Meeting of the Psychoanalytic Institute of New England, East

DISCUSSION: Dr. Arthur Valenstein felt that the tumult of the early years of the analysis, during which the patient was quite paranoid, was unavoidable. Patient and analyst had to travel the road together in that mutually dystonic way until the patient gradually achieved a more exact sense of self and correspondingly greater autonomy. Referring to Winnicott's work, Dr. Ana-Maria Rizzuto spoke of the patient's continued testing of the analyst, subjecting him to repeated attacks to see if he survived and eventually becoming convinced that the analyst was there as a real object. Only through that process could the patient develop the capacity to make use of the analyst as a new object to be internalized. Dr. Rizzuto took issue with the description of the patient as suffering from a cognitive deficit. Instead, she spoke of his difficulties in separating from the early representation of the object. She suggested that he had two levels of perception: an internal representation of mother as nurturing, and another of her as murderous, with only the former admitted to consciousness. He could not let himself know about the other level; this resulted in a variety of mechanisms that impaired his cognitive functioning. Dr. Evelyne Schwaber felt that there was a close connection between cognitive disturbances and paranoid moments in the analysis. She added that it was critically important to observe within the analytic hour the transference elements that trigger the cognitive deficit and those that tend to relieve it. Dr. Sheldon Roth also commented on the transference, with special reference to the patient's increasing identification with his father. Dr. Roth felt that this paralleled his decreasing cognitive impairment. Dr. Robert Kenerson and Dr. Jerome Sashin spoke of the considerable amount of "preanalytic" work necessary with this type of patient, in order to prepare him to make effective use of the analytic situation with its emphasis on interpretation. Dr.