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In her very moving plenary address, in which she describes the intertwining of her own painful life vicissitudes with those of her patient and with the vicissitudes of the treatment, Evelyne Albrecht Schwaber begins with the question, probably rhetorical, “Are we in the midst of a paradigm shift?” Or, as she goes on to ask, “is it the narcissism of each generation that leads us to believe that ours is a truly new and different step?” I think that we collectively agree, those of us who participated in the panels at San Diego, that indeed, at least in America, we have been engaged, over the past fifteen years or so, in a major shift—call it a paradigm shift or not—in our conceptualization of the nature of the psychoanalytic enterprise, both in theory and in practice. It should be said, of course, that this new conceptualization, or reconceptualization, had already occurred elsewhere, over a period of many decades (within, for example, the British object relations school), and had had its forerunners just as long ago in America—in Harry Stack Sullivan's interpersonal perspective, which at the time was not accepted within the ego psychological mainstream.
That shift has of course been characterized in many ways, but generally as a shift away from a natural science, positivistic model anchored in a one-person psychology based on the intrapsychic vicissitudes of the patient's instinctual strivings and the defenses ranged against them, all of this authoritatively surveyed by an objective, neutral analyst, the privileged arbiter of the patient's reality, and on the patient's neurosis as projected onto the analytic blank screen—away from all that to the ramifications of a two-person psychology focused