Epilogue

All of the Discussants, and probably all of us, resonate with Jill Scharff and her feelings of frustration, disappointment, and impotence that can be generated in difficult treatment engagements. We have seen a sweeping array of theories, understandings, assessments, and treatment recommendations. With Scharff's clinical material serving as the centerpiece, I wish to close by highlighting, ever so briefly, specific theoretical nodal points and, more particularly, by focusing on the theories of therapeutic action and the treatment recommendations of each discussant.

From his perspective of compromise formation theory. Arnold Rothstein views the patient's and analyst's conscious fantasies and behaviors as “related to and derived from complexes of unconscious fantasies.” In addition to drive derivatives, trauma or relational experience influences unconscious fantasies. Conflict is viewed as omnipresent and interminable with shifting multiple determinants. Interpretation and insight are the primary avenues to change. Viewing Ms. Ambar's sadomasochistic character trail as central, Rothstein felt that Jill Scharff should have been more firmly interpretive of Ms. Ambar's sadism.

When addressing change factors, Rothstein also speaks of the importance of the analyst's love of the patient, which includes the analyst's commitment to help, to tolerate, and to understand the patient's sensitivities and aversive responses. Also included is the analyst's willingness to endure the patient's sadistic attacks and to be disturbed by the patient. When Rothstein refers to the analyst's love of the patient, he is referring to new relational experience or, in Scharff's terminology, a new object relationship as a major agent of change. When discussing therapeutic action, however, he seems to back away from the new relational experience and return, instead, to a primary (and traditional) emphasis on interpretation and insight.