Discussion of Dr. Epstein's Case

I much applaud the current pluralism of psychoanalytic thought; I feel it much enriches and enlivens our discipline. At the same time, however, I feel we have to separate the different frames of reference in order to really understand them. I also feel that for practical purposes they can and should be integrated into one overarching theoretical and clinical frame. Thus, I am basically an ego psychologist subscribing to an inner life of unconscious fantasy, needs (libidinal, aggressive, and survival), defenses, and compromise formations. At the same time, I feel the internal world is populated by intrapsychic object relations, self and object representations, and affective valances. These intrapsychic object relations are internalized from early interpersonal relations and in turn affect later external object relations. These internal relations, thus, both form and populate the structures, id, ego, and superego, of our structural theory. I also include concepts from self psychology in my thinking as elucidating the self within the ego. Thus, in the transference, as the patient looks for gratification, he or she is repeating early needs and defenses, repeating early internal object relations, as well as looking for growth of the self. And the therapeutic action involves making the unconscious conscious, dealing with resistance, and changing compromise formations to more adaptive compromises. It also involves a kind of corrective emotional experience in a new object relationship, though not an artificially assumed one, as well as involving an environment of empathic attunement fostering transmuting internalizations, a la Kohut, and containment, à la Bion. The technical approach relating