Summation of Discussions

We have three discussions of Alan Kindler's case of Joanna Churchill by three outstanding clinicians, each of whom is identified with a specific contemporary theoretical model.

Did the three discussants differ in any substantial way regarding (1) their understanding of the central nature of the patient's psychopathology, (2) the primary clinical data that they selected in order to develop their case discussions, and (3) their recommendations for the ideal technical interventions. In my opinion, they did not. All three understood the patient's disorder as a pathologically organized self suffering from feelings of worthlessness and lack of confidence, damaged by the pathogenic early influences of both parents. They employed different evocative language to describe the problem, but they meant the same thing. They all saw the patient's seductiveness and demands for physical contact as erotization of a basic underlying need for acceptance and relational connection. They described it differently: Stolorow as an antidote to her invariant organizing principle, Fosshage as the use of sensuality to achieve affirmation of her self-worth and femininity, and Ornstein as sexualization of the wish for merger and mirroring. All three discussants saw it as imperative that the underlying motivation for the erotized behavior be discussed, which had not occurred. They all picked up on the ritualized need for reassurance as the central transference—countertransference dynamic, and all believe, as a matter of principle, that these dynamics are co-created by the dyadic pair. They alll said that bringing the reassurance ritual into the clinical dialogue, rather than through enactment, was essential to moving the treatment forward. All three discussants are self