Comments by a Post Kleinian Psychotherapist

Dr Horowitz's style of case presentation is not a familiar one to me: I am used to far more sessional material, and proportionately less summary. My comments are, therefore, provisional and should be read as questions that I should like to put to him.

A general uncertainty relates to the title, and to his calling this ‘a successful analysis’. I don't have enough of a sense of what the criteria of success are, and of what is meant by an analytic space's being socially constructed. Is what the analyst considers primarily important the patient's being able to re-enter medical school and survive the first year there; and does ‘social construction’ refer to the patient's growing adaptive capacities as seen in the transference? It is not clear whether the analyst is highlighting this limited part of the transference to illustrate a thesis about the importance of the social, and passing over other important material as contextually irrelevant; or whether he does not value as I do the concerns that I am looking for and not finding. These can be grouped under three inter-related headings: the infantile, the sexual, emotional linking.

When the patient is first introduced he appears as a potentially abused child - he brings the evidence quite concretely in newspaper articles. Thus we learn of a broken family, the traumatic discovery of his grandmother's suicide on his bed, the heartrending picture of the children waiting for the father who doesn't turn up. But how are such things experienced in the work? What, symbolically, is the New York Times? How is the patient's lying on the couch to be unpacked in terms of the denigrating grandmother who kills herself and about whom the patient feels guilty - what does guilt mean here? The absent father is embodied in both the silent analyst and the silent or absent patient; but what is he doing in his absence, who is he with, why doesn't he want to be with his son? When the analyst, in the two brief clinical vignettes, refers