Meeting of the Psychoanalytic Association of New York

DISCUSSION: Dr. Stephen K. Firestein was struck by how Miss Joseph's discussion of psychic change, particularly its moment to moment features, captured the essence of the so-called "analytic process." He mentioned his participation in a study group working with tape-recorded analyses, in which one goal was to determine if criteria could be formulated for deciding on the presence or absence of an analytic process. The patient's communication, the analyst's response, and the patient's reaction to the analyst's response at times lead to the deepening of insight, but at other times the analyst and the analytic situation are used by the patient for the gratification of quite different impulses. According to Dr. Firestein, this perspective is in accord with Miss Joseph's emphasis on viewing the total situation. Dr. Firestein noted how Miss Joseph's paper on psychic change "draws us promptly into the core of the psychoanalytic process."

Dr. L. Noah Shaw stated that Miss Joseph's paper on psychic change evoked several questions. What is it that is changing? How does it change? And from a therapeutic perspective, how might that change be facilitated? After citing a brief vignette from a child analytic session in which a young boy recovered from a phobia of bees following one interpretation, Dr. Shaw proposed a number of ways to characterize what had happened. How one would settle this—to understand how the psychic change took place—depends in part on one's theoretical orientation. Miss Joseph's orientation, following Melanie Klein, utilized terminology that can be misleading. She had suggested that Klein's ideas, particularly the centrality of projective identification, are fundamental to our understanding of psychic change. Dr. Shaw commented that we must be both "accepting in order to be receptive to a new and helpful way of approaching a problem," and "cautious to make sure that what we hear is … supported by clinical data and not just an assertion of belief."