therapy in clinical practice. Northvale, NJ: Aronson.

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Bowlby, J. (1973). Affectional bonds: Their nature and design. In: Weiss R. S. (Ed.), Loneliness: The experience of emotional and social isolations. Cambridge, MA: MIT Press. Bowlby, J. (1988). Developmental psychiatry come of age. American Journal of Psychiatry, 145(1):1-10. Broderick, J. E. & O’Leary, K. D. (1986, Aug.). Contributions of affect, attitudes, and behavior to marital satisfaction. Journal of Consulting and Clinical Psychology, 54(4):514-517. Brown, E. M. (1991). Patterns of infidelity and their treatment. New York: Brunner/Mazel. Buber, M. (1965). The knowledge of man: A philosophy of the interhuman. New York: Harper & Row. Charny, I. W. (1992). Existential/dialectical marital therapy - Breaking the secret code of marriage. New York: Brunner/Mazel. Christensen, A., Jacobson, N.S. & Babcock, J.C. (1995). Integrative Behavioral Couple Therapy. In Jacobson, N. S. & Gurman, A. S. (Eds.) (1995). Clinical handbook of couple therapy. New York: Guilford Press. Coyne, J. C. (1986, Jan.). Evoked emotion in marital therapy: Necessary or even useful? Journal of Marital and Family Therapy, 12(1):11-13. De Shazer, S. (1991). Putting difference to work. New York: W. W. Norton. Dicks, H. V. (1967). Marital tensions. New York: Basic Books. Emde, R. N. (1991). Positive emotions for psychoanalytic theory: Surprises from infancy research and new directions. Journal of American Psychoanalytic Association, 39:5-44. Feldman, L. B. (1979). Marital conflict and marital intimacy: An integrative psychodynamic-behavioral-systemic model. Family Process, March, 18:69. Ferguson, M. (1982). The aquarian conspiracy - Personal and social transformation in the 1980s. London: Granada.

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20

Reciprocal Empathic Responsiveness (RER)


Fisch, J. M. (1994). The self in psychotherapy. Israel Journal of Psychiatry. 31(2): 71-77. Fivaz-Depeursinge, E. (1991). Documenting a time-bound circular view of hierarchies: A microanalysis of parent-infant dyadic interaction. Family Process, 30:1. Framo, G. L. (1972). Family interaction: A dialogue between family researchers and family therapists. New York: Springer. Freud, S. (1921). Group psychology and the analysis of the ego. S.E., 18. Goldman, A. (1987). The comparative efficacy of an emotionally focused and integrated systemic couple therapy. Unpublished Doctoral Dissertation, University of British Columbia, Canada. Gottman, J. (1993). The role of conflict engagement, escalation and avoidance in marital interaction: A longitudinal view of five types of couples. Journal of Consulting and Clinical Psychology, 61:6-15 Grosbard, O. (1991). Development of process scale for the measuement of "Therapeutic impact" Differentiating the style of diverse therapists. (Under the supervision of Dr. H. Omer, and Dr. A. Raviv). Unpublished thesis submitted for the MA degree of the Tel - Aviv University. Gardner, J. (1995). Supervision of trainees. Clinical Social Work Journal, 23. Gardner, J. R. (1991). The application of self psychology to brief psychotherapy. Psychoanalytic Psychology, 8(4):477-500. Garfield, S. L. & Bergin, A. E. (Ed.) (1986a). Handbook of psychotherapy and behavior change. New York: John Wiley & Sons. Gergen, K. J. (1995). Realities and relationships, sounding in social construction. Cambridge, MA: Harvard University Press. Gilbert, H. D. (1994). Selfobject throughout the life span: Research with nonclinical subjects. In: Goldberg, A., A Decade of Progress - Progress in Self Psychology, Vol. 10, ch. 4. Hillsdale, NJ: Analytic Press. Gilhotra, J. (1993, June). The concepts of selfobject function and empathy in couples therapy. Australian and New Zealand Journal of Psychiatry, 27(2):294-297. Goldberg, A. (Ed.) (1978). The psychology of the self. New York: International Universities Press. Sara Ivanir, Ph.D.

