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The editorial intent of this issue was to ask: What, before you apply theory, do you do? What responses establish comfort or discomfort with what you do? What do you do next? And each contributor, with deep reflection and great courage, has found a way to make those questions her or his own.
Any analytic reader with an interest in the evolution and clinical application of contemporary theory will be familiar with Henry Smith, Frank Summers, and Fred Busch. Yet each of these authors found a way—while using concepts as means of communication—to provide (through vicarious introspection) to sit with him as he sits with a patient.
Henry Smith questions our preference “to think [that we plan our] clinical decisions consciously and deliberately” (p. 527) and frames his contribution in the context of enactment. In a detailed clinical vignette centering on a transference interpretation involving a patient’s dream of being chased, Smith makes clear: “I am an active participant in that scenario. In the very persistence of my efforts to facilitate her putting her fantasies into words, I am, in fact, chasing her and cannot not chase her with my own words” (p. 529). He goes on to describe and explore a dialectical process in both patient and analyst—functioning without regard to a specific orientation—of insight and action, each moving away from and yet provoking the other.
Frank Summers calls explicitly on the concept of a dialectical process, “for the analytic therapist [whose] life is lived on the precipice of the various possible intervention categories” (p. 538). Each choice of perception and intervention rules another choice. Summers describes his clinical back-and-forth between listening to associations, noting connections and patterns and the feeling of a gap in the affective relationship which leads him to intervene in the service of a shared feeling of connection. Within the dialectic, he states and demonstrates his priority. “I make my clinical decisions on the basis of w