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Almost sixty years ago, Norman Reider published a paper about spontaneous "remissions" he had observed. He discussed the manner in which psychoanalytic theory provided a way to partially explain these otherwise mysterious remissions or improvements in symptoms, some without benefit of either psychoanalysis or psychotherapy. Especially important were his comments about the negligible role of interpretation or insight in these examples. His conjectures reflected controversies that were current at the time and that remain unsettled. Of special interest is his introduction of some highly original ways to think of applying psychoanalytic ideas to supportive psychotherapy. But few analysts today have heard of this paper. A reconsideration of his paper allows us to be vividly reminded about our enduring and profound confusion about exactly what constitutes a "cure" at all. Spontaneous shifts in the severity of symptoms may be viewed as experiments of nature that we have neglected to investigate as valuable restraints on our immodest therapeutic claims., (© 2014 The Psychoanalytic Quarterly, Inc.)

Part I of this paper combined an introduction to Norman Reider's original 1955 paper with a republication of the paper itself. Part II is a discussion of the complexities of a comparison of past and present psychoanalytic literature. The concept of enactment is proposed as one of many possible alternative views in considering Reider's notion of spontaneous "cures." A careful consideration of these spontaneous cures within the ordinary ups and downs of any psychoanalytic treatment sheds important light on our continuing confusion about how we define the term cure, and therefore about the nature of change during psychoanalytic treatment. This alternative perspective is only one of many plausible ones for present-day readers. The purpose of this republication is not to propose an explanation for "what really happened" with Reider and his patients; rather, it is to reconsider the fallacy of evaluating his paper outside its historical context and thereby failing to appreciate his courage in presenting what at the time were radical views. Questions about the complexity and confusion regarding cure and change require reexamination of the neglect of epistemology on the part of psychoanalysis in prolonging the confusion about distinguishing psychotherapy and psychoanalysis., (© 2014 The Psychoanalytic Quarterly, Inc.)

Psychoanalytic disagreements are famously heated, polarized, and prolonged. These controversies are often the reflection of a shared agreement by the participants to engage in debate at an abstract level far removed from the clinical context in which the disagreement first arose. As a specimen example of such disputes, a case report by Patrick Casement is examined, together with a series of polemical discussions it inspired concerning physical contact suddenly demanded by an analysand in session. Over two dozen authors were almost evenly divided on whether to agree with Casement's technical conclusions, but showed a disquieting indifference to the detailed information available in his report regarding how this clinical crisis developed. The substantive merits of the contending arguments are not at issue; rather, the point is to demonstrate the crucial need to refine a methodology of contextualization to clarify inferential assumptions in clinical discussions. Premature truth claims might then give way to a more rational comparison of the clinical sources of divergent opinions. The term contextual horizon is introduced to facilitate an understanding of how the psychoanalyst makes inferences from the patient's associations.

One of the most pressing theoretical, therapeutic, and educational problems confronting the advance of psychoanalysis is our confusion about the nature of clinical evidence. There is considerable disagreement among psychoanalysts about how to define evidence. Recently, there has also been a growing tendency toward evidential nihilism, justified by some of the more radical constructivist-narrative views of postmodern epistemology. Two surveys, conducted ten years apart, of all the psychoanalytic institutes recognized by the American Psychoanalytic Association, indicate a continuing and disturbing neglect of this topic in the curricula of our institutes. This paper reports the views of a number of psychoanalytic educators who participated in these surveys and is intended to stimulate discussion about the causes of this critical problem.

The author discusses Hernández's enriching and clarifying paper, which directs us to the limitations of language with regard to affective movements that barely attain the condition of thinkability and thereby to the important and confusing topic of enactments, which are the lingua franca for the communication of dangerous and repudiated affects. Enactments bridge the interface between what is expressible, and inexpressible, between what is forgotten and what is pressing for revival, between reality and fantasy and also between one-person and two-person psychologies. Conceptually the term enactment facilitates the integration of the concepts of fantasy, projective identification and countertransference. Steiner's richly detailed and moving clinical report demonstrated the value of the concept of projective identification for understanding his patient's communication of affects. The concept has been neglected until recently by many US analysts; one source of confusion has been the assumed reliability of the analyst's emotional reactions as an indicator of what the patient is feeling. The author asks whether Steiner is speaking loosely or literally when he says that his patients put their feelings into him, citing examples to demonstrate that the value of the concept of projective identification would be enhanced by a clarification of this question.

