What's a Good Object to Do? - PsyBC

Psychoanalytic Dialogues, 16(1):1–27, 2006 

What’s a Good Object to Do 

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Neil J. Skolnick, Ph.D. 

Nearly all relational theorists localize therapeutic change in the 

relationship between a patient and a therapist, who functions as a 

creative form of good object. For that reason, the shift to a relational 

model necessitates the illumination of the clinical uses of an analyst as 

good object. The author proposes and describes three categories of 

analyst as good object: (1) dynamic identification, a clinical application 

derived from Fairbairn’s keystone concept of dynamic structure; (2) the 

acceptance of patients’ love, a requisite for treatment that follows 

Fairbairn’s redefinition of libido; and (3) empathic attunement to psychic 

organization, a subcategory of empathy that considers empathy from a 

structural viewpoint rather than from its usual reference to affective 

resonance. Clinical vignettes are used to illustrate the three inclusive, 

but not comprehensive, forms of good object functioning by the therapist 

in the clinical situation. 

I think more has been written about bad internalized objects similarly 

disowned than about the denial of good internal forces and objects. 

—D. W. Winnicott, Collected Papers 

URING THE LAST SEVERAL YEARS THE UNITED STATES HAS WITNESSED 

and experienced a level of destruction unlike any previously 

Dknown 

1 

on our shores. It is easier now to imagine how Freud 

(1920), observing and living through the massive destruction that 

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Neil J. Skolnick, Ph.D. is a Clinical Associate Professor of Psychology at the New 

York University Postdoctoral Program in Psychotherapy and Psychoanalysis; Faculty 

and supervisor at the National Institute for the Psychotherapies, the Institute for 

the Psychoanalytic Study of Subjectivity, and the Westchester Center for the Study 

of Psychoanalysis, as well as a number of regional psychoanalytic training programs 

throughout the country. 

An earlier version of this paper was presented to the National Institution for the 

Psychotherapies Psychoanalytic Association, New York City, October 21, 2001. 

1 

The level of destruction was the greatest inflicted by foreign forces, as opposed to 

either natural disaster or domestic violence against minority races (Native Americans 

or African Americans). 

1 © 2006 The Analytic Press, Inc.

2 Neil J. Skolnick 

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was World War I, could hypothesize the existence of a death instinct, 

a force contained in all living matter that maintains a perpetual struggle 

and conflict with the forces of life. The human psyche, he postulated, 

embeds, organizes, and expresses two irreducible basic properties of 

matter, one living and vital, and the other always seeking the inert 

entropic end product of nonlife. These forces, Freud theorized, are in 

constant struggle with each other in our corporal and psychic being 

from the moment of conception, then we are ushered into what we 

refer to as life, to the ultimate triumph of inertia, what we call death. 

Along the way, however, a major victory of life silently and joyously 

asserts itself. Human beings, by design, are imbued with powerful forces 

that ensure, after a decade or so of existence, the reproduction of the 

species and the perpetuation of life. But our individual selves ultimately 

succumb to the inevitable triumph of inertia, and it appears that the 

death force has prevailed. The life force, however, has the final word, 

the triumphant opportunity to thumb its nose at death in the 

perpetuation of the species, a caveat of inevitable ultimate destruction. 

And life has proven victorious for a very long time. 

As I think back to recent massive traumas such as the destruction 

of thousands of lives in the World Trade Center, it has become 

inescapably apparent that one of the most important ingredients 

contributing to healing and recovery—the perpetuation of life, if you 

will—has been the emergence of a powerful human need to both 

receive and express love and connection. In ourselves, our friends 

and loved ones, in our patients, in victims and their families, we have 

witnessed the response of people contending with overwhelming 

horror to connect with others in life affirming and loving ways. Chaos 

has been replaced by meaning, and meaning appears to be rooted in 

human connections. Is this a manifestation of life forces versus those 

of death, however one conceives of them Is it Eros versus Thanatos 

enacted on a large-scale societal level Or maybe it is a societal 

collusion in the creation of an illusion of life and meaning Perhaps. 

We might not be able to achieve these lofty levels of explanation, but 

when these acts are considered on a behavioral and emotional level, 

what we find repeatedly is the vital importance of human connections. 

Healing requires the outpouring of love, expressed in an infinite variety 

of life-sustaining, contextualized gestures. The presence of others is 

essential for the reaffirmation and continuance of our internal and 

external worlds of meaning. To put the matter simply, we have been 

living and experiencing, in vivo, the importance of good objects.

What’s a Good Object to Do 3 

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Good objects, but not great objects. And therein lies the essence of 

this article. Good objects are not perfect, neither flawless nor hopelessly 

flawed, neither ultimate nor ideal. Whether volunteering to contribute 

in the multitude of ways recent crises have required, or simply getting 

back to work, these good objects are everyday people expressing an 

elementary but pervasive life-affirming given of their core selves to 

support the existence of life, their own and others’, within the context 

of social connections. 

Psychoanalytic technique has periodically been modified to reflect 

historical and theoretical shifts (Lipton, 1983). Over the course of 

the last 25 years, the psychoanalytic landscape has changed to reflect 

the mounting importance accorded to context in the structuring of 

our developmental and motivational selves. The relational evolution 

has ushered in mind-numbing changes to psychoanalytic theory and 

technique. Shibboleths of classical or ego-based approaches to 

technique can appear almost unrecognizable today. Consider the last 

time you referred to a patient’s loving affects as neutralized libido, or 

a regression in the service of the ego, or evidence of a developing 

transference neurosis. This was the language on which I cut my 

psychoanalytic teeth. At the same time, mainstays of our contemporary 

technique that were relegated to the heretical just a few years ago are 

regarded as standard fare today. Witness the debates on the efficacy 

of the self-revealing analyst (Burke, 1992; Davies, 1994; Hirsch, 1994; 

Tansey, 1994; Greenberg, 1995) or the use of enactments to further 

the goals of treatment (Davies, 1994). Increasingly, contemporary 

models of psychic functioning and organization (Bromberg, 1998) are 

informing emergent twists and turns of technique. 

The practice of psychoanalysis during its infancy contained informal 

customs that appear to have violated the dictates of classical technique 

as it came to be. Freud at one time or another acted as a moneylender, 

dinner host, and matchmaker to his patients. These seeming lapses 

become more forgivable when we consider them within the context of 

what was a new, evolving science. Freud and his associates were 

experimenting with new forms of technique that had a way to go before 

being codified into a set of standard practices and, by implication, 

prohibited transgressions. Their “mistakes” awaited future contextual 

models before they could be defined as mistakes. 

It is my impression that a similar situation exists today. We have 

ventured into new realms of technique with alternating gusto and 

caution. The jury is out, I caution, as to whether these newer


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techniques, both clinically and theoretically derived, have proven 

clinical value. For example, analyst self-revelation has been touted by 

some as an important clinical option. Others consider it a possible 

imperative of relational technique. Unfortunately, it can at times be 

misused in the service of a political statement to mark allegiance to a 

theoretical camp, rather than a statement of its actual validity. Does 

it work And with whom When might it be decidedly unhelpful 

Should we be telling patients our dreams Do we run the risk of 

mistaking growing precedence as bestowing efficacy on newer 

technique 

Postmodern theories of mutuality, coconstruction, interpersonal 

principles, or relativistic truths have infused our modern sensibilities 

and consequently our analytic styles. Perhaps our contemporary 

technical innovations will also be scorned in years to come as 

contradictory to evolved relational practices in the same fashion that 

we hold Freud’s matchmaking with patients to be a transgression of 

his later thinking. It is too soon to tell, just as it was too soon to reach 

a verdict on Freud’s new “talking cure” at or near its inception. Our 

strong convictions can understandably outpace time-proven wisdom. 

