Meeting of the Psychoanalytic Institute of New England, East

October 29, 1984. PANEL: RECONSTRUCTION REVISITED. Axel Hoffer, M.D., Moderator, Henry Smith, M.D., Ana-Maria Rizzuto, M.D., Robert Pyles, M.D., Evelyne Schwaber, M.D.

Dr. Henry Smith noted the many connotations of the word "reconstruction" in the literature. Illustrating his discussion with several case examples, he used the term in its most general sense to refer to a mutual undertaking of patient and analyst to reconstruct the history and experience of the patient. The primary emphasis of those who have written on reconstruction falls somewhere between the poles of objective past experience and the subjective perception of that experience. It is difficult to know in any situation "what actually happened." The existence of an illusory component of perceived reality and of remembered experience is neither a new idea nor one limited to the field of psychoanalysis. Theoretical physicists also make linking constructions to fill in the gaps in our conception of physical reality. Ernst Kris wrote that the further course of life seems to determine which childhood experiences gain significance as traumatic. An illustration for the interrelation of fantasy and reality is Arlow's model of a translucent screen with movie projectors on both sides, one projecting the conscious perceptions of external reality, the other simultaneously projecting images of unconscious fantasy. The composite of the two images represents subjective, or psychic, reality. For some patients, one projector seems to dominate the other. The analyst must balance his or her attention to these images in order to note the relative absence of one image in the patient's experience of reality. There are certain patients for whom the therapist needs to pay particular attention to the images from the reality side of the screen. Among these are patients who have been physically or sexually traumatized, patients whose families have used considerable denial of reality, and adolescents (among them woul