Panel I:
Dolph and Gus: The War of the Worlds

By  James Herzog, M.D.

Discussants: Richard Geist, Ed.D. and Janna Sandmeyer, Ph.D.

Dolph and Gus: The War of the Worlds
James Herzog, M.D.

A young man experiencing debilitating panic attacks asks for help in understanding what is happening. The attacks have begun following the birth of his son and are initially understood to reflect the activation of something deeply resonant in the new father's relationship with his own father. As co-constructed exploration is undertaken, first in a psychotherapy and then in an analysis, deeper and deeper levels of longing and terror are navigated by both participants . The erotization of violence in the family is the portal through which this work commences but it de- and as-cends to multiple levels of safeness and danger with the selves of each of the co-explorers as they struggle together to find a safe enough play space for the work and ultimately for the analysand's effort to love, to play, to father and to work.

Discussion
Richard Geist Ed.D.

The 2016 IAPSP Conference, Panel I, was an experience near description of a treatment of a young man with panic attacks and a highly sexualized defensive structure that emerged during the treatment. The presentation, without theoretical phrases or concepts, illustrated how two people tick and tock their way toward mutual connectedness.

Geist's discussion focused on constructing a theoretical frame around the presentation in an attempt to conceptualize clinically why this treatment was helpful to the patient. The discussion focused on understanding how empathic processes assume a pivotal importance in evoking healing interactions. Specifically it illustrated how empathy promotes a myriad of healing interactions: rekindling of thwarted developmental needs, welcoming curative fantasies, repairing intersubjective disjunctions, corrective selfobject experiences, transitioning from self-protection to relational protectiveness, interpretative understanding, heightened affective moments, and transmuting internalization.

The discussion emphasized the importance of several clinical concepts. First, it prioritized "living with" the patient and joining him in managing his anxiety rather than asking questions. Second it illustrated the importance of Kohut's notion of trying to enclose the patient within our boundaries and thus experience him as part of one's sense of self. Third, the discussion highlighted the importance of answering questions as a way of deepening the treatment rather than promoting compliance or resistance by refusing to answer. It addressed the importance of allowing the patient to shape and mold us, thus teaching us what the patient needs to heal and thereby helping the patient to develop trust in the validity of his own inner experience. The discussion emphasized the importance of accurate empathic understanding of the patient's conscious experience rather than the interpretation of resistances as a way to facilitate the emergence of unconscious feelings. Finally, Geist's response accentuated the importance of helping the patient to transition from self protective defenses, in this case sadomasochism, to relational protectiveness by recognizing that inherent in these defenses is a wish for both protection and connectedness.

Discussion: Sex and Subjectivity, and Self Psychology: Discussion of Herzog's Case
Janna Sandmeyer, Ph.D.

Sex, gender, and subjectivity - three especially compelling themes. This discussion of Herzog's presentation underscores first the tricky issue of human subjectivity, in particular the relative absence of the therapist's subjectivity in the case presentation. It then highlights sex and gender - the gender of the patient, that of the therapist, and the sexuality woven throughout the case. Sex and subjectivity are exquisitely entwined and are constitutive of relationality. Jim's account of this moving case reflects a sense of the patient's - Peter's - subjectivity, but less so of Herzog's feelings toward and about Peter. The relative absence of Herzog's subjectivity in this paper challenges a relational sensibility. To relationalize and contextualize the clinical material, it would help to know more about Herzog's subjective experience of the treatment. Only from there can we begin to understand Herzog's contribution in shaping the intersubjective system that Herzog and Peter co-constituted. Noticeable is the relative absence of the female/mother/sister/daughter/wife (all of which I am). In invoking an exploration of subjectivity and co-constructed space, I ask, "What space might I inhabit in this case, and how would my femaleness impact the intersubjective field? And further, what might the absence of female subjectivity in this presentation signify in both Herzog's experience of the relationship and his patient's emotional world?" In raising these questions, this discussion expands the area of inquiry beyond the father hunger narrative around which the case material was organized. To that end, this commentary emphasizes that forward edge considerations could be useful and that we can now define a contemporized forward edge as an emergent property in the analytic space co-constituted by both patient and analyst. No longer limited to the patient's emotional world, the contemporized forward edge reflects the healthy tendrils that are cultivated in the dynamic system shared by the therapeutic couple, as exemplified by the enlivening and deepening aspects of their relationship. This discussion centers on the idea of bringing in the whole - a kind of holism - the entirety of the intersubjective field, the spectrum of male and female aspects of each participant, and the leading as well as the trailing edge. Through this lens of wholeness, Herzog's patient might experience himself more fully and could engage with Herzog in a richer relationship that would have vital implications for the analysis and beyond.

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