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Psychoanalytic therapy is a kind of theater, a dramatic realm defined both by formalized, role-governed behavior and by the expressive participation of patient and therapist (Hoffman, 1998). Within a space that is securely boundaried and provocatively open, the protagonists enact their unique convergences of self and other, past and present, literal and metaphoric. In its power to gather in and enact what is hoped and dreaded, analytic therapy traverses the dialectics of safety and danger, fantasy and reality. Qualities of familiarity and contrast, and repetition and creation, are necessary components of therapeutic action. The skill and inspiration of the analytic therapist are expressed in his ability to enter into, and collaboratively refashion domains of experience that were previously nonnegotiable. In meaningful measure, both patient and therapist follow, and “misread,” scripts originally authored long ago (Bloom, 1973).
I very much appreciate Marc Sholes's response to my discussion of his evocative case presentation. In so strongly and clearly enunciating his theory of therapeutic action, he has contributed to an exchange of ideas, and an engagement of contrasting views (one that I hope has been stimulating to more than just the two of us). Sholes notes that we end up in the same place, an agreement that analytic opportunities (those realized and missed) are shaped in meaningful ways by the analyst's favored participatory-observing modes. I would add a second point of agreement, that working according to the precepts of any particular approach will take unique forms in the hands of different therapists, and in different dyads.
One basic area of disagreement that our exchange has brought out concerns how we think about clinical situations such as the one depicted by Sholes in his work with George. Notice that I refer to “clinical situations,” whereas I imagine that Sholes would likely speak about “working with patients like George.” This divergence in language h