Kantrowitz on Her Greenberg Commentary

August 8, 2001. I wish to clarify a statement of mine that Jay Greenberg ( J. Amer. Psychoanal. Assn.  49/2)↗ has misinterpreted. He contrasts my statement, that we risk retraumatizing the patient if we do not do something new, with Patrick Casement's statement that we traumatize patients when we try to do something new. Actually, my thinking is similar to Casement's. My intended meaning was that we retraumatize patients when we fail to understand what they are communicating and so inadvertently engage in action (or inaction) that they interpret as a repetition of earlier traumatic experiences. Casement describes patients who are in distress or who have difficulty managing strong feelings. If the parent or caretaker has been unable to bear and contain these strong feelings, and if we as analysts do not understand the extent of the distress, and ourselves seem unable to bear and contain these feelings, then we are repeating an earlier traumatic experience. I believe that this is a kind of retraumatization for the patient. I was not suggesting that as analysts we should do anything out of the ordinary or engage in “exceptional maneuvers,” as Casement puts it; I meant only that failing to contain what was previously experienced as uncontainable, or failing to understand and articulate what was not understood, or was left unaddressed, is likely to be more harmful in its effect than any active attempt to do something different. However, my own way of working, when I am being my best analytic self, is not to undertake “exceptional maneuvers” but rather to listen, reflect, clarify, and interpret. Of course, I get caught by countertransference reactions, life stresses, and other such phenomena, and end up enacting and responding to patients' unconscious pressures on me. While I view this as an inevitable part of the work, I do not valorize it. If these reactions are understood and processed with the patient, very productive work may well emerge. That is why I think that these