21

Reciprocal Empathic Responsiveness (RER)


Goldman, A. & Greenberg, L. (1992, Dec.). Comparison of integrated systemic and emotionally focused approaches to couples therapy. Journal of Consulting and Clinical Psychology, 60(6):962-969. Gorney, J. E. (1996). Twinship, vitality, pleasure. Unpublished paper presented at the 19th annual conference on Psychology of the Self, Washington, DC. Greenberg, L. S. (1986). Change process research. Journal of Consulting and Clinical Psychology, 54(1):4-9. Greenberg, L. S. (1991). Research on the process of change, Psychotherapy Research, 1:3-16. Greenberg, L. S. & Johnson, S. M. (1986, Jan.). Affect in marital therapy. Journal of Marital and Family Therapy, 12(1): 1-10. Greenberg, L. S. & Johnson, S. M. (1988). Emotionally focused therapy for couples. New York: Guilford Press. Greenberg, L. S., Jaims, P. S., & Conry, R.F. (1988) Perceiving change in couples therapy. Journal of Family Psychology, 2, 5-23 Greenberg, L. S. & Johnson, S. M. (1990). Emotional change processes in couples therapy. In: Blechman, E. A. (Ed.), Emotions and the family: For better or for worse, pp. 137-153. Hillsdale, NJ: Lawrence Erlbaum Associates. Greenberg, L. S. & Pinsof, W. M. (Eds.) (1986). Process research: Current trends and future perspective. In: Et al. Eds., The psychotherapeutic process: A research handbook, pp. 3-20. New York: Guilford Press. Greenberg, L. S., Ford, C. L., Alden, L. S. & Johnson, S. M. (1993, Feb.). Insession change in emotionally focused therapy (Special section: Couples and couple therapy). Journal of Consulting and Clinical Psychology, 61(1):78-84. Greenberg, L.S. & Rice, L.N. (Eds.) (1984). Patterns of Change - Intensive Analysis of Psychotherapy Process. New York: Guilford Press. Gregory, S. W., Webster, S. & Huang, G. (1993, July). Voice pitch and amplitude convergence as a metric of quality in dyadic interviews. Language and Communication, 13(3):195-217.

Sara Ivanir, Ph.D.

22

Reciprocal Empathic Responsiveness (RER)


Hendrix, H. (1988). Getting the love you want: A guide for couples. New York: Henry Holt. Hendrix, H. (1992). Keeping the love you find: A guide for singles. New York: Pocket Books. Hendrix, H. & Hunt, H. (1994). The couples companion: Meditation and exercises. New York: Pocket Books. Hoffman, L. (1988). A constructivist position for family therapy. The Irish Journal of Psychology, 9(1). Hoffman, M. J. (1993, March). From initiative to experience: A contribution to the understanding of integration. Paper presented at the 3rd IPA meeting on research, London. Jacobson, N. S. & Addis, M. E. (1993, Feb.). Research on couples and couple therapy: What do we know? Where are we going? Journal of Consulting and Clinical Psychology, 61(1):85-93. Jacobson, N. S. & Gurman, A. S. (Eds.) (1995). Clinical handbook of couple therapy. New York: Guilford Press. James, P. S. (1991, July). Effects of a communication training component added to an emotionally focused couples therapy. Journal of Marital and Family Therapy, 17(3):263-275. Johnson, S. M. & Greenberg, L. S. (1985, July). Emotionally focused couples therapy: An outcome study. Journal of Marital and Family Therapy, 11(3):313-317. Johnson, S. M. & Greenberg, L. S. (1987, Fall). Emotionally focused marital therapy: An overview (Special issue: Psychotherapy with families). Psychotherapy, 24(3 S)552-560. Johnson, S. & Greenberg, L. S. (1987). Relating process to outcome in marital therapy. Journal of Marital and Family Therapy, 14:175-184. Johnson, S. M. & Greenberg, L. S. (1988, Apr.). Relating process to outcome in marital therapy. Journal of Marital and Family Therapy, 14(2):175-183. Johnson, S. M. & Greenberg, L. S. (Eds.) (1994). The heart of the matter: Perspectives

on

emotion

in

marital

therapy.

