Modifying the Analyst's Superego

The impossibility of reviewing ninety years of psychoanalytic technique in a brief panel presentation is obvious. Therefore, I focus on some changes in my own approach to technique over time. As I see it, the primary shift has been in the area of modifying my professional superego.

Let me illustrate with a brief clinical vignette. A patient of mine was angrily recounting a frustrating experience with her emotionally abusive parents. Suddenly, from the sidewalk outside my ground-floor office, we distinctly heard a two- or three-year-old-child angrily screaming, followed by a tired female voice, “Sasha, if you don't stop that this minute I'm going to kill … someone.” Simultaneously, my patient and I burst out laughing. After a moment or two, we stopped and she resumed talking. No mention was made of Sasha and his or her overtaxed mother. I see this incident as illustrative of how my attitude toward technique has changed over the years.

First, it represents a change in how I am with my patient compared to when she began treatment, because a few years earlier I probably would have encouraged her to talk about what had happened just then between us. At this point, I saw no need to make the obvious explicit. Her own painful experiences as a child with harsh, often abusive parents, as well as her struggles to be a better parent herself, were well known to us. Early in my career I thought that if the analyst were to change her behavior with a patient, something was wrong. Traditional theory suggested that consistency was the proper analytic position, year in and year out. By now, most of us recognize that the analyst is the object of transference as well as a new object and that the analytic relationship is one of mutual influence. Consistency in an analyst's approach to a particular patient, while desirable in some respects, can also be an indication of stagnation. If the analyst never needs to respond in a new way, perhaps it is because the patient has not ch