Discussion of Charles William Wahl's Article, Psychoanalysis of the Rich, the Famous, and the Influential

There is a wistful element in the problem of prestigious patients. Years ago it was accepted that those patients who were wealthy, famous, or politically powerful were indeed people with influence. Psychoanalysts had to be aware of countertransference in regard to these patients, just as they had to take note of their reactions to the weak, the minority group members, those who arouse special guilt, the sexually seductive, and the relatives of close friends—and, perhaps most of all, the acting-out, talented manipulators of other people, regardless of category.

If patients use their prestige to belittle or bribe the therapist,

it may take a few unhappy episodes for the therapist to learn how this has happened to him. The goal of seeing the patient's problem clearly and conveying insight to him is the only professional one. An example is the case reported by Theodore Reik (1948) in Listening with the Third Ear. This applicant for analysis was wealthy enough to buy all of Reik's time and to be taken as his only patient, but Reik would have to move from Berlin to Vienna. Reik finally agreed to this, with the rationalization that he would thus be freed for research, and gave up the rest of his practice. Although Reik received payment over a period of six months, the patient never showed up.

Pleasant, luxurious surroundings and prominent connections build up self-esteem. A sense of accomplishment builds up the analyst's self-esteem more effectively. The psychoanalyst's self-esteem may be consciously and unconsciously increased in various ways, enabling him to function better than if he felt depleted. His psychoanalytic skill and his degree of ego integration will help determine the extent of his success in helping the patient overcome neurotic patterns in order to be able to continue developing toward maturity. This is a different order of gratification from that of a narcissistic patient who uses wealth, prestige, or influence in the service of neurotic goals, repeated