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The author appreciates Kottler's suspension of her own theoretical framework in order more fully to enter and grasp his framework. He finds his theory of needed relationships/complex selfobjects and hers of twinship/alterego selfobject experience to be compatible if it is recognized that the two sets of constructs represent two different categories of analytic theorizing: what the author terms "holistic" vs. "categorical" constructs. Holistic theories and constructs pertain to the analytic relationship as a whole whereas categorical theories and constructs describe particular dimensions of that relationship. He argues that the major concepts of his model—the needed relationship, fittedness, specificity of recognition and specificity of connection—are all holistic constructs whereas twinship and alterego transference phenomena are categorical in that they refer to particular dimensions of certain treatments. The author's concept of complex selfobject experience is also a categorical construct but "moves in the direction of" a holistic construct. Finally, the author is in full agreement with Kottler that our theories and ways of working need to take into account and address the realities of otherness and difference between ourselves and our patients in such a way that our patients feel met, understood and fully welcome in the analytic space. [ABSTRACT FROM AUTHOR]

In this paper the author extends his metatheory of needed relationships to posit a more complex form of selfobject connection than has been previously theorized. He argues that there are degrees of selfobject connectedness and that for the fullest, most transformative connection to be actualized certain conditions in the patient's experience of the analyst need to be met. The co-creation of such conditions amounts to a new needed relationship—a transformational intersubjective medium—uniquely co-created and unpredictably emergent within each analytic dyad, which somehow comes to address a traumatic relational breach in the original parent-child field and restores an ethic of care, lawfulness, competence and love that was the patient's original birthright. This amounts to a fully relational self psychology, but a more forward edge relationality than that of mainstream Relational theory, which, at least historically, has placed more emphasis on repetition and enactment than on what the author calls the needed relationship. [ABSTRACT FROM AUTHOR]

Introduction: This study describes the characteristics of, services received by, and labor market outcomes of applicants with visual impairments to three state vocational rehabilitation programs. Our objective is to both document cross-state variation in vocational rehabilitation clientele and services and provide new insights on the longitudinal labor market outcomes of clients with visual impairments (i.e., blindness or low vision). This analysis is a first step in assessing the returns to vocational rehabilitation services for this population. Methods: We first created a unique longitudinal data set by matching administrative records on applicants who are visually impaired in state fiscal year 2007 from three vocational rehabilitation agencies to 8 years of employment data from state Unemployment Insurance programs. Using these data, we examined cross-state variation in the descriptive statistics for important client explanatory variables and vocational rehabilitation service categories. We then compared the long-term labor market outcomes of clients receiving services (treated) to untreated individuals. Results: We documented two important findings. First, there were substantial differences in client characteristics, services provided, and costs across the three states. Second, the long-run labor market analysis was consistent with vocational rehabilitation services having no employment effect but a positive earnings effect. Discussion: Labor market results indicate vocational rehabilitation services provided persistent earnings benefits. Yet the substantial cross-state heterogeneity suggests these labor market results might not be generalizable and should be interpreted with caution. We explain what was missing from this analysis and why the results should not be thought of as causal. Implications for Practitioners: This article gives practitioners a sense of a unique new data set on vocational rehabilitation and labor market variables for applicants with visual impairments. We highlight the importance of cross-state variation and linking vocational rehabilitation data to long-term employment measures. The question of how best to inform the efficacy of different vocational rehabilitation strategies for clients with visual impairments is left for future researchers to consider.