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IN THIS PAPER I WILL delineate what I believe are the essential ingredients for the therapeutic action of psychoanalytic work at crucial points of transition in middle phase work for patients across the entire diagnostic spectrum. The qualities of this experience will be seen to form a continuum from classical analysis with the neurotic to modified psychoanalytic psychotherapy with the most severely regressed schizophrenic.
Freud wrote, "Anyone who hopes to learn the noble game of chess from books will soon discover that only the openings and end games admit of an exhaustive systematic presentation and that the infinite variety of moves which develop after the opening defy any such description" (Freud, 1913, p. 123). I believe that, although this middle game will certainly play itself out in a humanly infinite variety of ways, there is a definable essence which involves a very particular interactive process. It consists of the therapist teasing out of the spontaneously arising interaction the more critical aspects of the transference-countertransference interplay. These insights then enable him to transform a potential impasse into a moment of therapeutic activity by functioning as a transitional object, to use Winnicott's term, or to use even more common parlance, by functioning in essence as a "teddy bear" does for a small child. This leads to the patient telling the story of the origins of his illness and thus can be seen to result in a therapeutic action which transforms the patient's tendency to relive his past into his verbally retelling it. Thus, this paper describes how patients from all diagnostic categories can usefully come upon the underlying causal story of their illness. This is the beginning of what must then be worked through in middle phase work.