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The Chairman opened the panel by pointing to the ambiguities in the concept of psychic reality, and to the inevitable distortions of perception as to what is external or internal to ourselves. As the clinical situation provides an excellent chance for us to infer the psychic reality of our patients' unconscious processes, Sandler expressed the hope that this plenary session would amplify our knowledge of these processes in both the patient and analyst.
The first panellist, Leo Rangell, spoke to his pre-published paper (1995). He said that the discovery of psychic reality neither excluded nor diminished the reality previously known, espousing the idea of a cumulative accretion of knowledge and understanding.
He then presented the case of a woman who had suffered a series of traumatic experiences throughout her development. She said that she would never overcome her past. She wished to disengage from her parents, with whom repeated attempts at reconciliation had continued to fail. She felt that she should make up with her parents and that they were good. This created a chronic impasse in the treatment. Rangell stressed that the choice was hers, and that any solution should be compatible with the patient's ego and not the analyst's ego judgement or superego values. The progress took place as the result of her analysis and may be understood as the result of an improved inner reality helping to bring about a more hospitable environment, each reciprocally enhancing the other.
Rangell considered that the analytic goal is the uncovering and re-ordering of the psychic realities, in order to bring them into a logical ego-syntonic order within themselves and in relation to other realities. Although analysts of all persuasions often downplay the role of external reality in mental states, he thinks that it is a coherent system, comparable to id, ego and superego and interacting with them. We should no longer limit causality either to seduction and its many modern derivatives or to