New

York,

NY:

Brunner/Mazel.

Sara Ivanir, Ph.D.

23

Reciprocal Empathic Responsiveness (RER)


Johnson, S. M. & Greenberg, L. S. (1995). The emotionally focused approach to problems in adult attachment. in: Jacobson, N. S. & Gurman, A. S. (Eds.) (1995). Clinical handbook of couple therapy. New York: Guilford Press. Kahn, M. D. (1986, Jan.). Response to Greenberg & Johnson: Where is the object of your affect? Journal of Marital and Family Therapy, 12(1):15-17. Karlsberg, J. A. & Karlsberg, R. C. (1994). The affectionate bond: The goal of couple-centered therapy (Special issue: Dialogue). Journal of Humanistic Psychology, 34(1):132-141. Karpel, M. S. (1976). Individuation: from fusion to dialogue. Family Process, 15(1):65-82. Katz, R. L. (1963). Empathy. Glencoe, IL: Free Press. Kelly, G. A. (1969). In: Maher, B. (Ed.), Clinical psychology and personality: The selected papers of George Kelly. New York: John Wiley & Sons. Kelly, V. C. (1993, Oct.). Affect and intimacy. Psychiatric Annals, 23(10):556566. Kelly, V. C., Jr. (1996). Affect and the redefinition of intimacy. In: Nathanson, D. L. (Ed.), Knowing feeling: affect, script, and psychotherapy, pp. 55104. New York: W. W. Norton. Kernberg, O. F. (1995). Love relations, normality and pathology. New Haven, MA, and London: Yale University Press. Kershaw, C. J. (Ed.) (1992). The couple’s hypnotic dance - Creating Ericksonian strategies in marital therapy. New York: Brunner/Mazel. Kiesler, D. J. (1985). The missing link in psychotherapy research. Contemporary Psychology, 30:527-529. Klein, M., Mathiew-Coughlin, P. & Kiesler, D. (1986). The experiencing scale. In: Greenberg, L. S. & Pinsof, W. (Eds.) (1986), The psychotherapeutic process: A research handbook, pp. 113-126. New York: Guilford. Kohut, H. (1959). Introspection, empathy and psychoanalysis. Journal of American Psychoanalytic Association, 7:459-483. Kohut, H. (1966). Forms and transformations of narcissism. Journal of American Psychoanalysis, 14:243-272.

Sara Ivanir, Ph.D.

24

Reciprocal Empathic Responsiveness (RER)