The evolutionary groove we currently traverse under the broad 

umbrella of relational perspectives (Skolnick and Warshaw, 1992) is 

for the most part anchored by theorists who are reluctant to codify 

technical recommendations (e.g., Fairbairn, 1958; Hoffman, 1998; 

Mitchell, 1988; Stolorow and Atwood, 1992). The increasing 

acceptance of relativistic truth in our theories has organically led to 

relativistic angles on technique. For today’s analyst, there are many 

more proverbial roads than ever leading to Rome. It is my observation 

that, while relational theories play an important role in guiding newer 

techniques, many of our contemporary theorists rely more on their 

clinical experiences to expand technical possibilities. Our current 

group of prominent relational authors, a few of whom include such 

notables as Jody Messler Davies, Peter Fonagy, Stephen Mitchell, 

Adam Philips, Stuart Peiser, Owen Renik, and Robert Stolorow, fashion 

treatment recommendations based more on clinical experience than 

strict adherence to theoretical parameters. 

I have no trouble with that choice. Although far from objectively 

reliable or valid, clinical data are the best data we have. We are at a 

point of hypothesis-generating in our literature on technique. This 

article, as well, can be considered a heuristic, hypothesis-generating 

endeavor. I hold no claim to new technical theory. My clinical data


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are garnered from years of practice and changing theoretical contexts. 

It is my belief that actual clinical experience with patients (our 

hermeneutic data, if you will), accompanied by careful, intense 

circumspection and debate, will lead to more reliable statements about 

higher levels of abstraction to accompany an evolving theory of 

relational technique. But we are not there yet. When I reflect on my 

own evolution as a relational psychoanalyst, I am reminded of the 

time I was treating my training control case, over 20 years ago. Toward 

the end of a session, it started to rain heavily. Noticing that my patient 

had not come with an umbrella and would surely be soaked on this 

cold day in March, I tortured briefly over the wisdom of lending him 

one of the extra umbrellas that had gathered in my closet. Would this 

be a major transgression, a libidinal gratification forever sullying the 

development of the transference neurosis and fatally derailing the 

treatment Was I involved in a major countertransference acting out 

requiring my own continued analysis Or was it simply a thoughtful, 

nonsexual but loving gesture required by the serendipitous forces of 

Mother Nature, forces that as far as I was concerned might fall outside 

the purview of transference Damning Charles Brenner, and every 

supervisor I ever had, I gave the patient an umbrella; I figured we 

would deal with the interpretive aftermath in future sessions. 

In fact, we did deal with the conflict-laden dependency issues evoked 

by my act of giving and his reluctance to accept, and the analysis 

continued. I was beginning to learn that my interventions, per se, at 

choice points in treatment were often not as important as analyzing 

the patient’s reactions to my interventions as well as the internal or 

coconstructed precipitants of my interventions. The umbrella episode, 

for me, marks the beginning of my shifting clinical sensibilities, 2 and 

these shifts have been channeled into altered theoretical organizations. 

For example, years after the analysis ended, the patient told me he 

considered my abandoning an analytic stance by offering him the 

umbrella one of the pivotal points in his treatment. He had observed 

my discomfort (my self-torture), my humanness, and my decency as 

my being just another person, who, like him, did not always have 

perfect answers. Today I would say he discovered the good object in 

me. That was not an encounter with the idealized or exciting object, 

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2 

Since that time, similar sentiments have been expressed by the contemporary 

Kleinians (Schafer, 1997) working in England.


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but, rather, with the good, fallible, integrated object with whom he 

could identify, thereby expanding the range of possibilities for his own 

overly perfectionistic ego or self. Risking a new, decidedly nonanalytic 

intervention that actually furthered the treatment likewise expanded 

me both clinically and theoretically. 

I am not attempting here to provide a comprehensive definition of 

the essence of a good object. As suggested by the title of this paper, I 

am primarily focusing on what a good object does and not the essence 

of its nature. The legacy of psychoanalytic theory and technique may 

rest more with careful descriptions of what analysts do than with the 

explanatory validity of the theory. Also, psychoanalysis as a theory no 

longer aspires solely to the constraints of a hypothetical-deductive 

model of scientific inquiry. While empirical research has been 

considered an important contributor to the accretion of psychoanalytic 

knowledge, with the shift in emphasis of relational theory to studying 

subjective experience and cocreating relativistic and hermeneutic 

truths, the cornerstones of empiricism—observation, reliability, and 

validity—do not always apply to the understanding of psychoanalytic 

phenomena. This paper presents a categorical description, gleaned 

from years of clinical practice, of what an analyst, as good object, does, 

not what a good object is. 

Furthermore, as the technique of relational psychoanalysis has 

increasingly disentangled itself from many of the technical dictates of 

drive theory, the importance of the role of the analyst has shifted 

from passive, neutral observer and interpreter to active participant. 

And relational analysis can (though not for all who consider themselves 

relational) insist that the analyst participate as a good object. To the 

skeptic, visions of analysts portioning out a never-ending supply of 

need satisfactions clouds their ability to attend to the more textured 

and complex nature of a good object. To the converted, objections 

and cautions to this relatively new technical turn may go unheeded 

with a cavalier acceptance of its validity. I explore here some broad 

technical strokes describing how an analyst might function as a 

good object. 

Before turning to a consideration of what actions determine a good 

object in treatment, however, I wish to describe briefly what I consider 

a good object to be. I see the good object as an amalgam of the object 

imagoes in the theories of Klein, Fairbairn, Winnicott, and Kohut. 

Whether rooted in nature or in nurture or an admixture of both, the 

good object is mostly on the side of life. The good object is a mature


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(Fairbairn, 1952; Kohut, 1984), loving (Fairbairn, 1952; Winnicott, 

1965; Klein, 1975a, b), whole, integrated self or other (Klein, 1975a; 

Kohut, 1984) who has acknowledged and accepted the goodness and 

badness in oneself and others. It occupies either internal or external 

space (Klein, 1975a, b; Kohut, 1984). This is an object who does not 

deny the existence of our more grandiose, idealistic strivings, which 

pull us with endless hope through life (Winnicott, 1965; Kohut, 1984). 

Nor does it deny our ever-present sinister affects or destructive 

motivations (Klein, 1975a). It has managed to accept their 

inevitability, to struggle with the tensions they evoke; to adapt to 

them, integrate them, and continue to be able to love and accept love 

(Fairbairn, 1952; Winnicott, 1965; Klein, 1975a, b; Kohut, 1984). 

Again, a good object is not a perfect object, one that Klein (1975a, 

b) referred to as idealized and Fairbairn (1952) referred to as exciting. 

