Afterword: Response to Neil Altman

I think Dr. Altman's thoughtful and very generous response to my comments is a very good parallel to what happens in the Project's consultation groups. For a variety of reasons and in a variety of ways we are sometimes prevented from thinking about the exceedingly difficult issues that confront us when we sit in a therapy session with these young people. I don't think it's true that Dr. Altman doesn't have an “internal map” for “locating the bad object,” only that something in the relationship with Geraldine made it temporarily unavailable to him. One of the functions of the consultation groups is to provide a collective memory—we can hold outside the hour what can/must be temporarily forgotten in the hour.

This reminds me of a situation in my consultation group in which a therapist became extremely distressed about the behavior of her adolescent patient. She felt that he was becoming so belligerent, irresponsible, rude, and just generally morally reprehensible in all of his relationships that she should call a meeting of all of the (many) adults in his life to try to understand and correct this problem. After listening to her worry about this young man, toward whom she usually responded with empathy and affection, the group members reminded her that both of his parents had died violent deaths in the previous two months. The therapist obviously “knew” this, but the knowledge was too much for her to bear. Her idea of gathering a cadre of protective adults expressed many wishes, including her wanting to demonstrate that “all was not lost” and that she was not alone with this child's grief. The group's capacity to hold this terrible reality for and with her supplied the necessary support to free her to attend to the needs of her patient. These comments merely echo Dr. Altman's sense that with free therapy may come the freedom to think and play which must include thinking about freedom and its inherent constraints.