I am afraid that I have to apologize to Dr. Herzog in advance since I will be quite critical of his presentation. I hope to do this respectfully, however, because I understand and appreciate the difficulty of presenting a case before such a large and well read audience. My distress with Dr. Herzog stems from my sense that his presentation represented very little of what I hold to be important in self psychology i.e. empathic immersion in the patient's vantage point, use of intersubjectivity theory and the important research and evolving theories in development conducted by infant researchers and theoreticians like Beatrice Beebe, Frank Lachmann and Joseph Lichtenberg. Instead, Dr. Herzog presented a case where the analyst and not the patient was in the foreground of the treatment. I was additionally distressed because I felt that his presentation lent support to the many critics of self psychology who maintain that we simply appease our patients, confuse empathy with sympathy, and that self psychologists similar to Franz Alexander, use a manipulative form of "corrective emotional experience" in our work. This said, I also realise how difficult Dr. Herzog's patient was to treat and that sometimes it is difficult to maintain an analytic stance with such people.

The patient, Rachel, had a history of failed psychotherapies. Her initial reason for coming to analysis was that she was having problems with her son's distracted behavior in school. She had an alcoholic husband and she grew up as an "army brat," continually sent to different boarding schools by parents who only touched her when they hit her. Her mother wanted to abort her and her father, who loved art, never took an interest in Rachel, although she tried to reach out to him by not only taking an intellectual interest in art but also by being a artist with outstanding talent herself.

Dr. Herzog presented what he considered to be three major moments of creativity within the treatment: 1. calling the patient an abortion; 2. letting Rachel give him art lessons; and 3. commissioning a painting of Rachel's for his "bathroom".

I found the two discussions by Dr. Breckenridge and Dr. Newman excellent. In her remarks about this case, Dr. Breckenridge made a very important point, which she took from the principles of Complexity Theory, or Nonlinear Dynamic Systems Theory. Her point was "that in living systems input is not necessarily proportional to output as it is in linear systems; that is, small perturbation, or input, can result in a huge result, or ouput. One just can't predict." In Dr. Breckenridge's opinion, which I share, Dr. Herzog's commissioning the painting from his patient was a risk that should not have been taken in this analysis. While it seems to have worked out, I question the degree to which its meaning and experience were explored. I beleive that it never should have occurred in the first place. It was too risky. At this point I am reminded of my supervisions with Dr. Evelyne Schwaber who frequently said, "Always listen to what comes after the but!" When Dr. Herzog was unsure of whether to buy the painting or not, it would have made sense for him to have sought consultation about this problem. It seems to me that Dr. Herzog was unable to withstand his patient's negative feelings and sense of rejection and felt a need to act as he did in an effort to prove to her that he was a "good guy."

In her discussion Dr. Breckenridge mentions the "now moment" of Dr. Herzog saying to his patient "you are an abortion." If this was a "now moment," I would first want to know what tension was felt in the hour that prompted this statement. I also want to know what intersubjectivity was occurring since "now moments" usually occur when the analyst has to act differently than usual with a patient. What was Dr. Herzog responding to, or was he trying to create a "now moment" himself, and if he was, why was he doing that?

Dr. Breckenridge in her analysis of this case paid attention to Dr. Herzog's statement that verbal interpretations are mere content. She maintains that "verbal interpretations are always - inextricably - delivered along with implicit communications. Her criticism addresses the point that perhaps what was missing in many of the interpretations was not the content but the affect. The words might indicate that Dr. Herzog understood his patient Rachel, but the affects he offered might indicate that he didn't get it! Perhaps Dr. Breckenridge's ideas are answers to her question: "Did they discuss why she assessed him as a 'smug, insensitive, over-privileged hack?'"

Dr. Newman's discussion picked up where Dr. Breckenridges ended, i.e. with the question, "What kind of inner dialogue giuded him, particularly as he lived in and through the negative transferences and found himself at some impasse?" Dr. Newman presented his concept of a "usable selfobject". A usable self object according to him is one that establishes new experiences for the patient thus separating this relationship from older pathological bonds and compromising ties. To be usable indicates a transference that reestablishes narcissistic strivings that have been left behind a barrier of repression.

He asks the same question as Dr. Breckenridge, namely, was the characterizaton of Dr. Herzog as smug etc., related to breaks in their routine or due to empathic lapses? Dr Newman also felt a need for more microprocess detailing of interaction between patient and analyst. This would have helped in the understanding of the alterations in the patient's self state. As it stands, it seems that Dr. Herzog attributed to the patient what Stolorow et. al call the myth of the isolated mind. The patient is seen as not reacting properly to the analyst but to a false "painting" she has of him. Dr. Newman would have liked to know whether Dr. Herzog considered making use of his own subjectivity in sharing with Rachel his sense of being unimportant and insignificant and through that understanding perhaps provide access to her sense of core uselessness.

Dr. Newman seemed surprised at himself that in writing his discussion he recommended rigourous questioning of the subjective experience of the analyst. It is my poinion that he probably did so because he felt that this was lacking in the treatment, a lesson we all have to learn when we enter into enactments, disclosures and provisions.