The frequency of contact between patient and therapist was originally conceptualized to accommodate the intensity of the transference. If the treatment is transference based, then it requires frequent contact as sessions build on each other conceivably ad infinitum. The past and present are relived within the transference.
However, if the treatment is primarily non-transference based, then it is a reporting process and requires no specific frequency, as the sessions could conceivably have a life of their own relatively independent of each other. To patients’ question as to how often the sessions should be is J. Bugental’s response: You go to the beach, dig a hole, come back the next week, dig the same hole. But if you go back to the beach every day, begin where you left off, you dig a deeper hole. The real issue is not as much how frequently you meet with a patient, but what you do when you’re together in a session, and what kind of relationship would set the optimum stage for transmuting identification and internalization to occur.
In identification, which usually refers to a relatively mature mental process of differentiation by which an individual integrates another into a cohesive self-identity, change occurs in a fairly global manner. In transmuting internalization (H. Kohut’s term) by comparison, bits and pieces of the object or selfobject are internalized. Introduction of the latter term reflects Kohut’s concern that, if the therapist actively assumes a role of idolatry, he thereby encourages only gross (nonselective) identification. This can obstruct a gradual integration and transformation of the patient’s own psychological structures, and also hinder the progressive building up of new ones. In transmuting internalization, however, aspects of the idealized other are slowly, selectively, and partially internalized, then reassembled in the psyche of the patient. This means a piecemeal assimilation of an ongoing identificatory process ― “microinternalization.” Instead of being an irrational, wholesale idealization or repudiation of another, it includes recognition of realistic imperfections of the object or selfobject, as new aspects of the clinician are continually internalized and integrated into the emerging self.