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I feel honored by Alyson Kepple’s use of my 2019 paper, “Airless Worlds,” to help her make sense of her patient Kathleen’s life-long struggles with the sequelae of her parents’ disappointed, frightened, and reflexively aversive responses to her from birth on. Kathleen did indeed grow up in the kind of negating familial environment I described in my paper.
Trying to capture in her own words her understanding of the implications of what I was writing about, Alyson writes, “If our caregivers have the capacity for exploration and they come to land on our world, recognizing us, these small steps become giant leaps for the developing self who discovers that a ‘me’ exists, that exploration is possible, that there are other minds and alternative perspectives out there” (Kepple, 2023, p. 585). Beautifully said! If we take this description of good enough parenting and apply it to psychotherapy, Alyson is describing the kind of analytic relationship patients who live in airless worlds need with us. Through our own exploratory efforts, we are trying to “come to land on [their] world” in such a way that they begin to discover that a “me” exists. Alyson is clearly succeeding in doing this with Kathleen.
Though she alludes to it, Alyson makes less explicit use of my writing about “needed relationships” (Stern, 2017). However, it is clear from her paper that she is connecting with Kathleen in critical ways and that they are co-constructing a unique needed relationship that has already been very helpful. Before looking at their process more closely, I want to say a few things about what I mean by needed relationships. You might say that my book on the subject posed the meta-theoretical question: What level of constructs do we need to be using to think complexly enough about the problem of how we fit what we do clinically to what each patient needs. The idea of needed relationship seemed to me to be one such construct. It gathers into itself the whole history of psychoanalytic thinking