An idealized or exciting object, when too pervasive or rigid, is 

ultimately a bad object. It represents neither a loving, a whole, nor an 

integrated object. Instead, it is a one-dimensional fiction, sometimes 

engaged with for survival, that denies the existence of complexity, 

ambivalence, or doubt. 3 The achievement and acceptance of doubt, 

which is a lifetime struggle of good objects, is an anathema to bad 

objects. Bad objects require immutable truths, truths that demand 

absolute adherence in order to survive. All doubt must be destroyed. 

If any uncertainty is entertained, the absolute truth and meaning of a 

bad object is in mortal jeopardy. For meaning to be maintained by bad 

objects, anything smacking of ambivalence, uncertainty, or doubt must 

be defended against, if not wiped out. In psychoanalysis we refer to 

this process as the deployment of primitive defense mechanisms, such 

as splitting, projection, introjection or denial. For Klein (1975b), the 

obliteration of doubt was the hallmark of a paranoid-schizoid 

organization. For Fairbairn (1952), overwhelming doubt lay at the very 

heart of our universally split egos. For Osama bin Laden, death to the 

infidels obliterates those who might suggest the existence of doubt. 

In his seminal paper on technique and published nearly a halfcentury 

after Freud and a half-century before now, Fairbairn (1958) 

demonstrated far-reaching clinical insight: 

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3 

This use of “doubt” receives a more thorough explanation in an article by Sullivan 

(2001). The article was written in defense of the argument that we are currently 

engaged in a modern holy war.


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In terms of the object-relations theory of the personality, the 

disabilities from which the patient suffers represent the effects of 

unsatisfactory and unsatisfying object relationships experienced 

in early life and perpetuated in an exaggerated form in inner 

reality; and, if this view is correct, the actual relationship existing 

between the patient and the analyst as persons must be regarded 

as in itself constituting a therapeutic factor of prime importance. 

The existence of such a personal relationship in outer reality not 

only serves the function of providing a means of correcting the 

distorted relationships which prevail in inner reality and influence 

the reactions of the patient to outer objects, but provides the 

patient with an opportunity, denied to him in childhood, to 

undergo a process of emotional development in the setting of an 

actual relationship with a reliable and beneficent parental figure 

[p. 377]. 

With this statement, remarkable for its time, Fairbairn catapulted 

the primary influence of analysis out of the arena of dispassionate 

drive interpretations and placed it squarely in the space created by 

the coming together of two vital, continuously interacting persons— 

the therapeutic dyad. Fairbairn’s revolutionary idea was that the 

therapeutic relationship offers the provision of a good object (or, more 

correctly, a good object relationship). 

But what is a good object to do 

What does a good object look like in the analytic setting Where 

are the lines between the provision of analytic goodness and the 

provision of exciting, taunting or seductive false promises How might 

a good object alter the therapeutic frame, including where, when, and 

how the boundaries are drawn or redrawn Does the goodness of an 

analyst relate to his or her authenticity Or the spontaneity of the 

analyst Or the behavior of the analyst Relational analysts struggle 

with these and similar questions today (Hoffman, 1998), when many 

of the rules of the analytic process have been thrown open for 

reconsideration. 

In what follows I attempt to describe a sampling of characteristic 

actions of a good object contextualized by the therapeutic relationship. 

The list is not exhaustive, by any means, and it is not intended to be 

used formulaically. Fairbairn (1958), for one, was reluctant to spell 

out specific technical recommendations; he feared a slide to the rigid 

and mechanical, which, he bemoaned, might serve more to allay the


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clinician’s anxieties or take care of the therapist’s needs than to help 

the patient. 

I consider three categories of activity provided by the analyst/good 

object. The first, which I have coined Dynamic Identification, is 

derived from Fairbairn’s most seminal postulate, that of dynamic 

structure. I discuss here the mechanisms, not of identification with 

the analyst, but of the internalization of a new object relationship 

provided by a relational analyst. The second category is also rooted in 

Fairbairn’s theory. His theory of motivation obtained its bedrock in 

the basic nature (Mitchell, 1988) of man to establish and maintain 

loving connections. For Fairbairn, loving relationships, from birth, 

required a mutual reciprocation. It was not news that a parent needs 

to love a child. What was news, and has often been ignored, is that a 

child, from birth, spontaneously offers its love to others. Fairbairn 

stressed the crucial need that the child’s love be accepted and 

cherished. The acceptance of love provides the thematic glue for the 

second category of good object activity I describe. 

Finally, in the third category, the analytic provision of empathy is 

discussed as it relates to Klein’s (1935) conceptualization of positions 

in development. The psychological organizations of the paranoid/ 

schizoid position are qualitatively different than the organizations of 

the depressive positions. Likewise, the two positions generate markedly 

different self and other experiential modes. I delineate the nature of 

the empathic response required by a good object when a therapist is 

interacting with a patient functioning in the paranoid/schizoid 

experiential mode and its distinction from empathy necessitated when 

a patient is operating in a depressive organizational mode. 

Dynamic Identification 

By Dynamic Identification I am referring to a construct I have derived 

from Fairbairn’s (1952) overarching principle of dynamic structure. 

Briefly, Fairbairn pronounced that psychic structure and psychic energy 

were equivalent. “Both structure divorced from energy and energy 

divorced from structure are meaningless concepts” (p. 149). In an 

Einsteinian moment he eliminated Freud’s (1923) distinction between 

dynamic id energy and an inert ego fueled by the drives. Paralleling 

the precepts of Einstein’s relativity theory, egos represent dynamic,


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ongoing systems imbued with their own energy, rather than discrete, 

singular entities. An ego (or self), for Fairbairn, 4 is what the ego does 

in concert with an object and an accompanying affect tie. For him, 

ego, object, and energy are inseparable and inextricable and are spoken 

of disjointedly only for linguistic clarity. 

What are internalized, then, for Fairbairn, are neither good nor 

bad objects, but good or bad object relationships, including the ego/self, 

the object, and the affective tie between the two. An ego cannot exist 

without reference to the objects, both internal or external, that 

structure it and perpetuate its essence. To interpret, then, becomes a 

useful cognitive exercise, but change itself becomes a problem of object 

relationships. To restate the title of this paper, “What’s a Good Object 

to Do” I would add, “What’s a Good Object to Do, in Interaction 

with a Patient’s Internal and External Selfobject Configurations That 

Will Bring into Being Modified Object Relationships Leading to Psychic 

Growth and Change” The provision of a good object, then, requires 

a dynamic interplay between analyst and patient. No longer is the 

analyst a detached imparter of wise, timely mutagenic interpretations. 

He or she is an active engager of the patient’s self in an ongoing 

constructive process. He or she is a relational analyst resuscitated from 

Fairbairn’s (1952) opus. 

It follows, then, that an important aim of the good object in the 

therapeutic process is to provide the patient with an opportunity to 

identify with the analyst’s self as he or she analyzes. This course of 

action I call dynamic identification. Dynamic identification needs to be 

distinguished from identifications with static traits, preferences, 

sensibilities, or ideographic qualities of the analyst’s character, although 

these sometimes enter the mix. By dynamic identification I am referring 

to unearthing and making one’s own the psychic processes, both 

conscious and unconscious, that an analyst engages in when relating 

to the patient in the analytic space. 

