A Patient Returns: Editors' Introduction

We are publishing these five contributions together, under the rubric “A Patient Returns,” because they reflect the experience of a group of experienced, highly respected senior analysts—major contributors to our field throughout their long careers. While there are important differences among them, we also note important similarities. Perhaps the most important similarity is the one alluded to by Shelley Orgel in his paraphrase of Mark Twain. “When I was a boy of fourteen,” Twain wrote, “my father was so ignorant I could hardly stand to have the old man around. But when I got to be twenty-one, I was astonished at how much the old man had learned in seven years.” While Twain's comic irony relies on the fact that it is the son who changed, not the father, the emphasis of our authors is on how much they, the analysts, have changed. It is to these changes that we wish to call readers' attention.

We are most interested in changes in the analysts' technique, the ways they behaved with their returning patients. What we read repeatedly (but not universally) is that they are today more “relaxed,” more flexible, and more demonstrative of their own emotions. They disclose more about themselves and their feelings toward their analysands. There is more of a sense of the importance of “the relationship” than in the first treatments. Self-reflection is more often and more successfully used as a means to access the analytic process. The analysts may be less reliant on making the “correct” interpretation than in the past. They speak more about the analytic dyad, even the analytic “couple,” and only much less about doctor and patient, analyst and analysand. Use of the couch is rare, analysts and patients now preferring once- or twice-weekly sessions facing one another. Much of these analysts' thinking about their therapeutic work today is redolent of the increasingly accepted analogy between the therapeutic situation and the very early one between mothers and their infants, especially