Kohut, H. (1971). The analysis of the self. New York: International Universities Press. Kohut, H. (1977). The restoration of the self. New York: International Universities Press. Kohut, H. (1979). Four basic concepts in self-psychology. In: Ornstein, P. H. (Ed.) (1991), The search for the self , Vol. 4. International Universities Press. Kohut, H. (1982). Introspection, empathy and the semi-circle of mental health. International Journal of Psychoanalysis, 63:395-408 Kohut, H. (1984). How does analysis cure? Goldberg, A. & Stepansky, P. (Eds.). Chicago: University of Chicago Press. Kohut, H. (1985). Self psychology and the humanities. London: W. W. Norton. Koldra -Yofe, O., (1992). "Therapeutic Impact" as predictor of success in treatments of bulimia, pain and marital problems. (Under the supervision of Dr. H. Omer, and Dr. R. Dar. Unpublished thesis submitted for the MA degree of the Tel-Aviv Univ. Krasner, B. R. & Joyce, A. J. (1995). Truth, trust and relationships - Healing interventions in contextual therapy. New York: Brunner/Mazel. Kriegman, D. (1989). On the existential/subjectivism - Scientific/objectivism dialectic in self-psychology: A view from evolutionary psychology. In: Lichtenberg, J. D., Psychoanalysis and Motivation. Hillsdale, NJ: Analytic Press. Kulka, R. (1995). The psychoanalyst's mind from listening to interpretation: Will psychoanalysis evolve from individuality to subjectivity? Sichot Dialogue (June) 9:3. L’Abate, L. (1986). Systematic family therapy. New York: Brunner/Mazel. Lachkar, J. (1992). The narcissistic/borderline couple: A psychoanalytic perspective on marital treatment. New York, NY: Brunner/Mazel. Lichtenberg, J. D. (1989). Psychoanalysis and motivation. Hillsdale, NJ: Analytic Press. Lichtenberg, J. D. (1991). What is a selfobject? Psychoanalytic Inquiry, 6:455479.

Sara Ivanir, Ph.D.

25

Reciprocal Empathic Responsiveness (RER)


Lichtenberg, J. D., Lachmann, F. M. & Fosshage, J. L. (1992). Self and motivational systems. Hillsdale, NJ: Analytic Press. Lichtenberg, J. D., Lachmann F. M. & Fosshage, J. L. (1996). The clinical exchange. techniques derived from self and motivational systems. Hillsdale, NJ: Analytic Press. Locke, H.J., & Wallace, K.M., (1959). Short marital adjustment and predict test, their reliability and validity. Marriage and family living. 21 155-251 Mann, J., (1986) The core of time-limited psychotherapy: Time and the central issue. In S. H. Budman (Ed.), Forms of brief therapy. Second Edition. New York: The Guilford Press Marmar, C. R. (1990, June). Psychotherapy process research: Progress, dilemmas, and future directions. Journal of Consulting and Clinical Psychology, 58(3):265-272. Maslow, A. (1968). Toward a psychology of being. New York: Van Nostrand Reinhold. Maslow, A. (1971). The farther reaches of human nature. New York: Viking Press. Miehls, D. (1993, Nov.). Conjoint treatment with narcississtic couples: Strategies to increase empathic interaction. Smith College Studies in Social Work, 64(1):3-17. Mintz J. & Kiesler D. J. (1981). Individualized measures of psychotherapy outcome. In P. Kendall & J. Outcher (Eds), Handbook of research methods in clinical psychology. New York: John Wiley & Sons. Noller, P. & Feeney, J. A. (1994, Fall). Relationship satisfaction, attachment, and nonverbal accuracy in early marriage. Journal of Nonverbal Behavior, 18(3):199-221. Noy, P. (1995, March). What is the self of self psychology? A historical survey (1), Sichot - Dialogue, Israel Journal of Psychotherapy, 9:2. Noy, P. (1995, June). What is the self of self psychology (2). Sichot Dialogue, Israel Journal of Psychotherapy, 9:2.

Sara Ivanir, Ph.D.

26

Reciprocal Empathic Responsiveness (RER)


