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Jill Miller opened the panel by noting that openness to uncertainty is central to analytic work; without that, we lose touch with our patients. Yet uncertainty may bring with it anxiety and fear. Our role is to tolerate and metabolize affective states, but at times when fear overwhelms the ego, to do this may seem impossible. The biologically driven response to fear is to fight or to flee, options that we do not allow ourselves in the consulting room. If these urges press toward imminent action, we experience what Racker calls “drowning in the countertransference.” Miller introduced the panelists and invited them to discuss experiences of uncertainty and fear in the clinical situation.
Warren Poland was the first presenter. He reminded us that analysis is not a theatre from which we can go home safely. It “is not a spectator sport, and risk-feeling emotional danger-comes with the analytic territory.”
Poland gave examples of how closeness can make us part of a patient's frightening internal world. When a paranoid patient unexpectedly erupted in rage against him, he experienced sudden disorientation and fright, feeling as if he were in a childhood nightmare. With another patient, he felt a buildup of dread as, session after session, he faced her “militant” hopelessness. Anticipating her inevitable suicide, he feared the destruction of his reputation, his financial security, and even his family's well-being.
Dangers also arise out of the perils of reality, Poland pointed out. “Patients remind us, often when we are least prepared, of just those parts of life about which we least want to think.” What perils are most unnerving depends on the situation and developmental phase of the