The good object provides something unique. In addition to the 

standard activities of labeling distortions, unearthing unconscious 

material, and providing interpretations, the good object engages with 

the patient in new ways of being, repeatedly, over time. The interaction 

with the analyst becomes coterminous with the patient’s expanded 

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4 

In my opinion Fairbairn’s use of the term ego was similar to Freud’s earlier 

(prestructural model), more encompassing meaning of ego as the center of selfexpression.


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self. The analyst’s analyzing-ways-of-being, both cognitively and 

affectively, becomes structured into a patient’s expanded and 

expanding self, each participant retaining his or her autonomous 

uniqueness. Expanded, more flexible, adaptive, and endurable selves 

are spun out and tried out. Over time, patients accumulate new ways 

of being with others woven and textured into the patients’ existing 

dynamic structures. A patient who struggled with sustaining a whole 

object/integrated psychic experience remarked to me at termination, 

“You certainly were not always the best analyst, but you helped me 

tremendously and for that I am grateful. I can now tolerate imperfection 

in myself and others without plunging into hopeless despair.” 

Dynamic identifications with the analyst are infinite in nature and 

will typically, although not exclusively, concern themselves with the 

particular trouble spots that impede a patient’s pursuit of satisfaction 

and pleasure. Of crucial importance is that the analysis provide an 

arena in which these trouble spots can emerge in the interaction. They 

surface in ways we alternately, depending on theoretical preference, 

label transference, transference–countertransference interaction, 

acting out, acting in, enacting, or a search for archaic and mature 

self–object provisions, to name a few. 

For example, if one is working with a person who struggles with 

containment of overwhelming, intolerable negative affect, the patient 

will identify with the many ways the analyst demonstrates an ability 

to contain. Interpretations may contribute to the process, but they 

are not sufficient, being more or less a cognitive exercise and rarely 

mutative. The patient needs to observe and actively participate in an 

actual, fully experienced interaction with the containing analyst, who 

variously struggles, stumbles, survives, accepts reparations, remains 

calm, or loses and recovers calm, to name a few of the genuine activities 

of containing. This interaction might also include the process 

participated in when the analyst makes a mistake and recovers from it 

without becoming defensive or inauthentic. We can extend these 

experiences to include most activities of the analyst, so that we have, 

for example, the working-through analyst; the forgiving, integrated 

analyst; the modulating analyst; the analyst who struggles with conflict; 

the analyst who becomes angry and recovers; the fallible analyst; and 

so forth. 

For dynamic identification to happen requires of the analyst 

concentrated devotion and an unwavering commitment to venture 

with the patient as a dyad to wherever the patient leads and regardless


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of the disturbance the analyst experiences. We must be prepared to 

roll up our sleeves and enter the patient’s inner world, as well as our 

own. We need, as Pick (1985) prescribes, to become greatly disturbed 

as we are made to experience, through concordant and complementary 

transferences (Racker, 1968), the object relationships inhabiting the 

patient’s inner world. On the way, we are called to reexperience the 

painful disturbances of our own inner object relationships. As we do, 

both consciously and unconsciously, so does the patient, who begins 

to identify with the struggles, failures, and successes of our own self– 

other dilemmas and how we negotiate them. The more we have 

resolved our own issues, or are at least able to tolerate them, the further 

the patient can safely venture. The further we have ventured ourselves, 

the further the patient will feel safe to go. 

Let me illustrate. A patient of mine, Marianna, an attorney in her 

40s, was successful in her work world. By contrast, her romantic life 

was in shambles. She was haunted by the shadows of a mother who in 

many respects was loving and providing but who was enormously 

anxious and would, at times, become impulsively and physically 

abusive. Marianna remembers episodes when her mother would smash 

her (the patient’s) head against a wall, at times drawing blood. 

Marianna, in a long-term relationship with a man, would luxuriate in 

comforting thoughts about the hoped-for possibilities of a life together. 

These hopes stood in marked contrast to the couple’s actual experience 

with each other. Inevitably, when they were together, their interactions 

would rapidly deteriorate into verbally abusive fights that were repaired, 

not by resolution, but only by being tucked into the passage of time. 

On one occasion, she entered my office following her vacation only 

to discover that I had replaced the old, worn patient chair with a new 

one. Complaining that I had not forewarned her about the change, 

she instantaneously entered into an enraged state, one I had not 

theretofore observed. She pelted me with virulent abusive language. 

She attacked my ability as an analyst and threatened to bring me up 

on ethical charges. At some point I became visibly addled, sputtering 

lame interpretations, while feeling a fine blend of helplessness and 

exasperated rage. My response only fueled her sadism as she upped 

her attacks while simultaneously announcing that, actually, she was 

getting great pleasure out of bashing me. In fact, she exclaimed, she 

had not had this much fun in years. I was thrust into that paralyzing 

place, familiar to most analysts at one time or another, of feeling that 

any intervention would meet with utter futility.


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So, what’s a good object to do 

First we must, as I am sure most would agree, survive the attack. 

Whether the patient’s outburst is seen as a ruthless attack by a 

Winnicottian, a dip into the paranoid/schizoid position by a Kleinian, 

or the result of empathic failure by a self psychologist, survival of the 

analyst is a must—it is a prime requisite of a good object. 

Let’s examine this process more closely. What do I mean by survival 

Allowing for nuanced differences by analysts of different theoretical 

creeds, I am referring to the analyst’s not succumbing to the patient’s 

omnipotence, not disappearing either consciously or unconsciously 

in the face of the patient’s conscious or unconscious fantasy of having 

wiped me out. We do not abandon, retaliate, or fall apart. 

That we survive ensures that the patient’s subjective omnipotence 

is challenged so that gradually he or she can tolerate the ongoing 

tension of surviving and tolerating an existence in which he or she 

must share the stage with others, while being allowed some measure 

of prime time as well. But it is not only by virtue of the experience that 

we survive that helps our patients. As important, if not more so, how 

we survive ultimately enables the expansion of the patient’s ego and, 

by implication, therapeutic change. 

Surviving is not enough. To rephrase Winnicott (1965), we can fob 

off a patient with a good survival. Survivals can be as staged and lifeless 

as a formulaic interpretation. When confronted with a murderous 

attack, we can manage to maintain a calm veneer while internally we 

fume, struggle, disorganize, become massively ashamed, sadistically 

attack, or settle into a lifeless remove, to name a few possibilities. 

While technically we have visibly survived, the patient does not get 

to experience or identify with how we survived. Patients, of course, can 

usually detect a storm underneath our best attempts to display calm. 

We need to straddle an impossible line between maintaining 

professional control and experiencing emotional upset. While 

maintaining a relative professional calm, we try not to affect a false 

remove, an aloof “nothing you say can affect me” attitude. Whether 

we are working with a more disturbed patient or a patient who is 

experiencing temporary paranoid/schizoid disorganization, we need 

to get stuck in our own psychic mud and experience our own painful 

disruption. To do otherwise (i.e., avoid, deny, etc.) we risk missing an 

empathic understanding of the underside of our patient’s skin. We 

also can appear inauthentic, typically signaling to a patient that it is 

not safe to venture further.


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Then, we work through, once again, as we did in analysis or selfanalysis, 

this place of disruption in ourselves, whether it resides in a 

neurotic, conflict-ridden arena or a primitive, paranoid/schizoid place. 

