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Chused, J.F. (2000). Discussion of Dr. Epstein's Case. J. Clin. Psychoanal., 9(4):440-443.

(2000). Journal of Clinical Psychoanalysis, 9(4):440-443

Discussion of Dr. Epstein's Case

Judith F. Chused, M.D.

Kathy is a masochistic single female whose determination to demonstrate that she is victimized by everyone, herself most of all, has been clearly represented. I can add nothing to her analyst's understanding of the patient's dynamics. Dr. Epstein knew well what was going on between them, was careful not to get drawn into either retaliating or withdrawing when the patient attacked through her suffering, and repeatedly was able to communicate her observations of their moment-to-moment interaction through clarifications and interpretations. As we have heard, the patient got better—albeit slowly and painfully—with the pattern of two steps forward and one step back repeated again and again. Dr. Furer has talked of the ways in which our technique has changed; as he has pointed out, our increased awareness of the nonverbal communications that take place between analyst and patient, that travel both ways, has alerted us to how what we analysts do and say takes on meanings to the patient of which we are unaware. I believe what he has said is true in this analysis. I don't know if I would call it an enactment, for I am not sure that Dr. Epstein was responding out of unconscious conflict. For me, an enactment requires that a patient's attempt to actualize a transference fantasy elicits a countertransference reaction. Enactments are symbolic interactions that have unconscious meaning to both therapist and patient and occur when a patient's behavior stimulates something unconscious in a therapist, which leads the therapist to behave in a way he had not anticipated, which he does not fully understand, and which he often considers not “therapeutic.”

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