On Communication from Patient to Analyst: Not Everything is Projective Identification

Although this talk has been billed as a summary of the Congress proceedings, this is not a very apt description. In what follows I shall consider an aspect of the theme of the Congress, taking it as a starting-point for describing some related ideas of my own. So I ask for your indulgence.

For many years psychoanalysts held to the belief that psychoanalytic theory—or at least the particular version of it to which they subscribed—was an adequate basis for understanding the psychoanalytic process. The concepts of transference and countertransference had come to be regarded as sufficient to comprehend how the patient repeated the past in the present, and interpretation of the analysand's conflicts, of his deep unconscious phantasies, or of his or her internal object relationships, especially as they showed themselves in the transference, was thought to be enough to bring about appropriate psychic change. But during the development of psychoanalysis there has been a growing awareness that theory and practice are not completely in step, and indeed that the gap between psychoanalytic theory and psychoanalytic technique has been increasing. One can say with fair certainty that it was this increasing divergence between theory and practice which led to the multiplication and subsequent coexistence of different psychoanalytic theories, of different psychoanalytic 'schools'. In part, such differentiation into so-called schools was the outcome of the interest of analysts in special groups of cases, leading to a theoretical reformulation, which was then put forward as a general theory of psychoanalysis. So, to give two examples only, we had the theories of Melanie Klein, derived from work with very young children, which led to a new psychoanalytic model of the mind and a different technical approach. The same holds true for the theories of self psychology, in which Heinz Kohut's work with patients with narcissistic and borderline character disorders led to change in psych