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In an age when there is an increasing emphasis on the importance of research in relation to analytic work it is extremely helpful to come across a paper that combines both research and analytic thinking in relation to the therapeutic relationship. It is doubly important when this research brings together both a scientific understanding of the anatomical and neurobiological processes of the mind with an analytic understanding and use of unconscious processes such as transference.
This paper, published in 2006, is groundbreaking in a number of ways. Firstly it is one of the first published accounts to consider neurological patients with amnesia in psychoanalysis and secondly it combines exploration of the anatomical and neurological aspects of the brain in relation to amnesia and severe memory loss with consideration of the dynamics of the transference relationship within psychoanalysis.
The focus of the paper is the clinical work with patient Mr N carried out by Kaplan some years previously. The original reports of the sessions are considered in terms of the presence of emotional related material in spite of the fact that there is no episodic recall (p. 200). The patient, who had previously been a gifted pianist, suffered a spinal injury following an accident and then later a cardiac arrest which resulted in ‘severe and stable amnesia’ and quadriplegia. The clinical work described covers weekly sessions over an 8-week period and during this time it was apparent that Mr N could remember his childhood but not more recent memories.
From the descriptions of the sessions two key areas of emotional memory and expression are evident. Firstly, the paper describes Mr N's expression of distress at his situation and his dependency, especially in relation to his father when he has to help him perform a suction procedure. And secondly, and more pertinently in relation to the focus of the paper, the development of an emotional rapport and sense of trust and safety with the analyst in