Olden, C. (1953). On adult empathy with children. Psychoanalytic Study of the Child, 8:111-126. Omer., H., (1987). Therapeutic impact: A non-specific major factor in directive psychotherapies. Psychotherapy, 24, 52-57 Omer, H. & London, P. (1988). Metamorphosis in psychotherapy: The end of the systems’ era. Psychotherapy, 25:171-181. Omer, H., (1989) Specifics and non-specifics in psychotherapy. American Journal of Psychotherapy, 43:181-192 . Omer, H. (1993b). The integrative focus: Coordinating symptom - and personoriented perspectivism therapy. American Journal of Psychotherapy, 47:283-295. Omer, H. (1994). Critical interventions in psychotherapy: From impasse to turning point. New York: W. W. Norton. Orden, S. & Bradburn, N. (1968). Dimension of marriage happiness. American Journal of Sociology, 73:715-731. Orenstein, P. H. & Orenstein, A. (1985). Clinical understanding and explaining: the empathic vantage point. In: Goldberg, A. (Ed.), Progress in self-psychology, pp. 43-61. New York: Guilford Press. Osterweil, Z. O. (1995). Open solutions. Tel Aviv: Schocken Publishing House. Piaget, J. (1969). The Psychology of the Child. New York: Basic Books. Prager, K. J. (1995). The psychology of intimacy. New York: Guilford Press. Renik, O. (1993). Analytic interaction: Conceptualizing technique in light of the analyst’s irreducible subjectivity. Psychoanalytic Quarterly, 62:553-571. Rice, L. N. & Greenberg L. S., (Eds.). (1984) Patterns of change: Intensive analysis of psychotherapy process. New York: Guilford Press. Ringstrom, P. A. (1994). An intersubjective approach to conjoint therapy. In: Goldberg, A. (Ed.), A decade of progress. Progress in self psychology, Vol. 10, pp. 159-182. Hillsdale, NJ: Analytic Press.

Sara Ivanir, Ph.D.

27

Reciprocal Empathic Responsiveness (RER)


Sager, C. (1981). Couple therapy and marriage contracts. In: Gurman, A. S. & Kniskern, D. P. (Eds.), Handbook of family therapy. New York: Brunner/Mazel. Satir, V.(1975) Peoplemaking. Tel-Aviv: Sifriat Poalim. Schafer, R. (1959). Generative empathy in the treatment situation. Psychoanalytic Quarterly, 28:342-373. Scharff, D. E. & Scharff, J. S. (1991). Object relation couple therapy. London: Jason Aronson. Shefler, G. (1991). Can process research teach us the essence of psychotherapy? Israel Journal of Psychiatry and Related Sciences, 28(4):31-39. Singer-Magdoff, L. J. (1989). Early fit and faulty fit: Object relations in marital therapy. In: Crosby, J. F. (Ed.), When one wants and the other doesn’t: Doing therapy with polarized couples, pp. 118-135. New York, NY: Brunner/Mazel. Slipp, S. (1984). Object relations: A dynamic bridge between individual and family treatment. Northvale, NJ: Aronson. Smith, M. L., Glass, G. V., & Miller, T. I., (1980) The benefits of psychotherapy. Baltimore: Johns Hopkins University Press. Snyder, D.K., & Wills, R.M., (1989). Behavioral versus insight-oriented marital therapy: Effects on individual and interspousal functioning. Journal of Consulting and Clinical Psychology, 57:39-46 Snyder, D. K., Mangrum, L. F., & Wills, R. M., (1993) Predicting couples' response to marital therapy: A comparison of short and long term predictors. Journal of Consulting and Clinical Psychology, 61, 61-69. Snyder, M. (1994, Winter). The development of social intelligence in psychotherapy: Empathic and dialogic processes (Special issue: Dialogue). Journal of Humanistic Psychology, 34(1):84-108. Solan, R. (1991). Jointness: Integration of merging and separateness in object relation and narcissism. Psychoanalytic Study of the Child, Vol. 46. Solomon, M. F. (1988). Self psychology and marital relationships. International Journal of Family Psychiatry, 9(3):211-226.

Sara Ivanir, Ph.D.

28

Reciprocal Empathic Responsiveness (RER)


Spanier, G. B. (1976). Measuring dyadic adjustment: New scales for assessing the quality of marriage and similar dyads. Journal of the Marriage and the Family, 38 no. 1:15-31. Stern, D. (1985). The interpersonal world of the infant. New York: Basic Books. Stern, D. (1996). The social construction of therapeutic action. Psychoanalytic Inquiry, 16:265-293. Stiles, W.B., McDaniel, S.H. & McGaughey, K. (1979). Verbal response mode correlates of "experiencing”.

