Discussion

Dr. Auletta has presented us with his approach to a very disturbed patient during the introductory phase of an analysis. His case was even more complicated than usual because he had to begin the therapeutic work during a 4-month period when the patient could only be seen bi-weekly, prior to the summer break. He describes his therapeutic work as an ‘intersubjective process … initially, in order to support the patient's security and stability.’ He also used “anticipatory interpretations” which make use of “an empathic-introspective method,” to contain the patient's possible repetition of traumatic situations in the transference. I will try to summarize his presentation with some commentary and then go on to discuss my own views of beginning analytic work with such patients. I will say at the outset that we share many ideas although our descriptive language is very different.

To begin with, Dr. Auletta emphasizes the need to protect the “stability and constancy of the setting, … by means of constant attention to the unconscious intersubjective dimension, understood as the interaction between the unconscious subjectivity of the patient and that of the analyst.” Although Dr. Auletta speaks of his attempt to “guarantee the avoidance of improvisation” by this attentiveness to each participant's subjectivity, it is clear that this is not entirely possible. Let me turn to the clinical material.

Flori was a terrified young woman, anorexic, frightened of having multiple sclerosis, and enmeshed in preoedipal problems with her unreliable but intrusive mother and incestuous/oedipal ones with her inconstant father. Faced with few hours and only 4 months before