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How can we mourn the losses of 2020 and 2021 when, in 2022, these losses are ongoing? Is it possible for us to help our patients with something that continues to disrupt the ordinary for us all? This essay explores the impact of existential crises on our patients' and our own ability to mourn within and outside analytic space. [ABSTRACT FROM AUTHOR]

This essay moves beyond my earlier focus on relational excess and turns a critical eye on my own work. After describing my relational holding model, I address its limitations—both theoretical and clinical. What is problematic in the implicit analytic ideal embedded in the concept of holding? How does this vision of therapeutic process both add to and narrow the clinical arena? What is absent, overlooked, or just plain wrong in this perspective? I address the dialectics embedded within the holding metaphor, their crucial and problematic implications. I then muse about what has shifted my relationship to my own theory over time. My aim is to push past othering and toward theoretical self-examination. [ABSTRACT FROM AUTHOR]

The concept of resistance has fallen out of favor, particularly in relational psychoanalysis. We've associated "resistance" with traditional analytic models—with the idea that therapeutic action lies in overcoming a patient's defensiveness via interpretation. I invite resistance back into relational thinking by relocating the concept dyadically—in the realm of enactment—and by considering the potential presence of individual resistance within a relational paradigm. [ABSTRACT FROM AUTHOR]

I address a psychoanalytic ghost with which we all will eventually contend; it's the ghost of who we will become—the ghost of our own aging and the changes it portends. We analysts have enormous difficulty dealing with this inevitability. We rarely examine, much less theorize, its impact on us as analysts and on our patients. How will we manage the impending diminishment of capacity that comes with aging? How will we help our patients confront it in us and in themselves? After considering the impact—personal and theoretical—of aging on us as analysts, I explore how aging may inform our relationship to the work we do. Aging can affect—and change—both the theory we use and how we use it. These shifts are subtle, often procedural, and easily go unnoticed. I describe the way my own, and several colleagues' uses of theory have changed over time and muse about what has informed those changes. [ABSTRACT FROM AUTHOR]

Silverman's moving essay is replete with vulnerability and uncanny resonances. I try to enter her experience and imagine its possible meaning and impact on Silverman and then on me, as discussant. Finally, I play with Silverman's clinical material and explore the potential consequences of other ways of moving in the therapeutic moment. When can we usefully engage our experience (in general) and of the uncanny (in particular) with our patient? What factors (theoretical and personal) might inform our choice to self-disclose or contain? Rather than privileging either way of working, I suggest that there's an upside and an underbelly to every clinical move—to holding, to self-disclosure, to the mutual analysis of enactments, and to neutral interpretation and imagine some of these clinical consequences. [ABSTRACT FROM AUTHOR]

Michelle Shubin’s and Marc Rehm’s papers (this issue) are linked by their creative use of paradox. Each addresses the dynamics of the clinical moment and invites us to query what we assume—about psychoanalytic goals and about our role in therapeutic process. Shubin revisits the role of analytic honesty, challenging the assumption that we analysts are always honest, and, more importantly, that we always need to be. Rehm asks us to consider the places of forgetting along with remembering in clinical work. He suggests that we may sometimes need not to help our patients remember, but instead to help them forget. I address the clinical and theoretical implications of each paper. [ABSTRACT FROM AUTHOR]

I consider the evolution of our relational ideal—its implications for our therapeutic goals, our patients, and for ourselves. Who do we aim to be in the consulting room? How do we view our patient—her potential and her limitations? What are the clinical goals of a relational analysis? What might those goals occlude? In this context I address the historical excesses of our ideal and the ways we may have gone too far. [ABSTRACT FROM AUTHOR]

Sexual boundary violations are ghosts that silence and haunt our psychoanalytic communities. In an attempt to break that silence and confront our ghosts, I put together a panel that included a faculty member (Seth Aronson), an institute graduate (Nancy Crown), and an institute candidate (Carina Grossmark). Our task: To address the particular impact of boundary violations on each cohort. Taken together, our aim is to disturb and provoke; that is, to get us all thinking and speaking about the unspeakable. [ABSTRACT FROM PUBLISHER]

Csillag challenges us to consider the presence and impact of the analyst’s sadism in the clinical encounter. Her theme usefully adds to the literature on the analyst’s countertransference and pushes us to look harder at ourselves. I distinguish between sadistic intent andexperiencedsadistic impact and suggest that Csillag is mostly speaking about the latter. Additionally, I address the absence of analytic restraint as a professional ideal that might moderate our slide to sadism in the countertransference. [ABSTRACT FROM AUTHOR]

The article presents a retrospective analysis of the baby metaphor in relational thinking which involves a theory that psychoanalysis patients should be considered as vulnerable as babies. The author argues that early relational critiques had skewed relationalists toward the patient-as-adult vision and the view of analytic dialogues as implicitly intersubjective. The author relates the relational perspective of psychoanalyst D. W. Winnicott with the concept.

