Discussion

When I first read Dr. Rudden's report I was reminded of a bitterly cold Friday evening early the previous December when, in the midst of a snow storm, I attended the monthly scientific meeting of the Austin Riggs Hospital in Stockbridge, Massachusetts. I had long admired Riggs as one of those legendary centers where inpatient psychoanalytic treatment and intense therapeutic engagement of even the most disturbed patients was routine. But I knew that now Austin Riggs was as afflicted by managed care control over its patient care as everywhere else, with shorter hospital stays and a focus on medication management, so I did not know what to expect of its scientific meeting. As Dr. Daniel Schwartz began his paper on “Caring and Its Troubles,” I sat back in pleasure and relief. Out there in that rural spot, amidst those people in parkas and heavy snow boots, dripping melting ice onto the floor of the faded, rather thread-bare, though obviously once grand paneled room on that windswept bitter night, psychoanalysis was alive and well.

And that is what I thought as I read Dr. Rudden's report. That here, in the midst of all of our struggles to survive economically and professionally in today's health delivery systems, analysis is alive and well. Here is a cogently written report, of a thoughtful and in depth encounter between two people, in which the meaning of their interaction is the central focus, and in which that meaning is being sought and conveyed in a manner that is indeed making a great difference to this patient's life. As I read the report a second time, I realized there was another reason for my association to Dr. Schwartz's paper. The process unfolding between Dr. R and Ms. A bears a distinct relationship to the kinds of transference and countertransference events that he was talking about.