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The following notations are a synopsis and review of the notes I took while teaching a case conference attended by a combined group of first- and third-year candidates at the Houston-Galveston Psychoanalytic Institute. When it became apparent that any clinical material leaving the room would be a compromise, I converted these “margin notes” into a set of aphorisms that were extracted from the case and clinical exchange. My hope is that these generalizations may serve as catalyst for further reflection, rather than viewed as axioms for the analyst.
Each clinical exchange may be viewed from perspectives including intrapsychic, intersubjective, developmental, object relations, and drive, as well as the emergence of various transferences from selfobject to object specific: The central organizer throughout, the access to the patient's experience, is his affect.
What is happening in the present analytic moment is as much about the new story as it is about the old story (transference). Interventions by the analyst involve a wide range of verbal and nonverbal communication and collaboration to mutually create the patient's new story: The patient's response will evaluate the effect.
Patients come in for psychoanalysis because they are no longer able to keep their secrets. They can only know their secrets by telling someone else so that they can hear themselves, past and present. A symptom is a secret hiding in the open.
The more someone runs away from something, the more they engage it, and keep coming back to what they run away from. This is why we never have to chase our patients.
Reassembling the present invariably changes the past.
As analysts we enter a domain of intimacy that the patient has never before allowed anyone else to enter, even and especially himself.
Emotional unavailability and frozen silence on the part of the analyst will deadlock the analytic process, and for many patients, this pervasive, passive silence would be a repetition of the parent who said nothing