“Bright Spot”: Technical Recommendations Concerning a Phenomenon Observed When Combining Psychoanalysis and Medication

In her 1993 brief communication in the Psychoanalytic Quarterly, Marianne Goldberger (1993) made particularly valuable observations regarding a type of analytic blindness of which she had become aware. She labeled it a “bright spot,” defining the phenomenon as “a subject that has especially vivid meaning for the analyst and is endowed with a rich associative elaboration based on readily available personal experience.” She went on to explain that this occurs, “When a patient talks about such a subject, the analyst has the feeling that he or she knows in detail exactly what the patient means. Because this feeling may be illusory, a bright spot may prevent adequate analytic exploration” (p. 270).

Over the past several years we have become aware of a subspecies of bright spot which has occurred with sufficient frequency in our own work and, by report, in that of colleagues, to warrant fuller clinical description. The phenomenon to which we refer is the interference with analytic listening which occurs in the face of analytic expectations specifically elicited by and associated with a patient's psychotropic medication. We are thinking of medication used in an analysis to treat specific neurochemically driven symptoms which subvert or block the patient's capacity to participate effectively in the analytic process. We have found that this particular type of bright spot seems to occur as often in the work of analysts who do the