We reinstate our integrity, our wholeness, and the survival of our 

subjectivity without extracting revenge on the patient whose 

reparations we lovingly accept and whose life we permit to continue. 

In the episode with Marianna, I needed to allow and be disturbed by 

my own experiences with precipitous losses, failures of omnipotence, 

uncontrollable rage and sadistic pleasures; my own experiences of 

paranoid/schizoid organizational states, my own shameful disturbances. 

And, equally important, I needed to recall my own recovery from 

those places. 

Furthermore, these disruptions and recoveries occur in active 

participation with the patient (either consciously or unconsciously). 

Through this interaction, the processes of our dynamic self enter into 

and become structured with theirs. Through the mutual human 

phenomenology of our disruption and recovery, patients dynamically 

identify with the how of recovery as they gradually internalize and 

incorporate our recovery processes into their selves. The patient’s self 

is, in turn, strengthened so that it becomes more integrated and 

resilient. The patient’s interactions with others likewise become more 

the realm of integrative, whole-object experiences. The time needed 

for achievement or return to integration shortens. 

Let us return to Marianna, whom we left enraged, in attack mode, 

and feasting on sadistic pleasure from the experience. Without my yet 

understanding the vehemence of the attack, my first task was to 

survive. I could have sat back in my chair, stayed attentive, remained 

calm, attempted to explore, offered interpretations, contained the rage 

with empathic attunement, or just remained silent. All reactions could 

be considered forms of survival, which, indeed, they are. Unless, 

however, I had allowed the attack to get under my skin, to disturb me 

in places I would rather not be disturbed, to touch rage or sadism 

within my own experience, my survival would have, in my opinion, 

been doomed to be experienced by the patient as formulaic, 

inauthentic—or worse, another display of enviable perfection on my 

part, to be either idealized or destroyed. I would be saying to the 

patient, “I am not ready to go to that place with you. I am overly 

anxious or fearful that it will not be safe.” 

In order for patients to internalize how we contain, organize, or 

negotiate such powerful, overwhelming experiences, they need likewise


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to experience that we have gone to a place of madness and worked it 

through ourselves. They need to detect, either consciously or 

unconsciously, that we have jumped into the muck as they had, and 

despite our fears we have reorganized and reconstituted a secure self– 

other vitality. This is the point of connection needed between self 

and other that patients observe, experience, and internalize. It is not 

only that we survive, but how we survive, how we venture to insanity 

and back. 

When Marianna precipitously attacked, I was unprepared. 

Unwittingly and uncharacteristically I experienced and displayed a 

measure of stunned disturbance. She observed my discomfort, which 

in the moment I neither went to great lengths to express nor to hide. 

My own not so very pretty sadistic impulses bubbled up, fueling a 

pleasurably charged string of invectives. My internal voice gleefully, 

though guiltily, complained, “I can’t just buy a fucking new chair 

without you giving me grief.” Continuing cursing to myself, I pressed 

my imaginary eject button and pleasurably watched her fly out the 

window, sail uncontrollably over Central Park, and land in a strong, 

icy current in the East River. 

Then, experiencing an admixture of painful guilt and shame I caught 

myself and decided it was time to recover. I became aware of how 

surprised, ungrounded, and frightened I had become, having never 

experienced such an unpredictable storm from this patient, with whom 

I had worked for years and for whom I had developed a fondness. I 

was clueless as to what had actually happened, and I was frightened 

about what might happen next. I accessed my own comparable 

childhood experiences. 

Enter reason, that wonderful harbinger of a more integrated place. 

I reasoned from a Kleinian vantage point 5 that I was being related to 

by means of a projective identification. Specifically, I was, in the 

interpersonal and intersubjective arena, being made to experience one 

pole of Marianna’s internal object relationship, that of her anxious 

and precipitously attacking mother, followed by a mother who ruefully 

experienced both guilt and remorse. During the interaction I was not 

spared experiencing the opposite pole of her internal self–object 

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5 

One’s theoretical convictions can be helpful at times like these, whatever theory 

one may subscribe to. They can provide meaning when one’s meaningful illusions 

are attacked.


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relationship. I was made to feel the horror of being the subject of her 

mother’s attacks, the surprise and shock of receiving abject hatred 

from a previously safe and loving mother. 

So our minds met on a paranoid/schizoid plane, and we both 

experienced these strange dangerous feelings of self and other. We 

had some awareness of each other’s struggle with powerful drive 

experiences, particularly sadism, as well as fear of being suddenly 

shamed and humiliated. 

From this place, I told the patient that it appeared she was more 

inflamed by my being upset than by my having not told her about the 

new chair. She concurred and went on to tell me that her most 

terrifying experiences as a child had been when her mother appeared 

confused and anxious. These times typically preceded physical abuse. 

We began to understand that my anxiety had aroused a similar fear of 

abuse and her sadistic attacks were an effort to ward off my impending 

attack. One might also say that her attacks represented an internalized 

self and object identification with her mother. Over the course of the 

next series of sessions, gradually achieving a more related calm, we 

continued to be able to explore and resolve the episode. We had both 

been through hell, worked our way over hot coals, and come through 

grounded on the other side—my regaining, and she achieving, an 

experience of reintegration of our selves and each other. Had I 

disavowed my sadistic pleasure, fear, or guilt, as well as my working 

through the shame and humiliation, I do not believe progress would 

have been made. Being a good object is not easy. Sometimes, Chicken 

Little is right. 

I should add here that I was also concerned that our recovery might 

have been only cosmetic, both of us staging a recovery by clinging to 

convenient historical myths and narratives to escape the tumult of 

our disruption. As with much of our work, we therapists are rarely 

given direct confirmation of our success. Indeed, many treatments 

appear to shift endlessly through disruptions, repairs, reparations, 

deaths, and any of the infinite possibilities of nuanced and shifting 

object connections. I have become increasingly more comfortable 

surrounded by uncertainty. While Bion (1967) instructed us to greet 

each session without memory or desire, I prefer to recall a wise elderly 

supervisor’s instruction to “trust the process.” Indeed, with Marianna, 

the ultimate proof came with the gradual, forward-and-back, and 

forward-again improvements in her sustaining integration in 

relationships with me and others, all leading to a satisfying marriage


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and children. Perhaps trusting the process 6 is another route to being 

a good object. 

I need to add that a similar process is advisable when patients reveal 

idealizing, loving, or intense sexual feelings toward us. Whether or 

not we immediately dissuade these patients of their idealized myths 

about us is not to me the crucial issue. We need to climb into the 

heavens with our patients’ positive feelings, just as we dove into the 

mud of their negative feelings. We need to find those places in us, and 

rework our own struggles with grandiosity, or perfection, or need for 

adoration. Consciously or unconsciously, we communicate this process 

to our patients and allow them, without fearing great shame, 

humiliation, or destruction, to identify with a similar process of 

disillusionment. 

