Response

Dear Sir,

I would like to thank Imre Szecsödy for his discussion of my paper at the Congress in Santiago and for the summary in his letter. While there are many points of agreement I suspect that, like Dale Boesky, he is not comfortable with the central role given to the mechanism of projective identification in the creation of mental states that the analyst is required to contain and to understand. There are undoubtedly other ways of describing what takes place between patient and analyst but I have found that thinking in terms of projective identification has particular advantages even though these are more descriptive than explanatory. Why a patient does something remains a question even after what he does has been described.

I tried to show how the analyst must integrate information from a variety of sources in order to create a picture of what Klein called the ‘total situation’ (Joseph, 1985) and suggested that it is this integration that leads to what we have come to think of as containment (Bion, 1962). Containment can lead to an experience of being understood in which the patient's projective identifications are given meaning in relation to other elements in the total situation which involves a differentiation from other unrelated aspects of the analyst's mental state.

Moreover, thinking in terms of projective identification provides a model of one way in which mental capacities can be inhibited or lost, namely when they are disowned and attributed to others. I have argued elsewhere (Steiner, , 1996) that in the course of an analysis the patient can regain access to elements in his psyche that were previously disowned by projective identification. I think this is close to what Szecsödy has in mind when he speaks of the reactivation of inhibited mental functions. Here I have argued that containment is a necessary stage in this process but that further stages are required before the patient can separate his own mental processes from those of the analyst and acqui