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Coen, S.J. Harris, D.R. (1994). What are the Boundaries of Psychoanalytic Work. J. Amer. Psychoanal. Assn., 42:1209-1224.

(1994). Journal of the American Psychoanalytic Association, 42:1209-1224

What are the Boundaries of Psychoanalytic Work

Stanley J. Coen, M.D. and Deena R. Harris, M.D.

COEN INTRODUCTED THE PANEL by discussing the need for it. In today's climate of stringent diagnostic criteria for third-party payment, managed health care, and competitive treatments, it is imperative that we recognize the value of psychoanalysis and its adaptability so as not to dismiss a valuable treatment modality. The history in our field of idealization of so-called standard analytic technique has served multiple functions. The analyst has been able to keep his own feelings about a patient manageable by relying on theories of abstinence and neutrality. Difficult situations and difficult patients make the temptation to fall back on rules and theory even greater, although not always with a successful outcome. Coen reminded us that our goal in treatment should be the use of those techniques and processes that best allow the patient autonomy and freedom from internal conflict.

A highlight of Coen's introduction was the point that with difficult patients, we must recognize that there will be limitations to what we can bear to work with and change within ourselves. The analytic task remains that of examining, with the patient, the patient's own conflicts so that he has the best chance to revise his pathological compromise formations. The goal of this panel is to show that analytic work with difficult patients does not abandon basic therapeutic strategies, but rather requires constant assessment on the part of the analyst as to what he and the patient can tolerate. As always, analysis of resistance, defense, resistance to awareness of defense, and transference is the central aspect of our work.

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