The final course, the dessert, of the self psychology meeting was one which left me very pleasantly satiated. It was delicious, yet very nourishing, leaving no doubt that the carbohydrate load was transformed into protein when fully digested. I enjoyed the chocolate soufflé, served up by master chef Frank Lachmann. He seems to know just the right music to enhance the lightness of his creation. Marian Tolpin supplied the healthy choice of a mixed berry salad with whipped cream. Just when I thought I couldn't eat one more bite, Judy Teichlolz presented a lovely plate of chocolates, which enhanced the flavors of the previous dishes. How could I resist?

The subject of the panel, The Emergence of Self from the Co-Creation of Clinical Experience, takes its lead from the nature of child development. Child development takes the shape of a spiral, looping backwards before turning forward towards further growth. Marian Tolpin incorporates this thinking in her conceptualization of repetitive cycles of health. The inevitable injuries to the self, followed by the importance of the response and recognition of the other promotes repair and recovery. Tolpin calls our attention to the "tendrils of health" which are entwined in the difficult, despairing moments - recognizing both the injuries and the pulls towards further growth. Embedded in the successful negotiations of repetitive cycles is the emergence of a sense of agency, the cohering of a self who can make choices and formulate goals and ambitions.

Teicholz underlined the signature elements of Lachmann's and Tolpin's, analytic work, as described in the examples of Nora and Colleen, each finely tuned to the dynamics, current analytic moment and self-state of the specific patient, and attentive to the importance of the emerging idealizing selfobject transference.

Lachmann's use of humor and spontaneity provides a technique in which the analyst can manage anxiety, reveal hostility which would be more disruptive if stated directly and "achieve an incomparable degree of intimacy that is hard to match through other avenues." In treating a patient whose narcissistic grandiosity could easily rub against the analyst, this analyst "plays with" Nora's grandiosity, preserving the emerging idealizing selfobject transference. To Nora's, "I am a swan and all those around me are ducks," Lachmann responds with characteristic generosity, poise, and humor, "I now understand why there is no ballet called duck lake," to which they both chuckled. "Playing with" Nora's grandiosity co-constructs an intersubjective field in which the analyst is empathically attuned, rather than shaming, and, as Teicholz indicates, both on his patient's side and responding from his unique subjectivity. Lachmann, as the consummate juggler, sensitive to language and nuance, aware of Nora's reactivity to shame, tempering the one-upsmanship potential of his humor, enlarges the reflective space. Towards that end, the analyst's creative construction of a model scene from his intimate knowing of Nora and her history, provides further illumination of the swan/duck dichotomy. As Lachmann says, "I tried to capture in imagistic and metaphoric form what Nora described with her co-workers and what she recalled about her childhood." By the analyst's evoking the critical, disparaging tone of the imagined mother, in response to 5 year-old Nora's Mother's Day card, the adult Nora recognizes herself in both roles, the little girl yearning for recognition and the mother-like Nora in her contemptuous behavior toward co-workers. Nora's appreciation of her analyst's "enjoyment of her swanness" interactively regulates the potential for fragility and shame, thus enabling further reflection and genuine swan feelings to emerge.

Tolpin speaks about the recovery of the fragmented self by a fitting together of patient and analyst, which restores a healthy self-assertion, focusing on the forward, leading edge. In the analysis of Colleen, a 30 year-old woman whose traumatic history bespeaks severe deprivation and abandonment, the analyst's awareness of Colleen's injured, fragmented self, in a mode of steady exploration, contains Colleen's angry, denigrating feelings. A dream follows, whose transferential meaning may relate to Colleen's feeling cushioned in the reliable calm analytic space. As with Lachmann's case, the importance of preserving the burgeoning, idealizing transference is emphasized. As Colleen and her analyst live through cycles of panic and self-restoration, a sequence begins in which Colleen becomes frantic as she is separating from her analyst, leaving for a European trip. The analyst makes an important interpretation, "You have jumped into the deep end and don't know how to swim yet. I won't let you go under - but it's hard for you to put yourself in my hands." Colleen becomes calmer and in the wake of this new relational experience with the analyst mother who, unlike her real mother, offers her steady presence, Colleen can begin to make cognitive and affective connections. Resonating with the experience of watching a TV interview of a woman who talks about her childhood ending prematurely, Colleen speaks insightfully and with emotion, about feeling that her childhood was cut short, with the recognition of her mother's emotional unavailability. The strain of being depended upon rather than being able to depend on her alcoholic mother marked her interrupted childhood.

The ways in which master clinicians work with challenging patients leading to the emergence of a healthier, more cohesive self is always instructive. Drs. Lachmann, Tolpin and Teicholz engage us in a dialogue about the essence of our daily work - the ways in which we conceptualize and use ourselves to co-create continuing opportunities for transformation and growth.