Discussion

Dr. Badaracco's presentation is at its most persuasive when she is describing the changing dilemmas of patients, defining the role of psychoanalyst as clinician, and delineating the openness and liveliness of the practitioners who can “attend to the movements, shifts, and complaints of society as well as those of individual patients.”

The patient must lead in the sense of designating the area of perceived problem and pain and in coming to the psychoanalyst in the first place. The psychoanalyst, in turn, must lead in the sense of being a guide for patients in exploring the deeper or unperceived recesses of intrapsychic, interpersonal, and cultural conflict, with an exposure of their “disregarding (of) themselves, in longing for what they are missing, but with unassailable riches and resources unknown and lying fallow within themselves.” I regard the foregoing as the observations of a psychoanalyst who is not only objective and scientific but who also has a poetic grasp of both the anguish and the promise of the human condition. I agree with Dr. Badaracco's criticism of psychoanalysis when it “does not recognize the new area(s) of vital interest … but keeps prowling about the old.” And I can say from experience that the confrontation of the “new” patient with the “old” psychoanalysis can be poignant and even destructive, particularly when the patient is an adolescent or young adult.

I prefer Dr. Badaracco's formulation of the psychoanalytic situation to Dr. Levenson's. It is my observation, too, that it is the patient who brings his problem and pain, while the function of the analyst is to shape the nature, scope, and direction of the exploration. Treatment is not an impossibly chaotic situation, and I am sure Levenson knows it, even though some of the dimensions of the treatment situation may be dim or scarcely perceived. For me, this is part of the promise and richness of the practice of psychoanalysis. Along with our hard-won knowledge and skills, there are always fr