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According to Stolorow and colleagues (1987), “The fundamental goal of psychoanalytic therapy is the unfolding, illumination, and transformation of the patient’s subjective world” (p. 9). To approach this goal, the therapist who operates with an awareness of the intersubjective nature of psychological processes must provide an environment in which the patient’s world of subjective experience is able to unfold. This environment includes the ambiance of the setting, the empathic-introspective listening stance of the therapist, and the relationship created between the two of them. In addition to these factors, many unforeseen elements arising from the histories and the organization of experience of each participant contribute to the context. “Analyst and patient form an indissoluble psychological system, and . . . neither can, without violence to the integrity of the analytic experience, be studied alone” (Orange et al. 1997, p. 76). During the course of treatment, the attuned therapist explores and draws attention to the impact of these subtleties on the treatment. Essentially, the patient and therapist together create the environment in which a therapeutic dialogue can occur. It is through this dialogue that the patient’s story will unfold.

A second task of the intersubjective approach to therapy is to illuminate, to shed new light on, the patient’s subjective experience and the personal meanings the patient has made of it. Intersubjectivity theory draws heavily on the hermeneutic tradition (Atwood & Stolorow 1984). Hermeneutics originally referred to the theory of interpretation of religious texts. It has subsequently been applied to the interpretation and understanding of human subjectivity. When we investigate human subjectivity, our focus is on personal meanings. Man is a meaning maker, and humans create meaning out of their subjective experience. Meanings made of today’s experience influence the meaning made of subsequent experience. Therefore, we must expand our domain of inquiry to include not just subjective experience but also the meaning each person makes of her subjective experience and the impact of that meaning on further experience.

Meaning itself is a multifaceted phenomenon, emerging from within the treatment context. Any context consists of an array of factors that the participants—in this instance, patient and therapist—separately organize to make sense of their experience. So, as with the hermeneutic tradition in the interpretation of religious texts, in psychotherapy the meaning we seek to illuminate is dependent on the context. Simultaneously, features of the context are selectively organized within our subjectivity, conforming to prereflective patterns. In a continuously interpenetrating process, meaning influences subjectivity and subjectivity selectively organizes context. Illumination is a process of focusing and understanding the elements (affective, cognitive, and relational) in the foreground at any given time.

For our patient who experienced her father as aloof, demanding, and critical, it is not enough to understand that this was her experience of him. We must also be concerned with understanding the meaning she made of her experience with him, in other words, how she structured or organized her experience of herself in relation to her father. Did she consider herself to be uninteresting or unappealing? After all, her father spent much more time playing with her brother and the dog. Might she have concluded that she was deficient or lacking? After all, her father seemed to set higher expectations for her brother. Could she have determined that she was worthless because her father tended to dismiss or devalue her efforts?

Continuing with our example of our patient and her father, we said above that “all that is knowable in psychoanalytic psychotherapy . . . is subjective experience.” But one’s subjective experience and the meaning made of it are not static; they are active and evolving. The past is as we experience it today. In therapy, as self-understanding grows, as the patient develops greater self-cohesion and enhanced capacity to listen to others empathically, her experience of the past will change. In a dynamic system, when one part changes, the whole system is thrown into disequilibrium and subsequently forced to accommodate to what is new. In psychotherapy, then, when the patient’s organization of experience changes, her relationship to others, whether in memory or in her present, also changes. In this way, subjective experience can be transformed and new meanings can be constructed. For example, the father who was characterized as aloof, demanding, and critical at the beginning of treatment might be experienced later as a well-intentioned and concerned man whose own harsh and impoverished childhood led him to prepare his daughter for the cruel world of his experience by promoting self-reliance and self-sufficiency in her.

We used the illustration of individual psychotherapy to examine the complexity of the intersubjective field created by the interaction of patient and therapist. But the context can multiply the complexity, like placing more balls on the pool table for the cue ball to engage. Let’s complicate the intersubjective field by introducing a supervisor into the therapy mix. In individual therapy done under supervision, the field would now include the impact of the supervisor on the system (Buirski & Monroe 2000). Furthermore, if the treatment were audio- or videotaped, the system would expand to include the real or imagined listeners. We can anticipate how the watchful eye or keen ear of the supervisor might impact both patient and therapist. However, the meaning that each makes of the experience of being observed might be quite different, depending on the organization of experience of each individual. For example, the patient might experience deep shame at revealing his flawed, devalued self-organization, while the therapist might fear being seen as hopelessly inept and uneducable.

In contrast to some other psychoanalytic theories that search for the presumed absolute or universal principles underlying human nature, intersubjectivity theory makes no such assumptions about the nature of human experience. We do not strive to fit a person’s subjective experience into preexisting theoretical frameworks, such as id, ego, and superego; depressive and schizoid positions; or stages of separation-individuation. Rather, these formulations are viewed as metaphors that may be helpful in understanding some people some of the time. Instead, intersubjectivity theory concerns itself with the way in which people form patterns or organize or structure their experience. According to Atwood and Stolorow (1984), “The basic units of analysis for our investigations of personality are structures of experience—the distinctive configurations of self and object that shape and organize a person’s subjective world” (p. 33).

