Discussions

As a clinician, I was particularly interested in those aspects pertaining to therapy, and in this spirit I will take up some points of each paper.

Dr. Kelman says that “people often interrupt their analytic work when the intensity and extensity of alienation is beginning to be experienced.” This happens at the time when they are starting to be involved in the central conflict, and it strikes me from the point of view of technique. Is there anything that the therapist can do, besides being particularly mindful and vigilant when approaching this precarious balance of forces? Dr. Kelman maintains that “such breaks away from analysis occur on the assumption that they can get away with murder,” which means that self-destruction still predominates. If the therapist could lend more support to the patient's constructive forces, already then in operation since he is involved in central conflict, more strengthening could be achieved by some gestures of special personal interest or by spontaneous offering of additional sessions. May there not be cases where a breaking away could be averted? Only the other day a patient who, after a long struggle and much drifting, was ready to face herself and her unhappy marital situation squarely, and to take a positive stand on her own and her child's behalf. She has gone through the period of “touching and tasting” her alienation. Yet she came late to her next session, angry and negativistic, and declaring emotionally, “I did not want to come! It is too much to face that I have been that sick and to go on….” Throughout the session she raved against me and against herself, that if she only would get run over by a car after leaving here, and so forth. Reviewing what had been going on before, I sensed that this was more than a negative therapeutic reaction. Next day I thought of calling her up and making her feel that I was with her, regardless. Before I had a free moment to do so, she called to tell me about a social event she had enjoyed; sh