Comment on Dr Nacht's and Dr Weinberger's Papers1

In recent years analysts have occupied themselves theoretically more and more with the earliest phases of development, including the preverbal and earliest verbal periods. At the same time, borderline and narcissistic disorders have come into the broadened clinical scope of psycho-analysis, and the psycho-analytic method, or at least psycho-analytic principles, have been applied to the treatment of conditions beyond the transference neuroses.

Thus it is not surprising that at the last Congress of the International Psycho-Analytical Association in Edinburgh, in the symposium on Curative Factors in Psycho-Analysis, Gitelson postulated that therapeutic procedures in the first phase of analysis are reminiscent of factors implicit in early mothering, emphasizing Spitz's concept of the analyst's diatrophic function. And at the same symposium Nacht, speaking more broadly of the psycho-analytic process in general, focussed on the issue that interpretation alone is not sufficient, in itself, to bring about a satisfactory outcome in an analysis. He especially warned that the neutrality of the psycho-analyst could become a binding detriment insofar as it might be 'absolute', and went on to stress the need for an evident and convincing humanity on the part of the analyst, who 'must bring love to his patient', not love in which he is personally concerned, but love at a deep level in that his 'inner attitude should be impregnated with love for his patient'.

As Nacht says, he has for some time been preoccupied with the effect of the 'deep inner attitudes of the analyst on the progress of therapy'—and with the impression that they seem 'even more decisive than his interventions and his formulated interpretations'. In 1961, Nacht stated 'It seems necessary to me that behind the analyst's silence the patient should sense a watchful presence which really exists and is felt as helpful.' In the paper now under discussion Nacht specifies the essential curative factor as an 'exchange'—