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CHUSED INTRODUCED THE PANEL by noting that there are many patients who find analysis an extraordinarily difficult task and who cannot seem to "do analysis right." Over the past 40 years, from K. R. Eissler's work on parameters to Leo Stone's work on the "widening scope" of psychoanalysis, analysts have attempted to find ways of treating these patients within a psychoanalytic framework. Chused said that in opening the door for technical alterations, which would still be considered analytic, Stone's work became the justification, in some cases, for multiple modifications in technique based on the special needs of certain patients.
In recent years, one reason given for these special needs has been a patient's deficits. Some analysts have hoped that current deficits in functioning could be corrected by supplying in treatment that which was not available in childhood. In reaction to these and other modifications, another group of analysts, who adhere to the conflict theory, rejected the usefulness of the deficit concept. The result of these extreme positions has created problems, particularly for those in psychoanalytic training, who often search frantically for the "good patient."
Chused announced that the panel would be focusing on clinical experience with patients who seemed to present insurmountable obstacles to engagement in the analytic task. She asked the panel to avoid labels such as deficit, and to focus on how to engage the difficult patient, hoping to arrive at some understanding of when and why modifications were used and, in the process, helping to puncture the myth of the perfectly analyzable patient.
Dowling then presented his analysis of a woman in her early thirties who came to him depressed and overwhelmingly anxious, with