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Lenoff, L. (2015). Epilogue: The Patient’s Contribution to the Co-construction of Clinical Theory. Psychoanal. Inq., 35(3):325-326.

(2015). Psychoanalytic Inquiry, 35(3):325-326


Epilogue: The Patient’s Contribution to the Co-construction of Clinical Theory

Lester Lenoff, MSW, LCSW

Looking back, this issue is written largely in the language of object relations. The term dissociation appears 15 times through the texts, in contrast to repression, which appears only once. Even then Rafael Ornstein uses it only as one of a variety of forms of disavowal. What is more, object relations language is used in the anticipation that the reader is already fluent. I have identified, as well, an implicit persistence of a self-psychological stance of vicarious introspection (Kohut’s “empathy,” 1959, pp. 205–212). As conceptual frameworks, self-psychology and object relations theory diverge in irreconcilable ways. But clinically, in these articles, each author takes a stance that privileges the patient’s subjective experience of the past, the present, and the treatment. Object relations theory has achieved a recognized, even preeminent, position in contemporary psychoanalysis. But it has been suggested that along with the recognized contribution of Kohut’s clinical innovations are now taken for granted in clinical psychoanalysis by therapists, analysts, and writers unaware of their origin. These articles bear witness to that.

Margi Kaplinsky and Shulamit Geller propose sadomasochistic enactments as a core dynamic. And they conclude, “The return of suffering is ensured” (p. 245). Both these assertions would seem diametrically opposed to Kohut’s (1959) ideas. But even within this context, the patient’s subjective experience—the self-perpetuating cycle of one-up and one-down—rather than metapsychological elaboration remains their central concern.

[This is a summary excerpt from the full text of the journal article. The full text of the document is available to journal subscribers on the publisher's website here.]

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