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For the clinician as for any parent, having a child with cognitive disabilities heightens one's sense of vulnerability and insufficiency. One is confronted with unbearably intractable limits, which generates doubt about one's therapeutic potential. The ability to empathize with a parent's distress is crucial, but only the starting point in treating a patient whose child is disabled. What may be most constructive is the dialectic between the analyst's relative detachment (involving compassion but also a willingness to dredge up disavowed negative feeling) and the parent's attached dismay. Lacanian and existentialist theories remind us that, whether normal or handicapped, we are all existentially in a state of lack. This perspective provides a useful touchstone for analyzing the experience of disability in one's own life and that of one's patients.
In further response to Lauren Levine's paper, it is argued that it is tricky to prove (beyond showing that a training analysis promotes maturation in the broadest sense) that a given aspect of an analyst's own personal analysis resulted in the capacity to heal a particular patient. The point can be made most persuasively when the actual analytic exchange, messy and circuitous as it may be, is offered in great detail.