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Franz Alexander once said to a dirty patient, “You stink.” The patient answered, “Now I know that you are honest” (Aaron, 1974).
Stuart Pizer, who also builds trust by not evading what alienates him, takes us further into the meanings of such psychic interplay between patient and therapist. He views the coconstruction of authentically shared reality as an essential aspect of evoking change. In this spirit he begins the treatment of a poignantly schizoid man, Donald, by injecting his own solution to the problem of being unable to tolerate the patient's body odor: he confronts the man with the presence of his smell. When the patient agreed to use deodorant, Pizer responded to this first “negotiation” as a sign that he would be able to commit himself to working with him in treatment. And so begins an interaction that leads to the patient's developing the emotional closeness for which he has always longed. Pizer notes his awareness that in giving the patient the pseudonym “Donald,” he has imbued his memory with a bit of the inspiring closeness he has felt for the writings of Donald Winnicott. His approach to Donald profoundly respects Winnicott's paradox that “it is a joy to be hidden but disaster not to be found.”
Echoing Pizer's dedication to connecting inner and outer worlds, the book contains two sections. Part I deals with the negotiation of paradox within the consulting room as a conceptual bridge between analyst and patient. Part II extends the horizon of the view from that bridge to high-light how similar processes of empathic connection or disconnection frame negotiations within wider social circles of gender, nations, and species. Here Pizer considers those damaging and polarized representations of distinctions in identity (gender categories, national differences, and so forth) which, rife with projection and the need for dominance, bespeak an intolerance for paradox and negotiation. The goal of developing ways to synthesize multiplicity and paradox within an