Letter to the Editor

To the Editor:

It was an unexpected pleasure to receive the inaugural issue of Psychoanalytic Dialogues. As a psychiatric resident worried that psychoanalysis is in danger of becoming an historic relic of interest only to literary critics, I read it straight through, murmuring affirmatives. Dr. Mitchell's editorial philosophy (“respectful yet playful”) seems pitched exactly where the real dialogue between clinicians is. Healing fractures in the “sustained and dedicated effort to discover and articulate personal meanings” is crucial to seeing psychoanalysis and perhaps all psychodynamic treatment safely into the future.

I was alarmed, however, by Dr. Eigen's concluding paper “Boa and Flowers.” While appreciative of his vivid portrait of “Janice” and his impassioned frankness, I know this patient all too well. Janice is the borderline who gives our “neutral” diagnostic term its pejorative connotation. What therapist isn't unsettled by a patient who, with a trail of discarded treaters behind, makes an instant, plaintive, hostile demand to, in effect, “Love me and fix me?” Eigen says, “How tantalized I was with her sense of rightness….” This is precisely what alarmed me.

Irrespective of the countertransference (in the broad sense) elicited by the baldness of Janice's articulate appeal — guilt, inadequacy, rescue fantasies, fury, pity, annoyance, love — to imagine that she is right, that she knows what she needs from a therapist, is a serious failure of empathy that makes the therapist hostage to the very monster (the “boa”) that is strangling her. To accept Janice at her word amounts to “siding with the good side of the split,” which will inevitably result in dissolution of the treatment in the abyss of her need, rage, envy and terror of boundary loss. In is neither cold nor uncaring to say “no” to Janice; in the long run, it is only helpful.

But, as Eigen makes painfully clear, Janice cannot be engaged by “no,” or even his furtive “yes, but….” Perhaps she will m