Summary and Commentary on Affiliated Staff Discussion

Considerable interest was engendered by this presentation because of its broad interface with many urgent contemporary practice issues. As it happened, this Treatment Center meeting was held on the eve of a New York Psychoanalytic Society scientific program on aspects of the use of psychopharmacologic treatment in psychoanalysis (presented elsewhere in this issue).

In the course of this psychoanalytic treatment, problems of psychopharmacologic and senior psychoanalytic consultation; psychotropic medication; suicide threats and management; alcohol abuse and potential hospitalization, all forcefully and often dramatically emerged. These crises shared analytic “space” with more ordinary treatment vicissitudes such as the analyst's marriage, pregnancy, and delivery.

The ensuing discussion focused, therefore, not only on the usual questions of psychoanalytic suitability and technique, but on the various physicianly, psychiatric, and psychoanalytic “hats” donned by the analyst and upon transference “parameters” resulting therefrom. There were certain issues forming clusters of concern, as follows:

The written history contained much oedipal-level reconstruction and interpretation. Allowing significant latitude for negative therapeutic reactions and for ego regression reactive to the psychoanalytic process, many of the group were concerned whether this patient was in fact organized and consolidated at an oedipal level. Were not her ego resources more chronically “besieged” than was originally apparent? Did not her high intelligence and appealing personality mask too much primitive turmoil, too