Despite the fact that I was chair of Panel II, which gives me a bias view, I nevertheless think it was an extremely provacative presentation and that two very different and vital discussions were presented. The case presentation by Nancy van der Heide, PhD, entitled "The Sexualized Transference as a Vehicle for Transformation: Hope for a New Beginning", depicted her ongoing analytic work with a male patient where the erotic sexualized transference was in the foreground. Dr. van der Heide struggled with a very major decision: whether to interpret the transference or, as she chose to do, make use of it and the continuing implications for the interaction in the analytic treatment that it involved. This meant that she chose consciously to "wear the attributes" not just for a short interaction but, in my opinion, almost continuously.

Her patient, Josh, an attractive man in his mid forties, had been according to Dr. van der Heide, handled with contempt and rage by his mother. In addition his mother used him in a seductive manner to provide needed mirroring for herself. Josh thus learned, through pathological accomodation, to be present for the needs of a female in order to establish a sense of inner regulation and safety for himself and to gain a feeling of "self-worth, of being loved and accepted". During the first year of treatment the topic of power played a major role in the analytic interaction. This changed radically in the second year where Josh "portrayed himself as a little boy infatuated with an omnipotent and unobtainable Goddess." In this part of her presentation Dr. van der Heide provided the audience with 4 pages of process notes. During the middle of the second year of treatment there was again a switch, Josh was no longer only the little boy, but became a stronger, more vital male. His fantasy entailed visions now of 'Lancelot and Guenevere.' During the next phase of analysis Josh envisioned that Dr. van der Heide was just like his mother, i.e. she was the needy one in the dyad and it was his responsibility to provide her with support for her fragile self. "On the one hand, he wanted in some way to force his way through my denial and fear of sacrificing my stable but mundane existence for a more fulfilled life as 'his woman.' On the other hand, he felt a desperate need to escape the palpable sense of revulsion and a contempt for my neediness and terror of my suffocating feminine wiles."

In her concluding remarks Dr. van der Heide maintained, "I have treated the sexualized transference held by Josh as a major source of information and as his way of expressing his experience of relatedness. The transference held by Josh proved, in fact, to be the primary window onto a world of possibilities for selfobject experiences, both archaic and mature. The reltionship was the primary source of information concerning many of Josh's dynamics, including organizing principles and the self-other configurations that play an influential part in Josh's intrapsychic and interpersonal life. The selfobject aspects of the transference that emerged enlightened him as to the nature and legitimacy of some of his deepest needs for safe self-expression, positve mirroring, and a calm, reliable environment in which his truncated attempts at development could begin anew. As Josh surmounts more of his distress about depending on a needed other whom he expects will scorn him for or take advantage of his vulnerability, and recognizes more fully the dangers hidden in that which he so persistently seeks, his ability to make use of what I do have to offer him continues to grow stronger.

The first discussant was Dr. Hans-Peter Hartmann from Germany. He began by using an observation made by one of his teachers, Dr. Christel Schöttler, who said regarding the treatment of difficult cases such as this one, that there can be no development without involvement. Dr. Hartmann's psychodynamic view, based on his knowledge of infant research, was that the failure of Josh's mother to provide early affect mirroring, as described by Gergely and Watson (1996), was a major source of Josh's problems. Dr Hartmann pointed out the difference that Fonagy et. al. mean when they use the term "affect mirroring" as compared to the Self Psychological use of the term "mirroring." This form of mirroring indicates that the caregiver not only understands but can show that it swings emotionally (often in an exagerated manner - pretend mode) with the infant or child. The child can notice the difference, feel understood and safe (because the infant learns that the caregiver does not necessarily have the same affect and is not overwhelmed by this affect) and thus the feeling i.e. the affect is mirrored or marked. According to Hartmann, because Josh's mother suffered from alcohol abuse and had a borderline personality, she probably "was overwhelmed by the negative affect. . .and (thus) congruent affect mirroring occured without markedness. When confronted with the distress of their infants, such mothers tend to express the same affect in a realistic way, and not marked. The child therefore does not develop secondary representations of his/her primary emotional states which results in deficits in self-perception and affect control." Hartmann maintains that such experiences tend to be repeated in relationships that are formed in the adult lives of such children.

