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It is now almost fifty years since Leo Stone (1954) wrote his classic paper, “The Widening Scope of Indications for Psychoanalysis.” As readers of JAPA, particularly during the recent past, we have been privileged to learn more about this broadened reach of psychoanalytic ideas. This issue, with its wealth of clinical material, focuses on the value of psychoanalytic principles, old and new, in understanding and treating very difficult patients, particularly those who have undergone severely traumatic experiences.
Encountering another's clinical material, particularly when it involves complex clinical situations, leads inevitably to an influence (conscious and unconscious) on our own clinical work, as we compare and contrast the other's theory and technique with our own. Are they consonant with each other or divergent? Which approach is more consonant with our actual practice? Is the novel theoretical construction helpful in organizing our own clinical data? Studying the difficult clinical situations described in this issue, and the theoretical discussion they inspire, can help all of us apply the successes (and failures) of these authors to our own clinical work.
In 1927 Freud described the nonpsychotic disavowal of reality of two young men who had lost their fathers in childhood. In these men, two mental states existed side by side: one comported with a wish, the other with reality. In the posthumously published “An Outline of Psycho-analysis,” Freud (1940) discussed further the idea that splitting, as a mechanism, is ubiquitous in childhood. Children, he stated, in addition to coping with undesirable instinctual demands by repression, often find themselves needing to fend off distressing demands from the external world. They do this by disavowing certain perceptions from