In recent years, there has been mounting pressure for the various scho
ols and techniques of psychotherapy to demonstrate their effectiveness
empirically. Numerous empirical studies, often ingenious, have been c
onducted for this purpose. Many of these studies have been misguided,
in my opinion, by attempting to operationalize qualities of the therap
ist, or an abstract psychotherapeutic process, rather than being able
to address change as the patient or client experiences it. The present
paper offers a way of thinking about change in the patient undergoing
psychotherapy in terms of his or her subjective experience of a chang
e of meaning during narrative acts. This requires turning to a traditi
on of thought in psychiatry, psychoanalysis, and psychosomatic medicin
e that is more philosophical; this is a tradition which has been large
ly confined to the German language, the tradition, namely, of phenomen
ological-anthropological and existential psychiatry.