Certain problems in defining the psychoanalytic process emerged during the five years in which a COPE study group was attempting to clarify the concept. There was agreement about the bed-rock criteria to be included in a definition: e.g., transference, resistance, a dynamic unconscious, intrapsychic conflict, defense, infantile sexuality, insight which causes change, and change which brings insight. The disagreements centered on the locus of the psychoanalytic process, the best way to conceptualize change, and the methodological problem of validating whether specific interventions cause specific claimed effects. Confusion about how to account for the interactional aspect of the psychoanalytic situation in a manner consistent with a one-person psychology emerged as an important source of the difficulty in arriving at a satisfactory definition of the psychoanalytic process.

The concept of mental representation has come to mean too many things. Some authors use representational terms to include both subjective experience and nonphenomenal, abstract, explanatory concepts. The reconciliation between the representational and structural frames of reference cannot be achieved by a conceptual stuffing of representations into the system ego as a container. The mediation of mental activities by substructures of the mind is a highly complicated problem with considerable clinical significance. It is useful to distinguish representational concepts which have circumscribed functional capacities from representational systems which parallel the ego in scope. It is not yet possible to claim that we have adequately reconciled our views of memory with representational terms. Just as the alluring prospect of inventing an infinite series of "instincts" misled biologists in the past, so must we now avoid an infinite series of representations to which we assign any problematic mental task for explanation. We lack information from object relations theory about what there is in the mind which is not a mental representation. The clinical advantage of representational language and models over the structural hypothesis of compromise formation remains unsettled. There is in principle no conceptual obstacle to the integration in one frame of reference of both representational and structural concepts. This requires clear understanding of the representational structure as the result of compromise formation, as well as an important influence on compromise formation. We could then better study our heritage of shared experience without confusing the precipitates of our experience with the structure of our minds.

Proverbs have much to teach the psychoanalyst. The purpose of this paper is to illustrate the clinical usefulness of viewing certain proverbs as analogous to typical dreams, to discuss some implications of the affinities between proverbs, riddles, and typical dreams in the context of applied psychoanalysis, and to view the proverb as stemming from the same common matrix as dreams, myths, symptoms, and folklore.

This paper advocates the clinical and theoretic superiority of structural theory in accounting for our therapeutic efforts to influence the phenomena of intrapsychic conflict. The fit between structural theory and technique is epitomized in the equidistant posture of interpretations vis à vis the id, ego, and the superego. The therapeutic effect of interpretations thus viewed is to alter pathologic compromise formations in a manner which will ultimately result in structural change that will be observable by the reduction of psychic pain, the increase in opportunities for realistic pleasure, and the diminished need for punishment. The paper reviews certain recent disagreements about the relation between interpretation, insight, and change on the one hand and the nature of transference and resistance on the other. Arguments are presented against the view that positive and negative transference can be simply contrasted as helping or hindering the progress of analytic treatment. Finally, the terms 'structure' and 'structural change' are defined.

Questions the analyst asks of the patient are a powerful but neglected aspect of the theory of psychoanalytic technique. Their importance resides in their dynamic impact on the psychic equilibrium of the patient because of their ability to destabilize existing compromise formations. A clinical vignette illustrates the view that the linguistic shift from other modes of discourse to the spoken question heralds a less visible parallel shift in the psychic equilibrium of either the psychoanalyst or patient. There is no more and no less complexity to questions than to any other communication by either analyst or patient. For that reason there can be no systematic classification of questions in the clinical psychoanalytic situation, just as there can be no definitive taxonomy of psychoanalytic discourse. It makes no sense to reduce the enormous diversity and range of all the questions the analyst asks to the simple dichotomy of good or bad for the analysis. Questions are the emblem of the analyst's mode of inquiry; they can further the development of self-observation, which is such an important concomitant, cause, and consequence of structural change.