A patient of mine has a father who has been, and continues to be, 

overly sexually stimulating with her. She, in turn, has been 

excruciatingly embarrassed by her sexual impulses since childhood, 

experiencing painful humiliation at the mere mention of anything 

sexual. A very attractive woman, she receives no pleasure from sex 

and shies away from all contact with men. She is unable to achieve 

orgasm. In the transference, she developed powerful sexual desires 

for me, which she gradually began to describe. In response, I began to 

feel pleasurably sexually aroused by her. Quite frankly, after a period 

of initial anxiety, I loved it. To my dismay and despite years of 

trumpeting ethical prohibitions and responsible professional probity, 

our mutual sexual seduction felt exciting, flattering, frightening, and 

embarrassing. I experienced enormous guilt about my pleasurable 

sexual arousal and was unspeakably afraid of lapsing into the 

inappropriate, of losing control. 

So, now what’s a good object to do 

Of course, my psychoanalytic superego struggled. Should I interpret 

the feelings while at the same time getting myself back into analysis 

for experiencing the dreaded countertransference Should I make 

reference to the original oedipal triangle in her family, in which her 

sexual feelings for her seductive father left her ashamed and in fear of 

reprisals from her envious mother, a dynamic that continued into the 

present Should I guide her toward relinquishing her strong attractions, 

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6 

Trust of process can provide a possible locus of integration between psychoanalysis 

and Buddhism. See Engler (2003) and Magid (2003) for more on this issue.


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which I relegated to transference Should I let her know how great 

sexual arousal can feel 

Crawling into my own unconscious, I found the place where my 

own sexual feelings had run into my parents’ arousals, competitions, 

anxieties, and prohibitions, which furthermore had left me in 

embarrassing, anxiety-ridden, and challenging places. Working these 

feelings through (again), I acknowledged the source of my sexual 

feelings and how they interplayed with Marianna’s internal sexual 

scenarios. What I had experienced prior to working my issues through, 

and in the mutual projection and introjection of self and other 

seductive scenarios, was something akin to what she and her overly 

seductive father had repeatedly experienced. Her sexual organization 

was contaminated by her family’s dynamics (as was mine, although 

not necessarily the same dynamics) and her father’s inappropriate 

seductive advances. 

Disidentifying with the projections of her father, I realized that, of 

course, I would never act on my sexual arousals with her. My purpose 

(and what should have been her father’s purpose) was to allow her to 

feel safe with her sexuality while I admired her attractiveness without 

lascivious intent (like a proud, enchanted, but appropriately distanced 

father). 

Without revealing, consciously at any rate, my own feelings and 

the process I was going through, over the next series of sessions I 

acknowledged her sexual feelings and their normality. I accepted them, 

celebrated them even, and assured her that we would never act on 

them. This acknowledgment, I believe, allowed her to experience 

sexual feelings in a new context, a safe, appropriate context with a 

new good object. Her embarrassment and shame, like my initial anxiety, 

gradually dissipated, and her tolerance for her own sexual impulses, 

now existing in interaction with my accepting but safe responses to 

them, increased. She began dating and having pleasurable sex and 

ultimately married, at which time she successfully terminated treatment. 

Some might scoff at my technique. They would belittle it as a 

“transference cure,” a cure in which I gratified her archaic impulses. I 

would reply that all “cures” are transference cures. But we do not 

gratify impulsive wishes; instead they are experienced and detoxified 

in the context of a new relationship, a new relationship with a good 

object. And in this new relationship Marianna had the opportunity to 

identify with the dynamic processes that I tortured through and worked 

on to recover from my own temporary insanity.


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Relational Needs Require Acceptance 

of Our Patients’ Love 

Recently psychoanalysts have turned their attention to deciphering 

the nature of love in a deconstructed world and, by extension, in the 

analytic relationship. Steven Mitchell (2001), in his last works, was 

attempting to shine new light on love and passion’s trajectory through 

the life span; and others (Davies, 1994; Hoffman, 1998; Applebaum, 

1999) have been exploring love’s sexual and nonsexual presence in 

the analytic relationship. Freud (1920) and Klein (1975a) considered 

love to be a derivative of our most basic instinctual inheritance and 

ultimately a sublimated expression of the sexual drive, at times in fusion 

with aggressive drive elements. Love was thought to be the ultimate 

mature expression of our bestial inheritance. Fairbairn (1952), 

reversing this primal scenario, proclaimed sex to be a well-suited, 

although by no means exclusive, expression of mature mutual love. 

Speaking on a different, less drive-infused level of discourse, he 

situated a person’s involvement with love at birth. He located love’s 

essence at the heart of our fundamental human nature, our need for 

establishing and maintaining loving connections. Mental health, for 

Fairbairn, was virtually assured with parental love; pathology arose 

from its disruption or absence. 

But he went further than that, although little of what he espoused 

has carried over to today’s sensibilities. As noted, he placed a need 

for love at the very center of the child’s psychic inheritance at birth. 

Love is not only a requisite of the child, needed for safe passage across 

developmental horizons. A child likewise enters the world with a need 

to express loving desires, desires that guide the child toward, and assure 

the child of, needed connections with others. In this Fairbairn was 

greatly influenced by Suttie (Harrow, 1998), a Scottish theoretician 

who wrote about the deleterious psychological effects of society’s taboo 

on intimacy. 

With the centrality of a primary need for love in mind, Fairbairn 

emphasized that for the healthy development of a child, not only 

should parents be able to love their child without excessive narcissistic 

investment, but also, and equally crucial, they need to accept the 

child’s offers of love. For infants and adults like, the acceptance of 

loving gestures affirms and reaffirms our secure connections and 

membership in a world of other like beings. Whether the loving gesture


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be a child’s offer of a smile, a scrap of paper, or an actual gift, its 

acceptance by a parent, in neither exaggerated nor devalued manner, 

is a crucial signal to the child of a secure, valued connection, a 

connection partially created by the child’s loving and creative gesture. 

A deficit of experience with a parent’s heartfelt embrace of the 

child’s offerings of love can weaken the child’s sense of efficacy, selfworth 

regulation, and ability to believe in the loving intent of others. 

It can also lead to a devaluation of ambitions and dreams, creations 

and productions whose loving offerings are also felt to be of no 

consequence. Most tragically, it can result in overwhelming feelings 

of worthlessness. 

The importance of analysts’ not retreating from their patients’ loving 

offerings has not been accentuated nearly enough in our technical 

recommendations. I wholeheartedly add this wrinkle to the list of 

therapeutic activities required of the good object. We certainly 

encourage our patients to express their anger and rage at us, yet we 

can have enormous difficulty accepting their loving expressions. These 

we tend to interpret, entirely missing the point. 

A patient’s loving gestures can take on an infinite variety 

of expression. It is important that we try to distinguish them from 

nonadaptive enactments or other collusive enticements. For example, 

sometimes a patient may offer an expression of sincere gratitude. Before 

dismissing it with interpretations of idealization, manipulation, or 

sexual bidding, which it certainly might be on occasion, I have found 

a simple “thank you” to be of enormous value. An interpretation at 

such a time can be experienced as a devaluation, an attack, or a 

rejection. Some other, but by no means exclusive, examples I have 

come across include receiving appropriate gifts, realistic compliments, 

constructive criticism, or real concern about real illness. 

