Commentary on Case

Analysts who present detailed accounts of their work for other analysts to comment on are, in my opinion, the great heroes and heroines of the contemporary psychoanalytic scene. So I want to begin by expressing my appreciation for Dr. Ornstein's article and my admiration for her thoughtfulness and openness. This is obviously excellent work of a highly skilled clinician. The patient seems to have benefited enormously; the formulations are cogent and persuasive. I found myself agreeing approvingly with most of it. In many respects, it seems presumptuous for anyone to attempt to second-guess any of it, especially for anyone, like the rest of us, who was not even there when it was all taking place. Nevertheless, agreement is usually much more boring than differences, and for our purposes here, it seems most useful to highlight the latter.

I also want to make it clear that I recognize that the actual work is always much richer and more complex and includes a great deal more than any case report can convey. Therefore, in what I am about to say, I think of myself, not as commenting on the clinical process per se, but rather on the necessarily reductive report on that process as organized through Dr. Ornstein's theoretical perspective. All theoretical perspectives are inevitably reductive in this sense. I think there are important differences between Dr. Ornstein's conceptual framework and mine, and my reactions and associations to various features of the case reflect those differences. They lead me to be more interested in certain features of the material than she was, less interested in others, and interested in some of the same features in a different way.

The most important differences, it seems to me, have less to do with concepts of aggression per se, about which, I believe, Dr. Ornstein and I largely agree. Where we diverge more significantly is in terms of