Discussion of Dr. Epstein's Case

The first point I want to make is that this analyst's technique is informed by what I consider the point of view of the New York Psychoanalytic Institute. There is a consistent analysis of the patient's resistances in the analytic work and of her defenses against affects and wishes; that is, against drive derivatives based upon the theory of intrapsychic conflict. Of particular interest is the influence of this patient's childhood sexual activity, on the one hand traumatic, on the other formative in regard to certain defenses used by the ego, including the trauma as denial of her own sexuality and wish for power over others, particularly men.

There are only a few prominent motifs in this report. The most notable is the role of moral or ethical conflicts as illustrated by the affect of guilt activating her defenses such as the regressive forms of guilt in the transference, fears of retaliation, and sell-punitive ideas and behavior. The second motif to be noted is the passionate temperament of this patient; the intensity of both her sexuality and her rage, which early on in the work was warded off and transformed. When the resistances were analyzed, derivatives appeared in full force in the transference and in her life.

The third motif, the most difficult and the most hazardous to the analytic work, is the pressure to seek revenge in a fashion familiar to us as reversal; to demonstrate to herself, to the world, and particularly to the analyst that the analyst has failed.

I will not take up the detailed data of the analysis, but instead I will target the technical issue of the interaction of analyst and patient. Ferenczi, some time ago, pointed out that analyst-patient emotional interaction is inevitable but must be subject to analytic work in regard to both analyst and patient. Does this aspect of the analytic process retard or enhance the analytic work? How and when is it important,