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Goldberger, M. (1994). Illness in the Analyst. Implications for the Treatment Relationship: Edited by Harvey J. Schwartz, M.D. and Ann-Louise S. Silver. Madison, CT: International Universities Press, Inc., 1990. 347 pp.. Psychoanal Q., 63:360-363.

(1994). Psychoanalytic Quarterly, 63:360-363

Illness in the Analyst. Implications for the Treatment Relationship: Edited by Harvey J. Schwartz, M.D. and Ann-Louise S. Silver. Madison, CT: International Universities Press, Inc., 1990. 347 pp.

Review by:
Marianne Goldberger

Parts of this book should be required reading for all analysts. The issue of illness in the analyst has hardly been dealt with in our literature, and several of these essays are remarkably helpful.

After reading the essays one can no longer deny the reality that psychoanalysts can suddenly become ill and die without any opportunity to prepare their patients. Most analysts will recognize themselves in some papers, as I did, in regard to their own tendencies toward denial and wishes for omnipotence. Very important is the suggestion made by Abraham Freedman that analysts should have a preplanned procedure for saving their patients as much grief as possible in the event of an emergency. He suggests that in a place easily found, probably the appointment book or daily log, there should be information readily available for a family member or colleague. For example, many analysts indicate their patients' names by some kind of code in their appointment books, and therefore it is essential that a decoder be easily available. Freedman also makes the point that psychoanalysts should make provision in their wills for the disposal of patient files.

The necessity for such preparations is shockingly demonstrated by Stephen Firestein's research into the fate of fifteen patients whose analyst or therapist died. The general tendency of analysts to deny the seriousness of their conditions and to rationalize delay in informing their patients was clearly shown in his study. Firestein makes the specific, very important suggestion that "as part of usual practice managment an analyst or therapist develop an understanding with two trusted friends that they will intervene if the analyst (1) shows signs of impairment in his work life; or (2) experiences sudden total incapacitation, or dies" (p. 338).

Firestein, in a separate document, has made explicit the need for a "professional will" and has proposed terms for such a will.

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