Pluralism in Action

This panel addressed the challenge of translating conceptual pluralism in psychoanalytic theory into practical action in the consulting room. Steven Cooper introduced the panel by noting that the analyst functions in a state of uncertainty about what is going on with the patient, particularly at the beginning of a treatment, and that the clinician's theory may be stretched or called into question by the patient as the treatment proceeds. The analyst, therefore, ought to regard underlying theoretical presumptions as tentative and open to revision as the treatment proceeds—or as Ronald Britton has said, our theories should be considered “vulnerable knowledge.” Cooper suggested that the analyst necessarily establishes a dyadic relationship with his preferred theory and its limitations. He always should be open, however, to recognizing a “pluralistic third,” which Cooper views as an alternative conceptual model for understanding the patient and the complexities of the clinical interaction. Acknowledging the existence and critical role of the pluralistic third involves a de-idealization of the analyst's preferred theoretical approach, but is required to provide appropriate treatment and to function in a profession where our theories have become so deeply interpenetrated.

Cooper proceeded to describe a clinical case in which a single conceptual model was insufficient and introduction of a pluralistic third helped to move the analysis forward. Simon was a bright and likable, yet hostile and contemptuous, thirty-year-old man who had recently completed a year of psychoanalysis in another city, which Simon said had not gone well. In an early session with Cooper, Simon reported that he perceived Cooper as “an exceedingly earnest, caring analyst,” and he decided to call Cooper by the name Ernesto. Cooper responded, almost reflexively, that he would call Simon by the name Contempto. So began a treatment in which, for the first six months or so, the early parts of the sessions wer