Response to John Steiner

I am very grateful to Dr. Gabbard for affording me this opportunity to respond to Dr. Steiner's stimulating and provocative paper on enactment. I come from an interpersonal perspective—heavily influenced by Sullivan, Fromm and Ferenczi—that has virtually since its inception been very invested in this issue.1 There is a hoary psychoanalytic joke that goes, ‘What is acting out?’ And the answer is, ‘Whatever makes the analyst nervous.’ It suggests how elusive and subjective these categories can be.

So, I must begin by indicating some puzzlement. Steiner seems to be conflating acting out, frame violations, countertransference and enactments, when he says that, ‘It is difficult to reconcile the idea that enactments can give helpful information about the patient and his relationships with the recognition that, in the process, boundaries may be violated and to a greater or lesser extent both the patient and the analytic work can be damaged.’ He continues, ‘Enactments by definition cross the boundary from thought to action and, unless they are recognized and regulated, can enter that grey area between normal technique, technical error, and unethical boundary violation’ (my italics).

I quote this in detail so that there can be no misunderstanding or misprision. This seems to put all failures of an analyst's neutrality on a continuum, a slippery slope whereon countertransference may open the floodgates to a major violation of the integrity of the therapy. Can Steiner mean this? In his opening sentence he references both Sandler and Joseph as supporting the idea that enactments are ‘recognized … [as] harmful to the … analytic process’—not sometimes harmful, one notes. In the very next sentence, he points out the very same two authors utilize enactments therapeutically. Is this not a contradiction?

I certainly agree about the importance of a clearly defined frame, a set of a priori rules that are designed to protect the analyst even more than the patient. Violations of the frame a