Discussion

First, I want to thank Dr. Shelley Doctors for letting us hear her vibrant account of Rachel's struggle and Dr. Marsha Levy-Warren and Dr. Susan Warshaw for their thoughtful reflections on this fascinating case presentation. Next, I would like to briefly summarize some of the theoretical and technical differences that have been expressed by the panelists, and finally I hope to try to move us toward common ground by addressing the concepts and approaches I believe all three panelists share.

Dr. Shelley Doctors' approach to her work with Rachel clearly reveals Kohut's self-psychological modifications of analytic theory. She permits Rachel to use the analyst as a self-object, and uses technical strategies (primarily mirroring and empathy) that her theory predicts will advance Rachel's ability to develop and maintain a self apart from her parents—intrapsychically as well as in her relations with her family in the real world. In fact, Dr. Doctor's clinical work adheres so exquisitely to self-psychological percepts, that the sessions appear almost seamless, as Rachel's life unfolds in the treatment hour.

Nevertheless, Dr. Warshaw, while admitting that it is hard to quarrel with success, expresses her concerns about whether Dr. Doctors' self-psychological focus is sufficient to the therapeutic task that Dr. Warshaw would envision. She wonders, for example, if Dr. Doctors' unconditional positive regard for the patient's perspective is blocking what she calls the “active inquiry around a full range of meanings between patient and analyst”—an inquiry that Dr. Warshaw would see as essential to her relational approach. Dr. Warshaw is also worried that the empathic immersion that Dr. Doctors works to achieve in her treatment with Rachel, may actually curtail the type of neutrality that Dr. Warshaw feels is necessary to her relational perspective. Additionally, Dr. Warshaw is concerned about what