Discussion

INCREASINGLY SINCE THE 1950's the impact of the patient on the analyst has been considered an area of valid study. With the reciprocal nature of relationships being generally accepted by analysts

of all persuasions, with operationalism in full bloom, it became convincing that patients have impact on analysts in the same way that analysts have impact on patients. The discussions continue. The problem remains. How much of this impact does the analyst reveal, and how does he do it.

While Sullivan himself admonished us against sharing, e.g., feelings of anger, some of his formulations stand us in good stead. His concept of participant—observer is very useful in this respect. At any given moment in psychoanalysis there is a mix of these two aspects of our behavior. How much of each is determined by the goal of the treatment, that is, the uniquely analytic goal—the making available of hitherto inattended and dissociated aspects of the personality. Prior to the achievement of this goal, many factors come into play as a result of the process. They are the result of an explicit sharing of the reason for the mutual effort, the detailed anamnesis, the coming into touch with the core of the patient, the establishment of a cooperative relationship, the changes evoked in the analyst by the patient, and the change in behavior by the patient which is followed by the cognitive integration of the inattended and the dissociated—called insight. Throughout all this process the analyst is influenced by the power of the unconscious processes and attitudes of the patient. Does he reveal this impact? Freud, Sullivan and others stood for reserve, tact, empathy, interest, curiosity but not sympathy, conversation, or mere exchanges of sentiment and anxiety. Considerations as to whether the interventions were for the narcissistic gain of the analyst were weighed. How many distortions from the past were in the analyst's head and how many did he display with a caveat against the di