Psychic Reality And Psychic Testing

Dear Sir:

I am writing in response to Dr. L. Grossman’s critique of my position in his paper, ‘“Psychic Reality” and Reality Testing’ (Int. J. Psycho-Anal., 1996, 77: 509-515). I believe it is incumbent upon me to do so lest the reader be misled to believe that I would sit by while a patient was ignoring a potentially life-threatening physical symptom, or, that there is anything inherent in my position that heightens the risk of such an eventuality. Regrettably, Dr. Grossman does not appear to have discerned the epistemological and conceptual implications in what I have written.

While he states that I suggest we ‘enter into the patient’s “psychic reality”’, viewing ourselves ‘as if one were not influencing it’ and ‘as able to suspend one’s own’ (p. 515), I have in fact emphasized the contrary, that our participation is a constant and continuing aspect of the patient’s experience, and that all we can know is from the vantage point of our own psychic reality. I do speak of the effort to locate the patient’s psychic reality, which includes the patient’s perception of our participation. Thus, I do not agree with his view that ‘empathy is … the appreciation of what a situation would mean to the analyst it he or she were in similar circumstances’ (Grossman’s italics), but an effort to apprehend what it means to the patient in those circumstances, realizing that this always reflects our own understanding.

I have written, ‘It is not that the analyst “goes along” with the patient’s view nor simply accepts it as such; rather, she uses her own view to enable her to locate the subtleties of the inner logic of the patient’s which have not yet been clear to her. We must surely employ our view, or experience, even vigorously so, as avenue to find the patient’s as long as we acknowledge ours for what it is—how it seems from within our vantage point—and listen with this realization’ (1996, p. 20). My central epistemological position has to do with the need to recognize the distinction