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It is a privilege to have the opportunity to discuss this very thoughtful and thought-provoking paper, and to participate in the Fielding Memorial.
Margaret Black tells us of an interesting sequence of events in her work with a gifted but constricted patient: an unplanned intervention and its unexpected aftermath took both patient and therapist by surprise. The author refers to the “unexpected appearance” of the crucial intervention almost as if it were some kind of involuntary happening—and one going counter to her theoretical conviction. Theoretically, she had assumed that Kohut's approach was most applicable here: that she must not challenge or confront this patient in any way, but rather stay close at all times to the latter's subjective self-reporting. The unexpected occurrence was one in which she in fact challenged or even contradicted the patient; this ultimately led to a new unfolding of a seemingly stalemated therapeutic process, to the uncovering of “an additional set of meanings” of her patient's symptomatic behavior, and eventually, in the author's words, to the emergence of “a new dynamic constellation.”
It also led the therapist to a thoughtful and searching exploration of some of the central issues and dilemmas in the learning, teaching, and application of psychoanalytic theory and technique. In her subsequent discussion, the author poses two key questions: (1) “ …is it possible to hold any theory and not ‘impose’ it, however subtly, on the process with the patient?” and (2) “… is there any usefulness to interventions that are