Meeting of the Psychoanalytic Association of New York

DISCUSSION: Dr. Martin Silverman focused on the patient's improvement as being prompted by her using Dr. silber as a new object with whom she could go through the developmental steps necessary to ego mastery and growth. Dr. Silber had recognized that the patient needed him at first to serve as a "facilitator of ego development" and had filled the role of a "parental, auxiliary, facilitating external ego" that her mother had not been able to fill. As trust in her analyst grew, the patient allowed herself to regress "back to an approximation of the ego-forming experiences with her mother which had been unsuccessful." Citing Mahler, Dr. Silverman spoke of the crucial role of the mothering person in helping the child to master experiences of "physiological and emotional disequilibrium [that] lead to affectomotor storm-rage reactions." Dr. Silber's patient had not developed an internalized ability to maintain her psychological equilibrium. Her reliance on external sources of self-control may have accounted for the fact that her neurosis became manifest when she moved away from a familiar environment, as well as for the fact that her first attack occurred when her analyst was away. Dr. Silverman viewed the attacks in part as "courageous returns to the scene of early mother-child interactions, with a new and better mother this time," so that basic ego building could now be achieved. Dr. Richard Yazmajian felt that Dr. Silber's discussion of the working alliance with this patient had addressed only the conscious rational components of that part of the therapeutic relationship; it had not dealt with those aspects that have their roots in persistent irrational childhood fantasy. For example, because of the instinctualization of Dr. Silber's verbalization and of the patient's, he felt that Dr. Silber's comments had a hypnotic quality; he wondered whether the patient had been under the influence of a subtle hypnotic suggestion when she calmed down in response to his co