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In this article, I describe how greater self-awareness and increased affect tolerance changed my clinical work with patients. I provide a clinical example to illustrate how my personal growth occurred. Blind spots, created through both conflict and ignorance, are discussed. My acceptance of my limitations in general, as well as those that come with age, and the awareness of the limitations of time itself all increase as I age. Grief and mourning become more central in my work. My comfort and confidence increase, but awareness of my age makes me more selective about whom I will treat. I treasure the work more than ever and experience the benefits of mutual peer supervision increasing over time. I hope to convey what a privilege it has been to be a psychotherapist., (© 2015 Wiley Periodicals, Inc.)

Development of a self-analytic function has historically been a goal of psychoanalysis. This article draws on interviews with former analysands to examine ways in which self-exploration continued after analysis. Former analysands who did not report ongoing self-exploration had not necessarily failed to benefit from analysis, nor had they not continued to benefit and grow after analysis ended. The author reflects on different ways of assimilating the analytic process and the analytic relationship, and self-analysis as a criterion by which to judge the success of analytic outcome is reconsidered.

An important area for psychoanalytic study is the significance for intrapsychic life of important events taking place in the community of which analyst and analysand are a part. September 11, 2001 provides a vantage point for examination of questions that arise from looking at the interrelationship between current environment and intrapsychic life. Two cases are presented as a focus for discussing the interaction of the memorialized past and occurrences in present reality, the significance for an analysis of analyst and patient sharing the same experience, instigations to progress that a current event may provide and the ways in which communal experience influences intrapsychic life. As a part of the discussion, we ask as well in what ways a common experience may be shared, and the significance of radically different meanings that the same event may have for analyst and analysand. We also pose the question whether the differences and similarities, each in their own way, may serve as progressive forces in the analysis.

The tension between privacy and disclosure in psychoanalysis operates in various ways in analyst, supervisee, and supervisor. Analysts need to maintain the privacy of their patients by keeping their material confidential; they also need to know and share their own internal conscious conflicts to be able to discover unconscious conflicts and their characterological ramifications. Clinical writing is one vehicle for the exploration, discovery, and communication of transference-countertransference issues and other conflicts stimulated by clinical work, but it does not provide the perspective that comes from sharing with another person. Telling a trusted colleague what we think and feel in relation to our patients and ourselves enables us to see our blind spots, as well as providing perspective and affect containment in our work. Mutuality in peer supervision tends to reduce the transference. The special problems of privacy and disclosure in psychoanalytic training are addressed, as are the ways the analyst's belief in maintaining privacy may affect the analytic process and therapeutic relationship.

In this paper, I wish to illustrate how working with a patient who had a certain kind of narcissistic difficulty led me to develop particular clinical strategies to facilitate the development of a sturdier sense of self, greater affect tolerance and modulation, the diminution of harshness of her superego, and the ownership of projected parts of herself, and to decrease paranoid ideation. I call upon concepts from various theoretical schools of psychoanalysis to make sense of the dynamic intricacies of the patient's psychological organization as they revealed themselves in the analytic process. These conceptualizations of the patient's difficulties and of clinical interventions to address them result in a hybrid theory of both theory and technique. What transpired in the clinical work also led me to propose an additional way to understand this kind of patient's difficulties with accepting interpretations or any view that differed from the patient's subjectivity. I am proposing that 'otherness' itself, rather than only specific conflictual aspects of the self, is disowned. It is the analyst's empathic stance toward all that is repudiated--the specific disowned aspects of the self and 'otherness' itself--along with empathy for the patient's conscious state that will enable reinternalization and ultimately healing.

When analysands read about themselves in reports, their reactions range from anger, disappointment, or condemnation to a sense of appreciation or even idealization of the analyst. The eleven interviews reported here reflect only conscious responses; the unconscious layers were not probed for. It should be kept in mind also that the analysts of these patients might report very different stories. Other limitations are the small sample size and the representation only of patients who volunteered. Nonetheless, the information they provide may help analysts consider how and when writing about patients may influence their representation of themselves, the analyst, and analysis itself.

The narratives of twenty analysts written about when they were patients are presented. Their stories provide suggestions about practices to avoid when writing clinical material, but no generalized prescriptions emerge. Individualization and sensitivity to the situation for each pair remain the best guide. The experiences these analysts recount run the gamut of emotions, from negative through neutral to positive. The neutral responses came mainly from twelve analysts who in the course of an interview about their own writing told of having been written about as patients. The other eight, volunteers who initiated contact for the sole purpose of reporting their experience of having been written about, appear on average to be motivated by stronger affective reactions. The era in which the analyst wrote also seems to have influenced the reactions; in earlier times, not asking permission was accepted professional practice. Today, however, it is increasingly common to ask permission when extended clinical examples are published. One problem specific to analyst-patients was concern about the loss of their role as patient when their analyst engaged them collaboratively in the writing.

