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Recently, on three separate occasions during conversation with colleagues, I was astonished to hear them make inappropriate disclosures of patient identification or material. It was the more surprising since I knew all of them to be excellent clinicians—experienced, conscientious men who took their Hippocratic responsibilities very seriously. Not one of them seemed to be aware of the inappropriateness of his communication and, most significantly, in each instance the indiscretion related to a person of celebrity or influence.
This set me to thinking about the analysis of the rich, the famous, and the influential, and to consider some of the special characteristics in the analysis of such patients and of the transference and countertransference that can be evoked therein. I began also to look more deeply into what has been my long-standing clinical impression, that many more patients in these three categories had had incomplete, ineffective, or unsatisfactory analytic experiences than any other category of patient.
I remember some years ago having been told by a famous man who had been unsuccessful in two previous therapeutic efforts and who was now my patient, “Both of the doctors were more like friends than doctors. They fawned on me, seemed to want to know me as a friend, and one of them even asked me for an autograph for his daughter.” As this third analysis progressed, it became clear that one of the reasons this patient had failed to form a working imago transference in his previous analyses was that an examination of the factors
which evoked such interplay in the analyst-patient relationship had been neglected.
In a general consideration of why such patients so often fail to receive a good therapeutic result in their analyses, several factors suggest themselves. Among these it is probably not without significance that our work, uniquely among the specialties of medicine, is intensely solitary in character. Its triumphs and defeats, difficulties and achievements