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This paper was written in the context of a conference—the 2017 Annual Conference of the International Association of Psychoanalytic Self Psychology in Chicago—and a plenary panel, both dedicated to the theme, "Empathic Depths and Relational Leaps: Creating Therapeutic Possibility." Jeffrey Stern's paper, "The Pilgrim's Progress: A Therapist and Patient Journey to London," had been one of the inspirations for this choice of theme; and selecting it as the Keynote Address provided the ideal platform for launching it. Because the format of the evening Keynote Address afforded only a limited context for considering the far-reaching implications of the paper, it was decided to devote the first plenary session, the next morning, to an in-depth consideration of its ramifications for contemporary psychoanalytic practice. Because Jeffrey, an accomplished psychoanalytic scholar and author, had chosen to write his paper in the spirit of the treatment it was describing—namely in a narrative style closer to a short story than a discursive psychoanalytic paper—I felt the paper invited a theoretical analysis of what Jeffrey was implicitly doing with his patient Drum, and an attempt to put into words the extraordinary conditions that made their high-risk frame expansion plausible, and ultimately profoundly therapeutic. [ABSTRACT FROM AUTHOR]

This paper makes the case for a holistic approach to conceptualizing what we actually do with our patients. Psychoanalytic theories, whether comprehensive or circumscribed, conceptualize the nature of analytic interaction and the principles of therapeutic action into distinct theoretical categories. These categories then shape our thinking, causing us to lose sight of our fundamental purpose: to provide each patient with the specific and unique forms of help they need to move toward and achieve their therapeutic aims, both implicit and explicit. To counteract this long-standing trend, we need more holistic constructs oriented toward each patient’s unique, and uniquely complex, aims and process. Louis Sander’s principles ofspecificity of recognition, specificity of connection, moments of meeting, andprogressive fittednessare identified as powerful examples of such higher order constructs. Sander’s language is unique in that it bridges the objective-descriptive perspective of nonlinear dynamic systems theory and the phenomenological perspective of the analytic therapist-at-work. The author adds three of his own concepts to Sander’s, then presents an extended clinical example illustrating the more personal, intuitive, improvisational quality of an analytic process grounded in these principles. The case and discussion follow the evolution of the treatment over time, focusing especially on an extended “moment of meeting” at the conclusion of which the analytic system had reorganized at a dramatically more complex and alive level of relational fittedness. [ABSTRACT FROM PUBLISHER]

In this reply to discussions by Donna M. Orange and David Wallin, I address both of their major concerns about my nine-year analysis with “Linda” by introducing a new organizing principle:The experience of power in our relationship. I argue that given Linda’s felt lack of personal power or agency, and the controlling, negating ways her mother had exercised power throughout her childhood and adolescence, Linda was extremely vigilant regarding the ways I used my power, and predisposed to “resisting” attachment and dependency in order to protect herself from the potentially controlling and exploitive influence of the powerful other. Given these sensitivities, much of the work in the early years of the analysis involved my trying to find a “language” of non-controlling, shared power to navigate between the shoals of retraumatizing control and facilitating therapeutic influence. [ABSTRACT FROM PUBLISHER]

This article was first presented as a plenary paper at the Annual Meeting of the International Association of Psychoanalytic Self Psychology in October 2013. In keeping with the theme of the conference, “forms and transformations of connectedness,” the article summarizes my nine-year analysis with “Linda,” a patient who was intensely conflicted about allowing the kind of deep connection I believed was necessary for her to make the kinds of changes she ostensibly was in therapy to achieve. The clinical narrative focuses on our dialogue and struggles around this issue as it evolved through different phases and relational configurations. [ABSTRACT FROM PUBLISHER]

I appreciate Noelle Burton's courageous paper in which she movingly demonstrates how the analyst's opening to her own vulnerable child self, as evoked by the analytic interaction, creates parallel openings between the patient and analyst and within the patient. At the same time, I wonder if there is a not-fully-mentalized enactment occurring in the analytic process—an enactment that is reflected in certain aspects of Burton's clinical narrative. And I wonder if the containment of Burton's childlike feelings—a central focus of her paper—is even more interactive than she has recognized. These questions are, however, overshadowed by the paper's significant creative (clinical and conceptual) contribution. [ABSTRACT FROM PUBLISHER]

The three discussants agree that a definition of psychoanalysis tied to session frequency is problematic and needs to change. Yet none supports my recommendation to redefine the practice of psychoanalysis in terms of the practitioner's training. This prompted me to look more closely at my proposal and push my thinking further. I argue that psychoanalysis, like many other professions, needs to define its practice as the application of its complex and evolving knowledge and skill base, grounded in its unique field of inquiry. Although there are individual exceptions, the inculcation of this knowledge and skill base is generally best accomplished through psychoanalytic training. This assertion, however, rests on the premise that our training curricula keep pace with our rapidly evolving field of inquiry and knowledge. To further clarify my vision I examine the nature of psychoanalytic expertise. I suggest that such expertise amounts to the inculcation and integration of a large number of psychoanalytic frames of reference. I contend further that the nature of contemporary psychoanalytic theories is such that important psychoanalytic frames of reference are proliferating more rapidly than in the past, that the relationships among them are becoming more complex, and that consequently the application of psychoanalytic theory to practice is also becoming more complex. Psychoanalytic training programs need to recognize this expanding complexity and revise curricula and pedagogic methods on an ongoing basis to reflect this evolution within our field. [ABSTRACT FROM AUTHOR]

Psychoanalysis as a field is suffering in part because we remain locked into a definition of psychoanalysis based on what Gill (1984) called its “extrinsic” criteria—especially session frequency. I argue that organized psychoanalysis needs to redefine what it means to practice psychoanalysis. Such a redefinition is dictated not only by current realities of the marketplace but also by contemporary theory, which emphasizes the co-created, nonlinear nature of the analytic relationship. Some implications of this redefinition (a) for the distinction between psychoanalysis and psychoanalytic therapy, and (b) for analytic training, are briefly considered. [ABSTRACT FROM AUTHOR]

The discussions by Pizer and Brandchaft are so different in tone and focus that I answer them separately. Pizer invites dialogue about the relationship between identification and dissociation, which I pursue further with him. I then briefly consider his therapeutic model, which emphasizes the negotiation of paradox, in the light of the identificatory divisions in self-experience that my model highlights. Finally, I address his concern that I bypassed the "crunch" of the repeated relationship in the case example of Jonathan. I argue that the stance I ultimately adopted was my way of bridging the paradoxes presented by Jonathan. Brandchaft couched his discussion as a dismissive attack, prompting me to defend myself while trying to engage in a dialogue about substantive issues. I respond to his criticisms regarding my epistemological position, my use of the concepts of identification and projective identification, and the process and outcome of my treatment of Jonathan. The bottom line is that the differences between our perspectives are not, as Brandchaft contends, those between an objectivist, causally "unidirectional" model and an intersubjective one, but rather those between two versions of intersubjectivity. [ABSTRACT FROM AUTHOR]

The article focuses on implicit relational knowing (IRK) and verbal-symbolic knowing as learning systems. It highlights the Boston Change Process Study Group's (BCPSG) assertion on implicit experience. Moreover, the author's discussion of implicit learning and verbal communication and his view on BCPSG's position concerning psychoanalytic theory are presented. The author notes that a primary function of verbal-symbolic communication as emerging from IRK is the transformation of IRK.