Response by Ian Alger

I am pleased there is controversy. And I am glad that Drs. Natterson and Winnicott encourage me to pursue these studies further. There is one issue which runs through all the discussions and is related to the fact that I am attempting to understand the reactions of both the patient and the analyst in the light of a different theoretical framework; namely, that of communicational field theory, whereas many points in the discussions relate to another theoretical model.

In the therapeutic session I believe that no reaction of either the doctor or the patient can be understood apart from the behavior of the other. In this understanding there is no separate “emotional life” of the analyst as talked about by Dr. Aronson. The analyst has emotional responses which are communicated to the patient. The problem for the patient arises not because of this, but only if such communication is in some way denied by the analyst. It is this kind of double yet contradictory message which leads to symptomatic behavior and “resistance.” The helpful aspect of the analyst's confirming the patient's perception is that this clarifies the contradictions. It is true that this is not all there is to it, and as Dr. Lipton points out, there are historical determinants in the patient's past which indeed may now become more available for analytic understanding.

Dr. Natterson also mentions the importance of the causative factors and expresses concern that the method advocated might lead to the patient's using it as a rationalizing resistance. This kind of reaction is, of course, possible, but could also be dealt with by dynamic interaction and understanding in the therapy session.

Dr. Natterson also touches on the basic theoretical issue when he speaks of the patient being more the center of the field than the analyst. Actually, it is true that the reason for the analysis itself is based on the patient's complaint about the way his life is going; but it is necessary to distinguish this main purpose