Discussion

DR. KAFKA HAS ALERTED US TO important often overlooked aspects of what keeps the passion in a long term analysis. She has focused on the needs for connection and self discovery, as well as the need to "satisfy generative and altruistic aims". Exploration and creative expansion lie at the heart of both patient's and analyst's commitment. She reminds us of Clara Thompson's warning that not everything observed is irrational or transferred from the past. Dr. Kafka's emphasis is optimistic and affirming. It not only reflects her interest in recent developments in self psychology, developmental research, and object relations theory, but also demonstrates her love of the process. Her emphasis on the holding environment and on issues of separation and connection in working with disturbed and self destructive patients seems very much on target.

Dr. Kafka thinks of the interplay between therapist and patient as akin to the playing of jazz. The story line of the music, the separate but interconnected voices, the shifting of foreground and background and the never fully understood complexity make this an apt analogy. The musicians apply their talent, intuition and imagination. My concern is that her use of the metaphor, as presented, focuses too exclusively on the benign and constructive motivations of the musicians. Often playing together involves a tug of war between cooperative, creative and competitive urges. The desire