Marc Rehm invites us to muse about the theme of undue influence as it affects our relationships with our patients and children. Marc suggests that alongside our good intentions and loving vision of their future lie feelings of hate and destructiveness that complicate our efforts on their behalf. I address Marc's thesis, its Winnicottian roots, and then turn his question back on itself by musing about how his paper—which was born and nurtured in my writing group—might have itself been shaped (as much as discovered) by the group. I raise the question of undue influence as it affects the process of mentoring. [ABSTRACT FROM PUBLISHER]

I describe a frustrating treatment relationship with a severely traumatized patient and consider what contributed to its successful outcome. Sexually and emotionally abused in childhood, traumatized in adulthood, Dani insistently kept associated memories and affect states sealed off and outside the treatment's scope. Dwelling with me in a deadened therapeutic space dominated by narcissistic imperiousness and apparent obliviousness to the other, Dani seemed unreachable. A single enactment broke into this deadened process and enlivened things, but this shift turned out to be temporary. Yet after years of flat, disengaged process, Dani changed dramatically. Querying the treatment's dynamics, I muse about what happened in our analytic enclave. Despite the clear therapeutic potential of both witnessing and intersubjective exchange in trauma work, there may be times when our tolerance for staying out—for not knowing—is clinically pivotal. By allowing our protected analytic enclave to remain nearly untouched and undisrupted—by keeping traumaoutand in this sense un-bridged, this very fragile patient established a nontraumatic relational space within which an alive, hopeful, resilient experience of self imperceptibly coalesced.Earlier versions of this paper were presented at the Winnicott Center, Jerusalem (2010), NYU PostDoctoral Program, New York, (2010), and Division 39 annual meeting, Chicago (2010). I am grateful to Stan Coen, Sue Grand, Adrienne Harris, Margerie Kalb, Stuart Pizer, Annee Ackerman, Leora Trub, and Dafna Fuchs for their very thoughtful feedback on earlier drafts of this essay. [ABSTRACT FROM PUBLISHER]

Donna Bassin and Moshe Spero have brought their own rich psychoanalytic understanding of mourning and memorialization's dynamics to my paper. Here I explore Bassin's idea that memorialization cannot occur until intense affect has been moderated. I then address Spero's view of my own experience as only partially reflective of integrated mourning processes. [ABSTRACT FROM PUBLISHER]

This paper explores the dynamics of commemorative ritual as it is embodied and enacted outside the consulting room. While the function of lifelong acts of memorial in marking traumatic loss has been well documented, psychoanalysis has given short shrift to the value of these ongoing commemorative rituals in instances of “ordinary” (i.e., less traumatic) loss. Historical and sociological writers have explored their functions, but commemorative rituals have tended to evoke resistance within psychoanalysis, perhaps because of their collision with the termination ideal and the value of relinquishment. Here, I build on previous essays concerning Jewish mourning ritual (shiva) by addressing the function of several acts of commemoration including that of Yizkor (Jewish memorial ritual). Enacted across the lifespan, commemorative rituals serve multiple functions. They allow us to mark absence and create “presence” as we access and sometimes reshape personal memory. Such rituals can create a sense of linkage to “like mourners.” At their best, these acts—in their multiple incarnations—mimic aspects of psychoanalytic work by helping us deepen emotional connectedness and facilitating integrated remembering in a way that enriches and frees rather than binds us. [ABSTRACT FROM PUBLISHER]

The article offers the author's insights regarding Kohutian theory, relational theory, and self psychology. The author discusses concepts on colliding, holding, and collaborating. The author explores the affective experiences that characterize expanding, self object function, and holding. The author also investigates the Kohutian focus on vicarious introspection and empathy.

This paper explores the dynamics of mutual idealization within the analytic dyad. While the subject of idealization is not a new one, very little has been written about the analyst's own participation in patients' idealizations or her vulnerability to idealizing the patient. I use both published and unpublished materials to muse about coconstructed idealizations as they appear to have coalesced in Winnicott's treatment of Masud Khan and Harry Guntrip. Because the notion that we might be involved in being idealized by our patients-or in idealizing them-collides with our professional vision, we tend to be highly resistant to acknowledging these dynamics and often turn to denigration when they are unmasked. I argue for the ubiquity of idealization's dynamics and against the demonization of Winnicott. [ABSTRACT FROM AUTHOR]

Adam Phillips asks why we need to engage in professional policing. He exceeds my own professional comfort zone when he suggests that a great thing about psychoanalysis is that 'it does not necessarily make people better.' I make a plea for a measure of professional idealism that takes account of the analyst's power. In her discussion, Linda Hopkins provides fascinating anecdotes that support my ideas about Masud Khan's analysis. Hopkins also argues for the value of idealization in therapeutic process, noting that I excessively emphasize its problematics. I agree with Hopkins's perspective and muse about why my paper reads otherwise. Emanuel Berman distinguishes institutional from individual idealizations and argues for the value of the latter while underscoring the difference between de-idealization and devaluation. I query the inevitably problematic nature of institutional idealizations. [ABSTRACT FROM AUTHOR]