Patients' reading of their psychoanalysts' papers about them as a vehicle for psychoanalytic work is a relatively new phenomenon in the field. Over the past five years, reports of analysts' employment of their writing in this fashion have begun to appear in the analytic literature. This paper presents clinical illustrations of this specific use of analysts' writing. These illustrations were drawn from interviews with analysts who published clinical articles in Psychoanalytic Dialogues between 1995 and 2003. The author considers some of the clinical and scientific implications of this use of papers written for publication.

Thirty American analysts who have published articles that include clinical material were interviewed about their methods for ensuring patient confidentiality. Eight of these analysts had patients who had read about themselves or heard their cases presented, though their analyst had not requested permission to use this material. Eighteen patients had been asked and gave their consent to have their material used. Twelve of these patients were shown the material written about them. The analysts' thoughts and reactions to their experiences of obtaining consent and having their patients read material about themselves, and of disguising material without asking consent and then having it inadvertently discovered and read by their patients, are discussed. Their views of the effect on their patients of reading written material about themselves are elaborated with case illustrations.

Thirty American psychoanalysts who have published articles using clinical material from their patients were interviewed about their method for ensuring confidentiality. Almost twice as many analysts chose to disguise material as regularly requested permission for the use of patients' material. The other analysts in the sample varied their approach, depending on circumstances, between using disguise alone and using disguise but also requesting consent. Methods of disguise, the timing of request for permission in relation to the phase of analysis, and changes in analysts' ideas about the benefits and detrimental effects of these choices are discussed and illustrated. Each decision is reconsidered in light of its potential effect on patients and their analysis. The dilemma posed by the importance of writing about patients for the health and growth of psychoanalysis as a field and the potential negative consequences for patients and their analyses is considered.

When analysts write about patients, they find themselves in a position of conflict. Their first loyalty is to their patients and maintaining confidentiality. However, they are also committed to advancing scientific knowledge in the psychoanalytic field. The attitudes and practices of 36 analysts residing outside the USA, who published articles using clinical material from their patients, are reported. Their attitudes and practices are compared with those of 30 author-analysts residing within the USA, who had been previously interviewed. Among the 66 analysts, geographic region was not a basis for distinguishing differences in attitudes or practices. Slightly more than twice as many analysts use only disguised material as regularly ask permission of their patients to write about them. The decision to use only disguise is somewhat more frequent for analysts who reside outside the USA than for those living within it. Analysts around the world are increasingly concerned about the accessibility of published material. More analysts have come to believe that it is necessary to ask permission before publishing material. Some analysts also believe that the request itself, and the patients reading written material about themselves, focus issues that are central to patients' characters and conflicts that can then be explored analytically.

The triadic match is the author's term for the interaction among analytic candidate, supervisor, and patient. Overlapping or diverging characteristics of candidate and supervisor may influence the candidate's learning for good or ill depending on the way patient's and candidate's character and conflicts interact. Four candidates who had found their supervisors' character and supervisory styles particularly beneficial in relation to a particular patient volunteered to describe their experiences. Candidates and supervisors were interviewed. The aim of the paper is to illuminate factors in the match that enhanced or interfered with the candidates' learning. While the paper is presented from the perspective of the candidates' experiences, the balance between challenge and comfort in learning situations is also considered.

A focus on the match between patient and analyst places attention on the dynamic effect of the interaction of character and conflict of both participants on the process that evolves between them. Match is neither a predictive nor static concept. Rather it refers to an unfolding transaction that itself shifts and changes during the course of analytic work. The treating analyst's perception of the effect of this match is by necessity limited by the analyst's own blind spots and other countertransference phenomena. Reporting the analyst's clinical experience to an analytically trained observer, external to the dyad, may broaden the analyst's perspective. Using the lens of the match, a colleague in the role of supervisor, consultant or peer can provide feedback from which the analyst may acquire insight. As a result of this process, the influence that the participants' similarities and differences have upon each other becomes clear to the analyst. This awareness, in turn, may lead the analyst to appreciate the effect of the analyst's stance of distance or closeness and to evaluate whether at this phase of treatment it is beneficial or detrimental to the analytic process. Clinical illustrations of the effect of the external observer's feedback in relation to the patient-analyst match are provided.

A focus on the match between patient and analyst places attention on the dynamic effect of the interaction of character and conflict of both participants on the process that evolves between them. Match is neither a predictive nor static concept. Rather it refers to an unfolding transaction that itself shifts and changes during the course of analytic work. The treating analyst's perception of the effect of this match is by necessity limited by the analyst's own blind spots and other countertransference phenomena. Reporting the analyst's clinical experience to an analytically trained observer, external to the dyad, may broaden the analyst's perspective. Using the lens of the match, a colleague in the role of supervisor, consultant or peer can provide feedback from which the analyst may acquire insight. As a result of this process, the influence that the participants' similarities and differences have upon each other becomes clear to the analyst. This awareness, in turn, may lead the analyst to appreciate the effect of the analyst's stance of distance or closeness and to evaluate whether at this phase of treatment it is beneficial or detrimental to the analytic process. Clinical illustrations of the effect of the external observer's feedback in relation to the patient-analyst match are provided.