Truth and ethics in the clinical dyad: Toward a synthesis of symmetrical and asymmetrical forms of intersubjectivity in the rupture and repair of the therapeutic alliance

This work examines contemporary concepts and structures of rupture and repair in the therapeutic alliance, primarily in the context of the relational psychoanalytic movement. Continuing the critique of the classical "one-person model" of treatment, three philosophical theories of intersubjectivity (i.e., the formal structure of human relationship) that have been utilized by psychological theorists to conceptualize the clinical situation are reviewed. The three philosophical analyses of intersubjectivity (involving the dialectics of Hegel, the hermeneutics of Gadamer, and the ethics of Levinas) are distilled into two forms: what the author has termed symmetrical and asymmetrical. The possibility of a synthesis between these two forms of intersubjectivity---involving truth and ethics, respectively---in the clinical dyad is then presented in the context of Safran and Muran's relational model of rupture and repair. This synthesis will be demonstrated in analyses of the process by which clinicians and patients recover from ruptures to the therapeutic alliance caused by unconscious enactments. Current theories of how the participants in psychotherapy are able to recognize, symbolize, and move out of the mutual lock of unconscious enactments are critiqued, and the attempted synthesis of two prominent theories of intersubjectivity is offered as an alternative. Both forms of intersubjectivity are deemed necessary for client and therapist to extricate themselves initially from mutual unconscious enactments and repair ruptures in the therapeutic alliance through the formation of new narrative constellations of relational identity.