Response by Herbert A. Rosenfeld

My paper was to clarify the transference problems of the acting out patient and to show that technique depends on clearly understanding the underlying causes of the acting out. Dr. Greenacre, who is herself greatly interested in the problem of acting out, feels I have not sufficiently discussed the technical procedure. I advocate bringing the problem which causes the acting out into the transference on the right level, for instance, a patient may act out by grossly promiscuous behaviour, which might be diagnosed as a defense against bringing his oedipal conflict into the transference. But detailed scrutiny of the patient's behaviour often reveals the acting out to be a defense against his early infantile dependency on the analyst-mother. In order to diminish the acting out, it is necessary to bring into the transference the exact details of the way the patient turns away from his dependency on the analyst as the feeding mother.

Dr. Kanzer criticizes the terms I use and among other points stresses the tendency of the acting out patient to manipulate the analyst. To invent new terms is a difficult task and in order to avoid confusion I defined as clearly as possible what I mean by partial and excessive acting out. In Psychotic States, I describe in much detail the manipulating and controlling behaviour of some acting out patients who exert strong pressure on the analyst, trying to draw him into acting out. Acting out behaviour is seldom an exact replica of the early infantile situation; patients often use their later experiences particularly their ego activities to act out the aggressive turning away from analyst-mother. These patients are particularly afraid of understanding their acting out in the transference, because they fear they will be faced with almost total regression during the analysis, as I described.

Dr. Grotstein stresses the tendency of manic acting out to diminish when the patient becomes able to face his guilt and depression. Dr. Grotstein emphasizes t