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I wish to draw attention to the need for further discussion of the criteria on which we base our assessment of a patient's progress in analysis. I recently wrote one of the comments on a clinical case for the section “Analyst at Work” (Discussion of “Ending Analysis: The Case of Karl,” 2018, 99[6]: 1444–1452). I was pleased to note the important agreements between my conclusions and M. Feldman's subtle and thorough analysis of the case. We both agree that the interpretations were more present in the analyst's mind than in the patient's, whose defences proved very difficult to overcome. On the other hand, Feldman's assertion that, despite the importance of the patient's resistances, there had been “substantial changes” (1456) and “a significant shift in the patient's relationships with his internal objects” (1457) came as a great surprise to me. I was also surprised that Abbot Bronstein, in his introduction (“On Analytic Endings,” 1424) argued that the patient had achieved “a deeper, more thoughtful and genuine relationship in the internal and external world.”
My surprise arises from the fact that I don't find enough support in the material to sustain this view of change in internal objects. Karl's analyst, B. Feinberg, points out that in his opinion, the continuation of the analysis would not have been beneficial for the patient given the characteristics of the analysis. I agree with Feinberg's difficult decision. In my opinion there was an impasse situation that after 10 years of analysis had become immutable, and that led Karl to obtain from his analysis the same kind of secondary benefit that he achieved through what he considered to be his “failures” in life. The inauthenticity of the patient led me to hypothesize a situation of “bad faith,” in the sense of M. Baranger. This situation remained unchanged and, in my opinion, does not suggest any significant change in his inner world.
My intention here is by no means to discuss this particular case, but to draw atten