The Effort to Identify Empirically Supported Psychological Treatments and Its Implications for Clinical Research,Practice, and Training: Commentary on Papers by Lester Luborsky and Hans H. Strupp

The current emphasis on identifying empirically supported treatments (ESTs) can distort psychotherapy research by emphasizing the investigation of treatment in an atypical context, with atypical patients, in a contrived treatment contract. An alternative to comparing the efficacy of different types of therapeutic techniques for treating focal symptoms is to seek to identify the factors that facilitate therapeutic change in various types of therapeutic intervention. The emphasis on identifying ESTs also has the potential for distorting clinical training and limiting clinicians' ability to develop the skills necessary for becoming effective therapists.     

Dances of Desire: Commentary on Papers by Dianne Elise and Jonathan H. Slavin

The richness and creativity of early classical work with dreams became narrowed through doctrinaire obedience to Freud's brilliant hypotheses. Interpersonal psychoanalysis, though originally little interested in problems of mind and private mentation, may be well suited, in part due to its lack of a comprehensive dream theory, to a clinical approach to dreams that is relatively open‐minded, pluralistic, complexly layered, collaborative, and playful. Multiple possibilities for the meanings of dreams and multiple ways of approaching dreams in analytic therapy are suggested. Although many therapists for complex reasons shy away from working on dreams, an interpersonal approach recognizes that several wishes of both patient and analyst may be significantly fulfilled in the pleasures of working together on dreams. If it is mindful of what is unfortunately a growing tendency to project into all dreams a single‐minded preoccupation with transference and countertransference, and if it respects the world of dream imagery in its own right, interpersonal psychoanalysis can make a genuine contribution to our understanding of dreams and dreams can lend an important dimension to interpersonal concepts. Several clinical examples are presented in an effort to highlight an approach that “stays with the image”; and allows the dream images to make their way into the psychoanalytic dialogue.     

Disruption and Desire Discussion: Commentary on Papers by Dianne Elise and Jonathan H. Slavin

Dr. Slavin's and Dr. Elise's paper are discussed, with reference to clinical theory.     

The Interplay of Subsymbolic and Symbolic Processess in Psychoanalytic Treatment: Commentary on Paper by Steven H. Knoblauch

Bucci's model of emotional communication, developed in the context of her theory of multiple coding and the referential process, is applied to Knoblauch's microanalytic report of his experience of the patient and himself and their interactions during a single session of an ongoing treatment. The referential process is a bidirectional function connecting the diverse sensory, somatic, and motoric representations of the subsymbolic system with imagery and words. The process operates partially and to varying degrees within both participants; in the case presented here, the dissociation among systems is severe, and emotional communication within the dyad occurs at first primarily in subsymbolic, bodily forms. Where gaps in the referential process exist for the patient, the analyst's own experience and associations operate to evoke new connections for her; we see this process in moment-by-moment glimpses of the analyst's experience and his interactions with the patient. Gaps in the reader's knowledge, and possibly the analyst's knowledge, of the patient are discussed.     

The Psychoanalytic Other: Commentary on Paper by Helen K. Gediman

Dr. Gediman locates the intersection of modern Freudian and relational theory in the arena of what she calls the “disclosures of everyday analysis” (p. 242). She suggests that because Freudian analysts, like their relational colleagues, work intersubjectively, relational theory does not itself embody a paradigm shift away from the Freudian model. I disagree. Relational theories assume that the analyst's work is inevitably informed by the relational context in a way that precludes clinical certainty. Gediman, however, believes that the analyst is capable of separating her countertransference response from her subjectivity and thus can interpret from a position of clinical certainty. Each set of theoretical assumptions is associated with a somewhat different analytic stance and analytic ideal. Freudian analysts aim for a position of “methodological neutrality” that relies on considerable certainty in the countertransference while giving the analyst plenty of room within which to use her subjectivity. The relational ideal concerns the analyst's capacity to enter into an asymmetrical treatment relationship and to tolerate the uncertainty generated therein.     

Commentary on Papers by Burton and Bonovitz

The author probes bastions in Noelle Burton’s and Christopher Bonovitz’s patients’ unsymbolized experience. Bonovitz and his patient were involved in a mutually created phallic collapse, one in which they are unable to use their minds aggressively and vitally to make sense of things together. Bonovitz gained purchase on a set of conspiratorial feelings he had held toward his two analysts, feelings that were enacted with his patient. For Burton and her patient there was a different kind of bastion in which Burton’s wish to know her patient couldn’t be experienced as something other than impingement. The author argues the value of our openness to reverie not only when patients’ have poorly developed capacities for verbalization and symbolization but more generally as a clinical sensibility to cultivate with all patients.     

Psychoanalysis and Nature: Commentary on Papers by Bodnar and Santostefano

This is a response to papers by Sebastiano Santostefano and Susan Bodnar. The response argues that the psychoanalytic view of constitutive conflict makes any assimilation of analysis and ecology very problematic. Patients may benefit from being in pleasant surroundings outside urban areas, but this is not psychoanalytic work. Psychoanalysis would entail them coming to understand why they are fueled by desires they do not recognize as their own. It would entail them working through how these desires have come to belong to them. Calling these desires natural or unnatural is not helpful, and it may be pernicious.     

Psychotherapy and its alternatives: Commentary on a critique

In this commentary, Michael Rustin reviews the articles in the symposium, outlining their main aims and arguments. He goes on to provide some critical reflections, asking questions about the key concept of the ‘therapeutic state’. He notes that little attention is given to psychoanalytic or other psychological theories of the mind, as distinct from the biological models which are the main object of criticism in the symposium. He argues that just as it is justifiable and useful to take account of theories of the mind in considering issues of mental health and therapy, so it is desirable also to take account of the structures of society which have responsibility for generating conditions of mental well- or ill-being, and to reflect on how these may be changed. The commentary argues that the counter-cultural and somewhat ‘post-modern’ critical approach which informs the symposium can only form part of a sufficient response to the problems which the symposium identifies.     

Whiteness Uncovered: Commentary on Papers by Melanie Suchet and Gillian Straker

In this discussion of papers by Gillian Straker and Melanie Suchet, the author draws some links between the two papers in the interest of expanding analysts' understanding of the nature of whiteness as part of a racist discourse.