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The Chairman opened the panel by noting that its title was both ambiguous and provocative and said that ‘mapping’ implied that psychic reality was conceptualised in spatial terms, a favourite metaphor for Freud ‘the Conquistador’. The ‘who’ in the title raised questions about the authority of the analyst versus that of the patient and about the limits of the expertise of the analyst.
Arnold Rothstein began the discussion with his presentation of two clinical vignettes. In the first, after considerable analytic progress had been made, the analysand's negative image of his wife came to dominate the analytic stage. Rothstein felt this reflected a distortion but was unable to help the patient move beyond its manifest content. Only after the patient's wife had confronted him with her own therapist's comment (‘I wonder why he can't see beyond those ten extra pounds to appreciate all of your numerous positive attributes’) was the patient able to explore the defensive ramifications of his static negative image.
In the second example, the patient experienced two paranoid reactions during the first year of treatment. Rothstein maintained his anchoring hold in reality as his patient's analytic course carried her through these two frankly delusional episodes. He confronted her with the irrationality of her delusions, suggesting that her ideas were ‘crazy’ and grandiose and based upon underlying guilt and rage. In a later episode, the patient expected her analyst's disapproval for soiling his carpet. When, instead, he expressed his compassion for her distress, she acknowledged that no one had ever been so understanding of her experience. Subsequently they were able to work more conventionally in the transference.
Rothstein was the only panellist to present clinical material and, although he did not pose them, his presentation raises a number of challenging questions. In analysis must we arrive at a consensual psychic reality to be explored and if so, what role does the analyst play