Discussion of Dr. Dunn's Case

The first question, following on some of what I said in relation to Dr. Epstein's paper, has to do with what constitutes consequential analytic data. Consider this description from Dr. Dunn's first vignette. The analyst tells the patient in the fifth session that she could begin analysis on the couch in the next session. And then: “This set in motion a complex interaction/enactment in which I felt that I had forced the patient prematurely and clumsily onto the couch to meet my needs to graduate and she felt subject to traumatic, intrusive, shameful exposure and feared an incestuous, sadomasochistic attack.” As the case history develops, we come to understand Ms. X's reaction, its relationship to her history, and its connection to her presenting symptom. That is, we come to see that she could not have an analysis without experiencing these feelings in the transference.

But Dr. Dunn, of course, tells us more. He tells us that he experienced himself in a particular way—was focused on his own narcissistic needs, and pursuing them without regard to his patient's best interest. Two thoughts about this come to mind. First, I believe that his description of his own vital, disturbing emotional involvement with his patient captures something of what it feels like to do analysis, at least some of the time. The analyst's affective participation—although like the patient's it waxes and wanes—is always there for the finding, especially at moments in which the engagement is particularly intense.

As I say this, I am fully aware that it is a controversial proposition. It could be said, instead, that Dunn's experience was simply a beginner's mistake. For instance, it might be argued that his feelings of urgency about getting Ms. X on the couch were driven by his own performance anxiety, by a transferentially overblown concern about being judged harshly by his supervisors. A more experienced clinician