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On February 7th, 2004, sounds of appreciative laughter filled the auditorium of the American Institute for Psychoanalysis, again and again, as our spirits were raised and renewed by Dr. Salman Akhtar. In a half-a-day workshop, Akhtar, a master clinician and educator-a rare gift to possess both-generously offered poignant clinical vignettes, let us into his thinking, and his theoretical understanding of important issues, all along courageously confronting some psychoanalytic ideas that needed to be revisited. The workshop announcement promised to explore three crucial psychoanalytic phenomena: regression, disruptions in the alliance and the threat of suicide in clinical work. The promise was amply fulfilled, thanks to Akhtar's inexhaustible enthusiasm, energy and unique ability to talk about very difficult concepts with great knowledge.
Akhtar approaches these subjects by asking, “What does regression look like?” He shares the clinical vignette of a lonely patient who keeps a bird in her freezer after it dies. This same patient, who then sees a beautiful spider in her house, asks Akhtar, “Am I crazy?” as she reveals a part of herself that she both delights in and is embarrassed by. Akhtar, a published poet, responds, “I think the spider is a poem.” Akhtar cites another well-known clinical example of regression; the patient who asks his therapist (who happened to be Michael Balint) if he can do a somersault in the office. Akhtar asks how we respond to these types of questions from our patients. He says, “If a baby started gurgling while you were stroking and cooing at him, you wouldn't stop and ask what he meant.” His point hits home; the clinician needs to become comfortable with all levels of the mind so that he can talk to his patient at his level.
Akhtar cites Freud, who says that neurotics suffer from reminiscences, old stories, and problems of the heart; the stuff regression is made of. Freud theorizes that regression is a step backwards and downwards in developme