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To the Editors: Dr. Joseph's thoughtful and interesting comments raise old and crucial questions dealing with definitions of clinical psychoanalysis and psychotherapy. Ascribing his viewpoint to Freud, he defines the essential psychoanalytic concepts to be those of the unconscious, repression and transference, and he states that concepts such as object relations are subsidiary.
Viewing clinical psychoanalysis thus, he finds it difficult to understand my technical approach to the treatment of schizophrenics within the framework of the structural theory. He finds my approach to involve the considerable use of parameters. Although he does not spell out what he means in this regard, he then infers that such employment of parameters is implicit in alleged procedures which distort the development of transference relationships. He
states that communication of one's own moral philosophy to patients is not analytic, although he does not say in what manner it would be possible to avoid doing just that, albeit implicitly. Without clearly defining what reality he has in mind, but suggesting that he means external reality, he states that technical procedures can be called psychoanalytic only if they are directed to interpretations of defense and resistance and not of reality. He does not state how one can interpret defense and resistance without alluding to a changed concept of reality.
In my understanding of the structural theory, the concept of object relations, far from being subsidiary, is of vital significance. Aside from factors inherent in the maturation of the nervous system, the ego is differentiated as the result of structural elements—some would prefer to say functional elements, but I do not wish to enter into a discussion of these matters here—which have resulted from identifications; such identifications are products of object relations. As I wrote in the paper, “The structure of the ego and superego results from the interaction of inborn and socialization