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IT WAS a beautiful Friday in autumn, the kind of day that reminds me why I live in Vermont. I was feeling jubilant that my internal medicine patients were all taken care of for the weekend, I was not on call, and I was anticipating with pleasure my upcoming session with Mr. A. He was my first analytic patient, and thus far the work with him had been going quite well; we had quickly established a good therapeutic alliance, he was committed to the process, and was working hard in his analysis. I felt confident that my plan to change careers from medicine to psychoanalysis was not only right, but indeed inspired.
Mr. A's sessions characteristically began with a litany of details, in keeping with his rather obsessive nature. At the beginning of his analysis, approximately one year prior to this session, it often took him the first thirty minutes of the hour to feel comfortable enough to abandon his scripted text. By the time of the session reported here, though, he usually settled in after about ten minutes. This particular hour began quite differently, however, with him asking if he could sit on the footstool next to my feet. In answer to my inquiry, he explained that he felt particularly emotionally close to me that day, and needed the physical proximity. I wondered what to do.
Looking back on my medical career, I think it is fair to say that I attempted to be the “good object” for all of my patients, whether tending to them during catastrophic illness or simply providing routine health maintenance. I felt able to provide unfailing care for even the most “difficult” of patients, and often accepted referrals of such patients from other physicians in the community. In an environment of unquestioning provision of care, all interpersonal negotiations between patient and physician are geared toward that care, and the subjectivity of the physician is considered relevant only to the extent that it serves that purpose. I transferred