Here I think of another patient of mine. He is a 30-somethingyear-old 

man, the son of a successful celebrity father. His father would 

engage in frequent contact with adoring audiences whom he likewise 

blessed with visible adoration. But, in the presence of his son, my 

patient, he remained distant, aloof, and reticent. My patient reported 

frequent attempts to connect with his father that were shunned, 

ignored, or criticized. He especially recalled repeated attempts to enter 

his father’s basement workshop, a place where his father isolated 

himself most of the time when at home. My patient craved a 

connection of any kind with his father, whether to shoot the breeze,


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get advice, or talk about his own endeavors. He had both athletic and 

artistic abilities that went mostly unnoticed by his father. When he 

entered the study, his father would typically regard him with a blank 

stare and remain eerily silent until my patient would quietly exit, 

nursing the sinking feeling of being an unwelcome and deplorable 

intruder in his father’s life. 

I remarked that, while his father had rarely expressed generous 

feelings of love and pride toward him, equally, if not more, unbearable 

was that his father could not accept his offerings of love and friendship. 

My patient concurred, breaking into deep sobs. He desperately 

wanted his father to receive his adoration, to accept his kudos and 

offerings of friendship. Being the youngest by many years in a house 

with much older siblings and a self-centered, narcissistic mother, 

he looked toward his father lovingly, as an ally. Unable to tolerate 

his father’s not accepting his offers of “sonship,” he retreated to 

an invisible, withdrawn, and dejected place he continues to occupy 

as an adult. 

I worked for a time with another man, who, after a brief idealization 

of me, comfortably settled into an extensive period of pure, unbridled 

contempt and devaluation of me. He particularly would bombard me 

with bitter disapproval, especially when I responded to his verbal 

hostility with suggestions of possible meanings (gingerly offered 

interpretations). In fact, all attempts to ascribe meaning to our 

interaction were cynically dismissed. I understood this rejection to 

reflect the unrelenting positioning of his psychic organization in the 

paranoid/schizoid mode. 

After a time, he entered a session with a story about walking down 

a street with a friend. They passed a hardware store, at which point 

he turned to his friend and pronounced that his apartment was very 

dry and he needed to buy a “humiliator.” His friend replied, he told 

me, “You don’t need a humiliator; you need a “dehumiliator.” Laughing 

and with a sparkle in his eye, he looked at me and declared, “That 

was a gift.” I laughed heartily, signaling my acceptance of the gift. 

I knew (or at least hoped) that at that moment we had turned a corner 

and his self and object integration had progressed. I could have offered 

a number of interpretations having to do with, say, his wit being an 

expression of hostility, or his making an offer of reparation for the 

numerous times he had degraded me. But I would have missed the 

essence of his message—the offer of his love.


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Empathic Attunement to Psychic Organization 

Relational analysts routinely hold up empathy or empathic attunement 

as a requisite provision of a good object. It is far beyond the scope of 

this paper to explore the development, phenomenology, or nuanced 

processes of therapeutic empathy. I would like, however, to note an 

observation on a specific use of empathy, gleaned from my work, that 

holds consequence for both theory and therapy. 

The positional psychic organizations identified by Klein (1935) and 

more recently expounded on by Ogden (1986) require a particular 

form of empathy as they emerge in treatment. To state this use of 

empathy in its simplest form: a patient who is, in the here and now, 

experiencing the analyst through the psychic organizational lens of 

the paranoid/schizoid position requires that the analyst provide a 

variant of empathic attunement. Rather than demonstrating an 

attunement for the patient’s affective expression at the moment, such 

as, say, “You are in a rage,” or, “You are in a rage because . . . ,” the 

analyst needs to express empathy for the patient’s experience of his or 

her psychic level of organization 7 and a diminution of attention to 

interpretation of psychic meaning. Obversely, a patient positioned 

more in the depressive organization requires more empathic 

attunement to interpretations of the meaning of their experience. 

The paranoid/schizoid psychic organization, as elaborated by Ogden 

(1986), devolves into a state of “it-ness.” Emotions, thoughts, and 

even behaviors do not seem to be arising from a locus within the 

patient. Instead, they are experienced as happening to the patient. As 

such, the truth of moment-to-moment psychic meaning is, for the 

patient, derived from an absolute external truth. The patient has no 

sense that he or she is in any way the arbiter of meaning, the master of 

his or her own perceptions. The contemptuous patient does not imagine 

that you are a hopeless incompetent, he knows that you are a hopeless 

incompetent, with no room for degrees of freedom. Similarly, the 

adoring, idealizing patient experiences the truth of his feelings in the 

same way. Consequently, his rancor or adoration toward you is not 

debatable; it is the only reasonable response from a reasonable person 

whose reasoning follows from the absolute truth. 

⎯⎯⎯⎯⎯⎯⎯⎯⎯ 

7 

This is similar to what James Fosshage refers to as empathy from within as opposed 

to empathy from without (2004, personal communication).


⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯ 

Furthermore, since this organization contains split-off islands of 

experience, in which time has collapsed into an eternal, dimensionless 

plane, not only do the experiences of the paranoid/schizoid 

organization contain no past or future, or paradoxically, both eternal 

past and future, there is no communication with other states. The 

patient has no awareness that she possesses alternative feelings or 

could imagine the possibilities of other feeling perspectives at any point 

in time, past or future. 

The ahistoricity of a paranoid/schizoid organizational truth requires 

that the analyst address his or her empathic attunement to just this 

experience. For example, a patient of mine who functioned in a 

relatively healthy state of mutuality with me most of the time came to 

her session the day following her mother’s death from chronic 

alcoholism. I greeted her with an appropriate expression of sympathy. 

Instantly flying into a vitriolic spewing of rage at me, she declared 

that my sympathy had nothing to do with her, that it was based solely 

on my selfish preoccupation with my desire to be liked. I was merely a 

“touchy-feely leftover from the 60s.” 

So, once again, what’s a good object to do 

I wondered, was she right Were my 60s sensibilities, honestly gained 

in that decade, appearing in as immature a fashion as they existed 

then Was my expression of sympathy formulaic Or did her rage 

represent a displacement of her anger toward her mother, who, being 

dead, became a more guilt-evoking target Do I empathize with the 

patient’s anger Or do I interpret 

As I have been arguing, I first discerned that my patient, at that 

moment, was ensconced in a paranoid/schizoid organization of self 

and other. In that place, she lacked capability to understand an 

interpretation, be it transferential, interpersonal, intersubjective, or 

whatever. The organization that could process the self-generative 

meaning of her experience was split off and unavailable to her. An 

interpretation at that moment would have appeared useless at best, 

and attacking at worst. Likewise, an empathic response to her affects 

would similarly fly out the window. “You’re in a rage at me,” would be 

experienced as my lame attempt at stating the obvious. 

I maintain that what was needed in the situation was an empathic 

communication of the state of her state, the immediate experience of 

her paranoid/schizoid way of organizing and enduring her mother’s 

death. I offered a statement something like, “It must be terrifying to 

trust me one minute and have that trust evaporate entirely the next.


⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯ 

Now it must seem that our relationship is permanently damaged and 

that hopes for it ever being reestablished, futile.” I made no interpretive 

ties to her mother, no identification of internal conflicts. My actions 

were more in the realm of empathic holding of unbearable affects. I 

would like to say she immediately responded, settled down, and 

returned to a higher level of psychic organization. Truth be told, she 

flew out of the room in an exasperated rage. 

