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Skolnikoff, A.Z. (1998). The Patient's Impact on the Analyst. By Judy Leopold Kantrowitz. New York: The Analytic Press, 1997, 332 pp., $47.50. J. Amer. Psychoanal. Assn., 46(4):1276-1279.

(1998). Journal of the American Psychoanalytic Association, 46(4):1276-1279

The Patient's Impact on the Analyst. By Judy Leopold Kantrowitz. New York: The Analytic Press, 1997, 332 pp., $47.50

Review by:
Alan Z. Skolnikoff

This is an important book in the evolution of our conceptualization of the analytic process. Many of us are already convinced, through reading Chused, Jacobs, and McLaughlin, about how often and how much patients have an impact on their analysts. As the author states in her introduction, this has not always been the case. Until the 1980s, most analysts focused on an intrapsychic model in understanding the analytic process. It was assumed that a well-trained analyst was able to remain neutral, having resolved in the training analysis any conflicts that might interfere with a capacity for analytic work. It was presumed that if these conflicts reemerged In work with patients, the analyst would resume analysis. So we focused on the intrapsychic life of the patient, paying little attention to the analyst's reactions. At most, one described countertransference signal affects, implying that the analyst could gain information about the patient's dynamics from these signals without being drawn into reactions. Over the past twenty years, however, increasing attention has been paid to an interactional model in describing the psychoanalytic process. Without shifting away from the basic study of the patient's intrapsychic processes, we understand that the interchange between patient and analyst, including the analyst's spontaneous emotional involvement and/or reactions to the patient, is the focus of attention.

Kantrowitz, in her previous work, has been one of the principal researchers in the study of psychoanalytic process and outcome. Through a series of measures of patient and analyst in the evaluation phase, the analysis proper, and after termination, she has conceptualized the therapeutic action of psychoanalysis. More recently, she has shifted her study to the subjective reactions of analyst to patient. This descriptive research has been based on her experience discussing cases with colleagues, on supervision, and on introspection.

The present book is based on a survey of four hundred graduate analysts (two-thirds of whom are training and supervising analysts), written clinical illustrations by two hundred of these analysts, and telephone interviews with twenty-six of these. She focuses on how these analysts, once their training was finished, came to recognize aspects of themselves that required more self-scrutiny, particularly concerning how work with patients stimulated this self-analytic process.

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