Discussion

IHAVE BEEN IN THIS BUSINESS about half as long as Dr. Witenberg and it's nice to have many of the observations that I have made during this short period of time confirmed by his much wider and longer experience. I think what I'll do first is summarize the many areas of agreement and then focus on several areas in which I might change the emphasis a bit in his presentation.

The major theme that I loved in Dr. Witenbergs' talk could be paraphrased as something like, "everyone should read about theory with an awareness that they're doing it at their own risk and also at the risk of the patient." There should be some precautionary label on every book by a psychoanalytic theoritician. There's nothing that ruins a good therapist more than becoming overly devoted to an archaic non-commonsense theory. And no theory ever tells us what to do in the room at a particular moment, nor should it in any specific way. There are many people whom I thought were excellent therapists when I trained them as residents to whom I can't refer patients now, when I realized that the therapists changed a lot. They've learned more along the way and I don't want my patients subjected to what they've learned. That's not to say that there's no place for theory. It does provide a very useful framework. It can be a transitional object as Dr. Witenberg mentioned—it's a comforter, it can provide a rationale for what we do; or magic; or a metaphor. Theory guides the overall practice but shouldn't intrude too much on the therapists' intuition in the room. I think that doing therapy is a little bit like hitting a fast ball. A good deal of what goes into hitting a fast ball or throwing a fast ball one is born with. The skill could be trained somewhat and improved but it can also be worsened if there's too much attention to detail without focussing on the current needs of the situation. We don't want to make great natural hitters too self conscious.

Another point that Dr. Witenberg makes that I