On Panel IV, Mark Smaller related the story of a successful analysis, the budding and blooming of a seriously depressed thirteen-year-old girl during a three and a half year treatment. Then, Iris Hilke and Estelle Shane each responded positively to Smaller's work while placing it within the context of each of her own theoretical position. Hilke addressed the ways in which Smaller facilitated the complex process of his patient Anne's gender and sexual development. She described some ways in which Smaller compensated for the failures of the girl's father, compensated for the father's inability to recognize and prize the girl's growth into womanhood. Estelle Shane not only pointed out ways to understand Smaller's effective work from a linear perspective - e.g., he provided a reliable, consistent and predictable selfobject experience - but she also used the clinical material to describe the process of non-linear state changes and system shifts. Unfortunately, not enough time had been allotted to Panel IV to allow for Shane's complete commentary or for interactive discussion.

At thirteen, Anne made a suicide attempt after telling a girl friend of her intentions. She then spent two weeks in an inpatient adolescent program. On release from the hospital, she arrived for her first analytic meeting without a parent in attendance. Anne presented herself as a very intelligent, asexual, gender-confused and slightly disheveled girl, profoundly unhappy with herself as a female, a daughter, a student and a friend. Depressed and socially isolated, she was skipping school, sleeping a lot and forging absence notes. Anne identified her problems as related to her disappointment with her father, an irascible and critical recovering alcoholic; her sadness about her mother, a psychologically absent woman who was more interested in Anne's sister than in Anne; and her distress over her parents' unhappy marriage. At the time she came for therapy, withdrawal into solitary pursuits such as reading and painting had become the primary way Anne regulated her affective life. She did not turn to her parents for guidance or support and had little confidence that she could be socially successful with peers. Except when reading or painting, Anne described herself as "basically an unhappy person."

In the course of therapy Anne moved from an arrested state of gender development to become a feminine young woman, intrigued, involved and normally perplexed by her own and others' sexuality. Initially, she viewed her mother and sister as different from her, as happy feminine allies who were interested and engaged with each other. She placed her primary but ambivalent identification with her depressed and "nerdy" father who teased Anne and criticized her attempts at feminine development. She neither felt understood or able to talk to either parent.

In the analytic relationship Anne found a willing ear and an admiring eye. She responded very quickly to the analytic environment, finding in Smaller first a mirroring selfobject and later a twinship: "You're kind of a nerd like me," she remarked a year into treatment. Smaller supplied a secure attachment base for Anne. Analysis quickly became a place for her to bring complaints about parents, disdain for other girls and general musings on herself in relation to gender identity and relationships with boys. Later, Anne explored the intensity of her feelings for Smaller, sharing with him how her father and boyfriends reacted to the value and importance she placed on her analysis. Over the years Anne moved from self-regulating her emotional life by skipping sessions to settling into regular meetings. I particularly liked her ease in the mature phase of the analysis as she expressed her ambivalences, confusions, and conflicts about the whole range of her life experiences: her self as a sexual being, her participation in sexual experiences, her self in relation to other girls, and her need for, yet resistance to, Smaller's guidance. In an unselfconscious flow of words she revealed her whole complex wonderful self in Smaller's presence. All the while, the analyst maintained an interested, buoyant, and accepting listening stance, creating a space for Anne of freedom and comfort. He also noticed her feminine development, admiring, for example, a chic haircut or pretty clothes.

Iris Hilke, in her response to Smaller, emphasized the ways in which fathers help daughters negotiate the tricky, paradoxical task of adolescence: separating while remaining identified with mother and pulling away while simultaneously staying connected. In Hilke's view, Smaller both compensates for the confusion of Anne's parents in relation to Anne's emotional needs and provides necessary selfobject functions. Hilke particularly saw Smaller's ability to love and admire Anne in safety and security as the spur for the resumption of her feminine development.

Shane viewed the analysis through the lens of systems theory. She explained how state shifts can emerge from unexpected and surprising interpersonal events. In analysis change happens as a result of novel or surprising moments that perturb an existing relational system. Small gestures, a glance of an admiring therapist at a new haircut, for example, can perturb an existing system and result in a state shift or an expansion of dyadic consciousness. Good analysis creates frequent perturbations; it is, in fact, one huge perturbation. According to Shane, as Anne and Smaller immersed themselves in their mutual work, the girl came to feel known, understood, connected, more like other people, and good enough.

I want to emphasize two impressions that I have from listening to the tape of Panel IV. First, Smaller's delight in Anne is striking. I could hear a smile in his voice as he described her precocity and some of their playful exchanges. Beyond its value as a positive mirror, I imagine Anne experienced her analyst's delight as refreshing, novel and transforming. I also see some of the playful exchanges - i.e., Smaller agreeing that Anne's father was right; all analysts are narcissists! - as excellent examples of perturbations of Anne's existing relational system. Humor is a subversive force in analysis just as in the larger world. It functions to shake up, unstick, and re-form static states. For Anne the delight and good humor she experienced with Smaller must have felt like wonderful scratching on some out-of-reach itch.

Second, I noticed Anne's willingness to help Smaller when he missed something or made small gaffes. Indeed, I am generally struck by how hard most patients will work to right a listing therapeutic boat when there is basic confidence that the vessel is seaworthy; that is, confidence that the analyst is present, attentive and positively tuned. Hilke noted that Smaller missed the large issue of Anne's perfectionism and the important part it played in Anne's unhappiness. Shane also pointed out some disconnects and missed opportunities in Smaller's work, as, for example, in his not recognizing and articulating the meaning of a dream the girl had about Thomas Mann's Death in Venice. Yet, both commentators recognized the extraordinary power of Smaller's interested presence and good will toward Anne. This power, of what for Hilke is a safe and compensatory male figure and what for Shane is an interpersonal relationship that perturbs and shifts Anne's existing relational system, is far greater than what emerges from a mere description or technical analysis of the couple's verbal and behavioral exchanges.