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Analytic time passes more unconsciously than otherwise. Hours become days, days months, months years; work continues slowly; psychic growth is ongoing and has a rhythm of its own. Much like the physical inches a child gains, our patients' progress is often measured in yearly intervals. Embedded in this timelessness, in this setting uniquely characterized by a paradoxical fusion of illusion and reality, our patients become constant objects. The repetition, so much a part of working through, is at times tedious, and can dull our senses. We become comfortable, perhaps too much so. Comfort may convert to boredom, a warning signal that a shift of attention, perception, understanding, affect, expression, may be required. For this article, I selected certain “critical incidents,” clinical events that seemed to change things for both the patient and me, a change that seems to be preceded by an empathic breach that alters relational dynamics once again—a change or discovery or rediscovery that injects new fuel. What seems to shift is the interpersonal field. Forces become reconstituted in a somewhat different pattern. A common dynamic denominator is some increase in, or some rediscovery of, contact and connection.
Conflict, an inherent part of any form of intimate relatedness, is typically an aspect of the countertransference (defined here as the therapist's “total responsiveness to the patient”). Tuning into it, working with it, creating something new out of it, these become reparative tools. Central to our understanding of countertransference is the paradoxical notion that real affects are being induced, shared—stimulated in an extraordinary setting, perhaps unlike any other in reality. The task at hand, it seems to me, is to be fully open, receptive, and welcoming of all affects, fantasies, and thoughts, to try to respond with sufficient restraint, to follow, to respond flexibly, to be aware of the need to “titrate” tension between gratification and restraint,