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November 16, 2003. opens his article “Telling Stories” ( JAPA 51/1) with the following statement: “The capacity of patients to tell and own their stories is central to their developing a sense of wellbeing from analysis” (p. 25). This assertion strikes me as reflecting Busch's belief and so requires qualification as his personal conviction, rather than as a recognized fact. Busch is certainly entitled to his personal conviction; indeed, it's questionable if an analyst could function clinically without one. However, in this age of psychoanalytic diversity there are many different beliefs about what is “central” to a patient's developing a sense of well-being from analysis, and we may assume that whatever is “central” probably varies with every patient-analyst dyad; one size does not fit all. I believe that there is widespread agreement about our uncertainty regarding the principal mutative factors in any individual's treatment.
Busch's report of case material documents a singular analytic approach. In his six-page summary of a session, there is no reference to the patient's current relationships or activities, either outside the consulting room or in relation to her analyst. He concludes: “I want to emphasize that this was one of those sessions in which a convergence of the patient's associations, feelings, and actions lends new clarity to the work” (p. 36). This conclusion does not address the patient's earlier protest “that it was her real life that she needed to be concerned with” (p. 30).
The patient's apparent improvement is irrelevant to the issue of the acknowledgment of contemporary analytic diversity. Analysts of many persuasions help patients by generating stories of quite different sorts, or by not generating stories at all. Accepting Busch's expression of an unqualified conviction that the analyst's therapeutic approach is “central,” and therefore the most effective form of treatment available, is inconsistent with that fact. We need to acknowledg