Dr Hartmann shows how difficult it was for Dr. van der Heide to continuously "wear the attributes" by demonstrating from the process notes how the patient said "Right now I almost feel loved by you," and Dr. Van der Heide answered, "I think you are experiencing what it is like to feel loveable." In this sequence Dr. Hartmann felt a "now moment" was missed that could have been used in a moment of meeting. I think perhaps this shows how difficult it is for us, as analysts, to wear the attributes and that at certain times we need to help ourselves and/or our patients by using what Fosshage calls an "other" perspective, another way of seeing something, from another vantage point.

In his concluding remarks Dr. Hartmann shows the specificity in this treatment of the male patient - female analyst dyad. What occured in this analysis could never have happened with a male analyst. Presumably this was why Josh picked Dr. van der Heide out after seeing her give a lecture instead of a male analyst. In an amusing thought, Dr. Hartmann compares this treatment to the stereotyped depiction of analysis in American films as studied by G.O. and K. Gabbard. The male patient heals the female analyst by their falling in love with each other. Fortunately, Dr. van der Heide did not fall into this cliche but was able to work with the sexual transference to provide major psychic development for her patient.

The second discussant was Dr. Ken Corbett, who provided a humorous yet critical vantage point to the discussion. He picked up where Dr. Hartmann left off, i.e. the stereotype dyad of the meeting between Dr. van der Heide and her patient. He pointed out how Dr. van der Heide used the sexualized transference not as a resistance but as a possibility for "hope," seeing the leading edge of the transference configuration rather than the defense mechanism.

Dr. Corbett commented on his view of the central issue in Josh's development and in the treatment process which is the dialectical tension within Josh, and within the dyad with the analyst, of Josh's desire to be big, i.e. not small, and the opposite, to be small and not big. To be big, to be phallic, to be a man, "to keep that power (to stay big) requires the denial of smallness and the pleasures of smallness. . .." Dr. Corbett pointed out how, in the course of the work, these issues were often in the foreground. The feelings of adequacy and inadequacy, or as Dr. Corbett put it "the boy's paradoxical experience of being both enough and not enough" were central to Josh's life. Thus, for Dr. Corbett, the issue was often that of power or the imbalance of power. Dr. Corbett showed how he thinks Dr. van der Heide assisted Josh, when she had the power, to become more aware of what he felt. She renamed his fear as shame, his abject smallness as his wanting, his confusion about dependence as a lack of the experience of being loved for what he is. Here, an interesting analytic question is raised. Do we want to rename feelings for patients, help them better understand what we think they are feeling or would it be more productive to work and understand why they would consider something to be fearful rather than shameful. Most probalby the answer depends on the specific dyad and the understanding of that particular analyis. Each individual analyst must make that decision and understand the why and when and with whom in this type of interaction.

Dr. Corbett also saw the function of grief as a major issue within the treatment. In this case, Dr. Corbett maintains it created, "an opening through which she can see her patient's seduction from pain into idealization." It was a way of opening more reflective analytic work. But, Dr. Corbett asks, what about the other direction, the "seduction into pain through idealization. . .Might we not look at Josh's efforts to find someone who he can "plug into himself," not only as a wish for protection and self cohesion but also as a return to a painful, yet exciting and seductive state of overstimulation and negation." I think the answer can be yes to this question, since we do often look for vitalizing, invigorating experiences and not just calming and protecting ones.

Dr. Corbett was curious about Dr. van der Heide's fantasy about Josh's expression to put his head in her lap. Did she want to smooth or pull his hair? Both or neither? How did Josh react to her feeling states? Dr. Corbett suggested exploring "not only the pain he avoids as a man, but also the pain he invites as a boy."

The discussions of Dr. Corbett and Dr. Hartmann raised vital and interesting questions that, because of time constraints, could not be fully explored by either the participants or the audience.