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Winnicott and Kohut both emphasized that the analyst's offering of himself as an empathically available object attuned to the specific requirements of the patient provides the necessary atmosphere to permit the reactivation of derailed developmental structures. Recognizing thwarted need states as imbricated in our patients' adaptive and pathological character presentation has led to major changes in the analytic attitude. This accompanying change is of vital importance in facilitating within the transference the kind of object relationship that can become usable. What I have come to realize is that, owing to the nature of the character solutions forged out of earlier environmental trauma, the shift from pathological ways of relating to the capacity to make use of the object seriously challenges standard clinical approaches and requires an expansion of our clinical theories. Hence, the creation of conditions that facilitate a therapeutic regression often requires much more from the analytic situation and the analyst than merely providing an empathic surround. Or we may now say that to move from object relating to object usage, or from archaic grandiosity to the mobilization of a solid narcissistic transference, recommends a broader application of the concept of empathy, so that concepts such as optimal responsiveness more definitively include the analyst's participation in the patient's inner world.
The concept of “usability,” as applied to analysis and the requirements for bringing it about, defines a major theme for me. Usability refers to the developmental stage in the child's life whereby the object can be placed outside the sphere of omnipotent control, which then renders it available for emotionally nourishing exchanges, structure building, and conflict resolution, and importantly where affects can become integrated. I am defining usable clinically to