Meeting of the Psychoanalytic Association of New York

January 30, 1984. PEER REVIEW, THIRD PARTY PAYMENT, AND THE ANALYTIC SITUATION: A CASE REPORT. Howard S. Rudominer, M.D.

Dr. Rudominer reviewed the rather meager literature on peer review and third party payments and then discussed whether or not analysts should write peer review reports. He concluded that the reports need not compromise an analysis; they might even facilitate various aspects of the analytic process if both transference and countertransference are properly analyzed. The technical aspects include how and when to discuss the reality of the situation with the patient. An important aspect is that the analysis continue long enough after this intrusion to attempt to fully resolve the dynamic issues stimulated by the situation. Dr. Rudominer frankly discussed the analyst's reactions, both from personal experience and from the literature. He then presented a detailed case report of a thirty-six-year-old divorced woman who came into analysis because of episodic depressions, loneliness, and repeated sadomasochistic relationships with men. After she had been in classical analysis for over a year and a transference neurosis and a good working alliance had developed, Dr. Rudominer received a request for a peer review report. He felt both pressured and dismayed. He wrote a detailed narrative report and, in a general way, told the patient the contents. It was then not mentioned by either patient or analyst for the next five months. The receipt of a request from the APA for a presentation at a forum on the topic jolted Dr. Rudominer into realizing that he had unconsciously colluded with his patient in avoiding further analysis of this issue.

Analytic attention was now turned to this subject, which led to the patient's association of the insurance company with her mother—a depriving mother who would always follow any good and nurturing act with something designed to make the patient suffer. This exploration enabled the patient to uncover the hatred and r