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WHEN PSYCHOANALYSTS GATHER to discuss psychoanalytic issues they seldom become the subjects of their own fascination. The topic today, however, excites such self-scrutiny. What keeps the passion in a long-term analysis? The deeply troubled people with whom we work instill in us profound commitment and caring. But often enough, they not only refuse the hands we extend, but spit on them. Neither the money we earn nor the intellectual challenges of the work can explain our doggedness, resilience and interest in these long-term engagements. Why do we persist? What keeps the psychoanalyst going?
When Freud deemed psychoanalysis the impossible profession, he was thinking of its results rather than its practitioners. Although he alerted us to countertransference issues, he did not contend with the particular travails of a protracted analysis. His theories disallowed the possibility that the seriously disturbed, whom we now see for many years, could profit from psychoanalytic treatment. Sullivan, Fromm-Reichmann, and Searles evolved understandings and techniques that proved otherwise. Their work was paralleled in England by the object-relations theorists: Winnicott, Little, Guntrip and Balint. And now Kohut's emphasis on the psychology of the self renders the difficult patient even more accessible. With these more pathologic people, analysis becomes far from a brief encounter.
The question I address then, concerns the psychoanalyst at work for many years with a single individual. What sustains this involvement? What keeps it alive?
I pay tribute here to those aspects of the work little heralded as part of our satisfactions. Most often we center on the pleasures