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Steven Stern has proposed an integration of what Mitchell (1988) has labeled the relational-conflict perspective (Stern's Paradigm I) and the developmental-arrest perspective (Stern's Paradigm II). Although his undertaking is a laudable effort in which we share an interest (Tansey and Burke, 1989; Burke and Tansey, 1991), we find ourselves in strong disagreement with both the theoretical and technical implications underlying his argument. We focus our objections on three main points: his distinctions between “needed” versus “repeated” relational patterns; his extension of the concept of projective identification; and his conceptualization of his “true integration.”
Our clinical experience has led us toward an ever-increasing appreciation for the complexity of the therapeutic exchange and the simultaneity of “needed” and “repeated” dimensions of the therapeutic relationship. Although Stern mentions an “interweaving” in passing several times, fundamental to his argument is a sharp dichotomy between old, pathogenic, inauthentic, repeated therapeutic relationships requiring “mastery” and “transcendence” on the part of the analyst and new, healthy, authentic, needed therapeutic relationships that the therapist must strive to provide. In a clinical example used to illustrate his understanding of the “complex interweaving,” he describes his patient as alternating between an “unappealingly needy and whiny” presentation and one that is “appealingly vulnerable, forthright, and expressive.”