Discussion: The Several Relationships of Theory and Practice

The question of how theory affects practice is fundamental to psychoanalysis. Repeatedly addressed in our conferences and our literature, it has led not to an answer but rather to an evolving dialogue that reflects the changes in psychoanalytic discourse and practice over the years. Freud himself was both a theoretician and a practitioner, and we are still debating whether his theory led to his practice, was derived from his practice, had more to do with nineteenth-century scientific ideology than with clinical psychoanalysis, was strangely disconnected from his practice—or whether, paradoxically and to varying degrees at different times—all of these have been true.

The ten contributions from psychoanalysts assembled here from around the world discuss several different types of theory. Some speak of the formal, public theories of psychoanalysis— those that are presented in our textbooks, discussed in our journals, and often associated with the names of leading thinkers in our field. Thus, we have Busch on structural theory, Smith on conflict theory, Ornstein and Ornstein on self psychology, Hirsch on Sullivan's interpersonal theory, Blevis and Feher-Gurewich on Lacan, and Ferro on Bion. Others emphasize the private theories that, although sometimes out of the analyst's conscious awareness, nevertheless mold his or her stance and approach (Michels 1999). Fonagy discusses Sandler's (1983) distinction between public and