Ruth Gruenthal invites us to explore the dynamics embedded in disengagement. She suggests that this very concept is an oxymoron; by virtue of the fact that the patient is in treatment she is, in fact, engaged. Gruenthal focuses on disengagement's self-sustaining function, noting that it represents an attempt to regulate emotional distance while still retaining a connection to the other. Recognizing how difficult work with withdrawn patients can be, Gruenthal suggests that theory can actually shift the analyst's negative countertransference response. Implicitly she challenges the relational assumption that active engagement around the analyst's subjectivity always lies at the center of therapeutic process. I offer my own take on the dynamics at the heart of Gruenthal's treatment of Helen, proposing that neither disengagement nor containment can be accounted for by the patient or analyst alone. I explore how theory helps us manage our subjectivity while also embodying it. [ABSTRACT FROM AUTHOR]

The article comments on the paper "In the Beginning There Was Darkness: Images Across the Void," by Nina Farhi in this issue. It is observed that Farhi's sensibility is demonstrated in her view of the psychoanalyst as being capable of being receptive, permitting the patient to discover the analyst's views. It is also noted that Farhi has shown that shifting and shared self-states mold the therapeutic procedure.

The article comments on the paper "What is a Writing Group," by Dominick Grundy. It says that a new dimension of the writing process by exploring the writing group as a facilitator of creative activity was explored by the paper. It mentions that a vision of the therapeutic writing group that gives hope and thus facilitates writing was provided by Grundy.

Dr. Gediman locates the intersection of modern Freudian and relational theory in the arena of what she calls the ‘disclosures of everyday analysis’ (p. 242). She suggests that because Freudian analysts, like their relational colleagues, work intersubjectively, relational theory does not itself embody a paradigm shift away from the Freudian model. I disagree. Relational theories assume that the analyst's work is inevitably informed by the relational context in a way that precludes clinical certainty. Gediman, however, believes that the analyst is capable of separating her countertransference response from her subjectivity and thus can interpret from a position of clinical certainty. Each set of theoretical assumptions is associated with a somewhat different analytic stance and analytic ideal. Freudian analysts aim for a position of ‘methodological neutrality’ that relies on considerable certainty in the countertransference while giving the analyst plenty of room within which to use her subjectivity. The relational ideal concerns the analyst's capacity to enter into an asymmetrical treatment relationship and to tolerate the uncertainty generated therein. [ABSTRACT FROM AUTHOR]

Discusses the development of interior experience and the clinical dilemmas in handling patients undergoing psychotherapy in the U.S. Significance of the experience of interiority to the practice of psychoanalysis; Approach in dealing individuals who cannot access articulate interior experience; Tendency of psychoanalytic work to recapitulate the patient's reliance on the concept of Other for interior definition.

I respond to two key issues raised by Bernstein and Frankel. One concerns the complex and potentially useful impact of misdemeanors on the treatment process. Without, however, minimizing this dimension of misdemeanors, I focus instead on how we deal with instances when we fail our patients by deliberately placing our own needs ahead of theirs. Bernstein raises the possibility that we are most likely to commit misdemeanors when we embrace an idealized Winnicottian model. I disagree, suggesting that all theoretical positions exclude some aspect of the analyst's personhood. Ultimately, we cannot escape the conflict between the analytic ideal and the reality of our nonideal humanity. [ABSTRACT FROM AUTHOR]

Despite a burgeoning literature on major analytic boundary violations, there has been little investigation of what might be called analytic delinquencies or misdemeanors—the small and virtually ubiquitous ways in which analysts deliberately withdraw from the therapeutic endeavor. I consider the impact of professional misdemeanors on patient and analyst and compare both with more serious analytic "crimes" and enactments. Professional delinquencies may reflect a therapeutic reenactment, an expression of the analyst's split-off or disavowed need, or an unconscious attempt to self-regulate or to negotiate space within the constraints of the treatment setting. Because the professional ideal leaves so little room for the analyst's humanity, it is often difficult for us to address and work with evidence of our own need when it clashes with what we regard as the analytic contract. [ABSTRACT FROM AUTHOR]

Several studies of the effects of physical handicaps on helping behavior report increased help when the confederate (C) is ill or physically handicapped (i.e., wearing an eyepatch or a cast). This finding apparently reflects Ss' increased sympathy for the disabled C. However, in these studies, the C's handicap was relatively minor. A question therefore arises concerning observers' responses to severely disabled individuals. It is possible that a severely handicapped person would arouse intense anxiety, and therefore decreased help from observers. The present study evaluates people's helping response to a severely handicapped or a nonhandicapped C in a field setting. [ABSTRACT FROM AUTHOR]