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Sulkowicz, K.J. (2000). Discussion of Dr. Stilman's Case. J. Clin. Psychoanal., 9(4):560-567.

(2000). Journal of Clinical Psychoanalysis, 9(4):560-567

Discussion of Dr. Stilman's Case

Kerry J Sulkowicz, M.D.

It's a pleasure being here to discuss this wonderful case. Before I speak about the analysis, I first wanted to say a word about the report itself. It's a treat to read such a well-written case, which brings to life the patient, the analyst, and the work they have done together. I want to congratulate Dr. Stilman at the outset on an artfully and thoughtfully done presentation.

The first time I read through Dr. Stilman's report, I started to get worried. I thought that I would have little or nothing to add to the discussion, and that I would merely say what analysts tend to say about all cases these days, which is that it is obviously a difficult patient who will need more years of analysis. This, of course, might be a true statement, but as I reread the case, I came to the conclusion that my initial reactions—which I don't usually have—might be telling me something about Mr. X. Within the atmosphere of solid, painstaking analytic work going on, and despite the oscillations between Mr. X's reflectiveness and defensiveness, I was sensing what seemed to be one of the basic difficulties in the analysis; namely, an affective distance and wall of narcissistic protection that led the analyst to feel frustrated and the patient to feel that not enough progress was being made.

I have a few ideas and questions, and even one or two technical suggestions, but I want to begin by mentioning an image from Dr. Stilman's report that kept haunting me as I thought about Mr. X. It is her literary reference to his imperturbably, Panglossian, “All is for the best in the best of all possible worlds,” demeanor. It had been a while since I read Voltaire's Candide.

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