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This misleadingly titled book is essentially an extended refutation of the outmoded view of analysis Kantrowitz was taught in the 1960s, that assumed any competent analyst should be able to treat any analysable patient. She convincingly demonstrates the wide range of crucial interactions between the individual dynamics of the patient and the analyst, sometimes adding the role of the supervisor. While we never want to burden a patient with irrelevant self-disclosures that shift the focus from the patient to the analyst, she shows how frequently the analyst's personal vulnerabilities are stirred by the patient's material. As she puts it, “The subtle impact of the interaction of the analyst's and patient's character and residual conflicts on the analytic process is not an aspect of our work that we can teach easily. Only with difficulty can we recognize and monitor it” (141).
The book is based on 15 previous articles by the author, plus an introduction which is new. Kantrowitz shares an enormous amount of her valuable clinical wisdom, with vivid vignettes. What moved me the most was her detailed account of the impact on her of her 31-year-old son's death from brain cancer, five years after it was diagnosed. It is almost unbearably painful to accompany the author on her journey, as her personal burden inevitably influenced her clinical work. She candidly acknowledges that she ultimately realized it was her wish to deny her son's poor prognosis that led her to want to “protect” her patients from knowing about his illness. Kantrowitz writes critically of the many analysts who never disclose their fatal illnesses to their patients, depriving those patients of being able to say goodbye. David Feinsilver, who wrote movingly of working the last few years of his life with a fatal cancer, told me it is impossible to predict how one will react to being given a fatal prognosis. Analysts, being human, sometimes have no alternative than to resort to denial when they are dying.
Kantro