To say that experience is structured simply means that people organize and give meaning to the recurrent patterns or themes that emerge from their formative relationships with caregivers and other significant players in their lives. These patterns, themes, or structures of experience are now generally referred to as organizing principles because they function as the emotional framework around which self-concept and self-esteem are built. In the example of the patient with the aloof, demanding, and critical father, she organized, or made sense of, her experience by concluding that she must be fundamentally defective and unworthy of love. It is important to bear in mind that the concept of organizing principles contains both cognitive and affective components. For the patient in the example above, her organizing principles concern both the idea that she is defective and unworthy of love and the painful affects of shame and self-loathing that are at the core of this organization of experience.

Another young woman had organized her experience around the idea that she lived under a black cloud that shrouded her life in bad luck. She was convinced that only disappointment and hurt would come to her if she reached for anything or anyone, and she was without hope for the future. After several years of treatment in which this organization of experience was identified and discussed, she met an attractive man at a local coffee shop. He expressed interest in her, and they saw each other a few times and spoke occasionally on the phone. Eventually they began dating, and following their first sexual encounter, he suddenly stopped calling and did not respond to her phone messages. After many anxious days, she finally reached him by phone at his work, and he indicated that he no longer wanted to pursue the relationship. This was devastating for her. It fit perfectly, like a jigsaw puzzle piece, into her organization of experience. Hadn’t she always known that nothing good would come to her, that she was destined for hurt and disappointment? Who would want someone as loathsome as she? Let us imagine another woman with a different organization of experience—someone who feels self-confident and worthy of love. No doubt she too would feel hurt and disappointment at such a cold rejection, but this second woman would not find this experience to be a perfect fit in the waiting jigsaw puzzle. It might be viewed as a painful piece of bad luck but not a puzzle piece that fits seamlessly into a lifelong picture.

In both examples, these organizing principles and the affects at their core, though formed in childhood relationship with caregivers, get carried forward into the present and serve as a filter through which all subsequent experience must pass. One of the tasks of the intersubjective approach to psychotherapy, then, is to identify and articulate both the organizing principles and the underlying affect states that structure people’s unique experience of themselves and others.

This brings us to one of the major current controversies in psychoanalytic thought: does psychopathology result from conflict or arrested development? The ego psychology perspective views neurosis as the compromise between conflicting forces or functions, operating predominantly within the unconscious mind of the individual. This intrapsychic conflict is understood to be occurring between the id, ego, and superego. The principal locus of psychopathology is found in the forces in conflict within the mind of the individual and the internal management of this conflict.

In contrast, developmental arrest theories, like self psychology, might view psychopathology as resulting from a developmental history of insufficient or inadequate parenting in which the person was deprived of vitally needed selfobject experiences, such as mirroring, idealization, and twinship, that promote the consolidation of a mental structure called “the self.” From this perspective, the person is seen as suffering from developmental deficits in the structure of the self. The developmental deficit perspective focuses then on what is missing (Atwood and Stolorow 1997), and these defects in the structure of the self are understood to be the outgrowth of a deficient relationship with an external other.

While intersubjectivity theory values the importance of selfobject experiences for healthy development, “the concept of structure within intersubjectivity theory, by contrast, refers to broad patterns within which experience repeatedly takes form, prereflective organizing principles manifest as recurring themes in the flow of subjective life” (Atwood and Stolorow 1997, p. 520). From the intersubjective perspective, psychopathology is understood as resulting from neither intrapsychic conflict nor developmental arrest in the formation of a structure like the self. Rather, psychopathology is thought to result from something that is present: the complex context out of which the person’s subjective experience became organized.

In addition to the unfolding and illumination of subjective experience, an important treatment aim of the intersubjective approach is the transformation of subjective experience. Transformation of archaically formed organizing principles does not mean that treatment leads to their modification. Successful treatment leads to the formation of new organizations of experience, new ways of understanding oneself, and new expectancies based on these new understandings. If new structures, new ways of organizing experience, and new organizing principles are constructed during treatment, what happens to the archaically formed ones? They neither disappear, are forgotten, nor are completely replaced by the newly formed ones. Rather, they persist in weakened form within the organization of the personality. In times of stress, in the absence of needed selfobject experience, old organizing principles may reemerge, reviving in the person old feelings of worthlessness or emptiness. The revival of these archaic affect states is referred to as either experiences of fragmentation, where prior attainments of self-cohesion begin to break down, or experiences of depletion, where vitality affects cannot be sustained. Because the old coexists with the new, it would be inaccurate to talk of cure. Successful psychotherapy leads to the formation of new structures, that is, new organizations of experience and new organizing principles.

The idea that what is accomplished in psychotherapy is the formation of new structures or new principles that organize experience is quite different from the idea that in psychotherapy people learn new ways of relating. If what happens in psychotherapy is that patients learn new ways of relating to others as an outgrowth of engaging in the transference relationship with the therapist, then psychoanalysis would be merely some variant of a social/learning theory.

From the intersubjective perspective, as a result of forming new psychological structures, new organizations of experience, people acquire new expectancies of relationship and are therefore capable of relating in new ways. They are capable of relating differently because they experience themselves and the world differently. It is not so much that they have learned new relating skills as that, feeling differently about themselves and their place in the world, they have become more open to risk and more resilient in the face of injury. Thus, from the intersubjective perspective, psychotherapeutic success involves structural change.