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In clinical analysis, the patient is asked to report his or her thoughts with unusual honesty. Clearly, a corresponding honesty is called for from the analyst. There is a great deal of controversy in our field concerning the issue of self-disclosure—i.e., the question of what it is useful for an analyst to say to a patient—but I think there is general agreement that whatever an analyst decides to say, it should be honest. At any given moment, an analyst may choose not to share all of his or her thinking with a patient. However, an analyst should not deceive a patient, either by omission or by commission.
The problem is, of course, that there are important limits to how successfully we can avoid deceiving our patients, no matter how well intentioned we are, because we deceive ourselves; and we cannot help passing on our self-deceptions. Consider the following clinical experience that I had some years ago.
Leon was a young man who was terribly hemmed in by obsessions and compulsions of all sorts. He spent the better part of every day preoccupied with intrusive, nonsensical thoughts or executing various rituals. After two years or so, our analytic work together had gotten to the point at which we were able to understand that these activities served to prevent Leon from being aware of violent, sadistic fantasies that would come to his mind and disturb him very much. This timid and inhibited man was inwardly boiling with rage, often in response to apparently trivial events. A female coworker would close a window he had opened and he would imagine grinding his heel into her face.
The question for us had become why Leon was so prone to fury, especially to fury at women; and here we were stuck. He had certain grievances toward his mother, and we had gone over these. Something in