Journal of Consulting and Clinical

Psychology, 47:795-797. Stiles, W.B, (1980) Measurement of the Impact of Psychotherapy Sessions. Journal of Consulting and Clinical Psychology, 48 / 2 : 176-185 Stiles, W.B., Shapiro, D.A., Elliott, R. (1986). “Are all psychotherapies equivalent?” American Psychologist, American Psychological Association, 41:165-180 Stiles, W.B., et al. (1994). Evaluation and description of psychotherapy sessions by clients using the Session Evaluation Questionaire (SEQ) and the Session Impacts Scale. Journal of Counseling Psychology, 41: 175185. Stolorow, R. D. (1986). On experiencing an object: A multidimensional perspective. In: Goldberg, A. (Ed.), Progress in self-psychology, Vol. 2. New York: Guilford Press. Stolorow, R. D., Atwood, G. & Brandchaft, B. (Eds.) (1994). The Intersubjective Perspective. New Jersy: Jason Aronson. Strenger, C. (1989). The classic and the romantic vision in psychoanalysis. International Journal of Psycho-Analysis, 70:593. Strenger, C. & Omer, H. (1992). Pluralistic criteria for psychotherapeutic interventions: An alternative to sectarianism, anarchy and utopian integration. American Journal of Psychotherapy, 46:111-130. Teicholz, J. (1996). Optimal responsiveness: Its role in psychic growth and change. In: Lifson, L. (Ed.), Understanding therapeutic action. Hillsdale, NJ: Analytic Press.

Sara Ivanir, Ph.D.

29

Reciprocal Empathic Responsiveness (RER)


Thompson, L. & Walker, A. J. (1982, Nov.). The dyad as the unit of analysis: Conceptual and methodological issues. Journal of Marriage and the Family, 44(4):889-900. Tomkin, S. S. (1980). Affect as implication: Some modification in theory. In: Plutchik, R. & Kelerman, H. (Eds.), Emotions: Theory, research, and experience, pp. 141-164. New York: Academic Press. Trop, J. L. (1994). Conjoint therapy: An intersubjective approach. In: Goldberg, A. (Ed.), A decade of progress. Progress in self psychology, Vol. 10, pp. 147-158. Hillsdale, NJ: Analytic Press. Waring, E. M. & Chelune, G. D. (1983). Marital intimacy and self disclosure. Journal of Clinical Psychology, 39:183-190. Waring, E. M. (1990). Self-disclosure of personal constructs. Family Process, 29:399-413. Whitaker, C. (1982). From Psyche to System. (Eds. Neill, J. R. & Kniskern, D. P.). New York: Guilford Press. Whitaker, C. (1989). Midnight Musing of a Family Therapist. (Ed. Ryan, M. O.). New York: Norton & Company. Weiss, R. L. & Heyman, R. E. (1990). Marital distress. In: Bellack, A. S., Hersen, M. & Kazdin, A. E. (Eds.), International handbook of behavior modification and therapy (2nd ed.). New York: Plenum Press. Winnicott, D. (1960). Ego distortions in terms of true and false self. In: The maturational process and the facilitating environment. London: Hogarth Press, 1976. Wiseman, H. & Rice, L. N. (1989). Sequential analysis of therapist-client interaction during change events: A task focus approach. Journal of Consulting and Clinical Psychology, 57:281-286. Wiseman, H. & Shefler, G. (1995). Exploring the event of the “central issue� in time-limited psychotherapy - process analysis in set of cases. In: Shefler, G., Time-limited psychotherapy - theory practice and research. Jerusalem: Magness/Hebrew University. Wolf, E. S. (1988b). Treating the self: Elements of clinical self psychology. New York: Guilford Press. Wright, R. (1994). The moral animal: Evolutionary psychology and everyday life. New York: Pantheon Books. Sara Ivanir, Ph.D.

30

Reciprocal Empathic Responsiveness (RER)


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