She returned the following day, ready for business as usual, with no 

mention of the previous day’s events. Tossing aside my attempts to 

bring up the previous session and dismissing it as silly, she proceeded, 

calmly as always. This cycle of disruption followed by nonchalant calm 

began to occur with increasing rapidity, and there were fewer and 

fewer calm sessions. Finally, after many months of this cycling, during 

one outburst she exploded into tears and wanted to know how I could 

stay so calm. In fact, she hated my calm. My calm, we discovered, 

felt to her like a sadistic attack, highlighting by distinction, the 

disruption of her explosions. Ultimately, she felt mortified in the face 

of my calm. 

We continued to understand that her hateful experiences of me 

were fueled by intense, powerful envy. During her tumultuous 

paranoid/schizoid states, her envy and hate blinded her to other aspects 

of my character, past or present. She rebuked my calm, empathic 

holding with scathing, envious attacks. Her responses rendered her 

tragically unable to absorb, by dynamic identification or any other 

means, a more adaptive containing process. 

Gradually, over a long time and through my empathic attunement 

to her states of futility and hopelessness, she could tolerate and 

internalize my calm offerings of holding. The process of dynamically 

identifying with a good (in this case surviving) object was jump-started 

as she returned to her previously rather high level of depressive position 

integration. Despite her disapproval of my lame “60s” type of 

responsiveness, she could also regain her equanimity toward me. This 

more evenly regulated perception of me led to fewer stormy eruptions 

and increasing expressions of gratitude, which I heartily accepted. 

It also led to a greater understanding of her original outburst 

following her mother’s death as an attempt to hold on to her 

internalizations of her mother (who was prone to vitriolic outbursts), 

which the patient required to prevent further disintegration of her 

self-experience. While the meaning was, of course, important, of more


⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯ 

significance was the strengthening of her ability to regain access to a 

more integrated appreciation of self and other, a strengthening she 

gained in interaction with a new, good object. 

Summary and Conclusion 

I have described and illustrated the use of the analyst as a good object 

in the mutagenic arena of the good-object relationship. I have 

discussed its use from a pluralistic consideration of concepts taken 

from different relational theories. Drawing mostly from Fairbairn, 

Winnicott, and Klein, as well as my own clinical experience, I described 

categories of good “objectness.” These included the process of dynamic 

identification, the acceptance of a patient’s offering of love, and the 

use of empathy in a Kleinian framework. Obviously, additional ways 

of being a good object await either description or discovery. 

Certainly, the events of the months following the September 11 

disaster and the wars in Afghanistan and Iraq have challenged us in 

ways never before experienced in our lives or profession. We have 

come to each other with stories, events, and experiences from both 

sides of the couch. One response of therapists in the immediate 

aftermath of the September 11 attack has struck me as almost 

universal. Therapists have spoken of their need to bend whatever have 

been the usual limits of their therapeutic frame. Whether it was to cry 

openly with a patient, give political opinions, or reveal personal 

experiences, analysts report having surrendered their usual objective, 

professional role. We have been and will continue for some time to be 

the traumatized treating the traumatized, especially at anniversaries 

of traumatic events or during dreaded occurrences of future events. 

In response we have approached our patients with a universal desire 

to connect in mutual, loving ways. We need our patients just as they 

needed us. We have not feigned a hold on professional authority when 

it comes to reestablishing equilibrium following a major confrontation 

with traumatic, unprecedented horror and chaos. We have been forced 

to a place none of us have previously been, unfortunately a place that 

promises to continue indefinitely. I strongly believe that our willingness 

to be with our patients in this flexible fashion is yet another 

manifestation of the analyst as good object. Recently a 24-year-old


⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯ 

man had been imploring me to assure him that the world will remain 

a safe place. Suddenly realizing I was not able to provide him with the 

assurances and protections he sought, he exclaimed knowingly, “Oh, 

I get it; you’re going through this too.” 

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Psychotherapies Psychoanalytic Association, New York. 

Bion, W. (1967), Notes on memory and desire. In: Melanie Klein Today, Vol. 2, 

ed. Bromberg, P. H. (1998), Standing in the Spaces. Hillsdale, NJ: The Analytic 

Press. 

Bromberg, P. M. (1998), Standing in the Spaces. Hillsdale, NJ: The Analytic Press. 

Burke, W. F. (1992), Countertransference disclosure and the asymmetry/mutuality 

dilemma. Psychoanal. Dial., 2:241–271. 

Davies, J. M. (1994), Love in the afternoon: A relational reconsideration of desire 

and dread in the countertransference. Psychoanal. Dial., 4:153–170. 

Engler, J. (2003), Being somebody and being nobody: A reexamination of the 

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Buddhism, ed. J. D. Safran, Somerville. MA: Wisdom. 

Fairbairn, W. R. D. (1952), Psychoanalytic Studies of the Personality. London: Routledge 

& Kegan Paul. 

⎯⎯⎯ (1958), On the nature and aims of psycho-analytical treatment. Internat. J. 

Psycho-Anal., 29:374–385. 

Freud, S. (1920), Beyond the pleasure principle. Standard Edition, 18:7–64, London: 

Hogarth Press, 1955. 

⎯⎯⎯ (1923), The ego and the id. Standard Edition, 19:12–59. London: Hogarth 

Press, 1955. 

Greenberg, J. (1995), Self-disclosure: Is it psychoanalytic Contemp. Psychoanal., 

31:193–247. 

Harrow, J. A. (1998), The Scottish connection—Suttie-Fairbairn-Sutherland: A quiet 

revolution. In: Fairbairn, Then and Now, ed. N. J. Skolnick & D. E. Scharff. Hillsdale, 

NJ: The Analytic Press, pp. 3–17. 

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4:171–192. 

Hoffman, I. Z. (1998), Ritual and Sponteneity in the Relational Process: A Dilectical- 

Constructivist View. Hillsdale, NJ: The Analytic Press. 

Klein, M. (1935), A contribution to the psychogenesis of manic states. In: 

Contributions to Psychoanalysis, 1921–1945. London: Hogarth Press, pp. 282–310. 

⎯⎯⎯ (1975a), Love, Guilt and Reparation and Other Works, 1921–1945. London: 

Hogarth Press. 

⎯⎯⎯ (1975b), Envy, Gratitude and Other Works: 1946–1963. New York: Delacorte.


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Kohut, H. (1984), How Does Analysis Cure, ed. A. Goldberg & P. Stepansky. Chicago: 

University of Chicago Press. 

Lipton, S. D. (1983), A critique of so-called standard psychoanalytic technique. 

Contemp. Psychoanal., 19:35–45. 

Magid, B. (2003), Your ordinary mind. In: Psychoanalysis and Buddhism, 

ed. J. D. Safran, Somerville, MA: Wisdom. 

Mitchell, S. (1988), Relational Concepts in Psychoanalysis. Cambridge, MA: Harvard 

University Press. 

⎯⎯⎯ (2001), From angels to muses: Idealization, fantasy and the “illusions of 

romance.” Presented posthumously at the National Institute for the 

Psychotherapies’ Annual Colloquium, New York. 

Ogden, T. H. (1986), The Matrix of the Mind. Northvale, NJ: Aronson. 

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Today, Vol. 2, ed. E. B. Spillius. New York: Routledge, 1988. 

Racker, H. (1968), Transference and Countertransference. NY: International 

Universities Press. 

Schafer, R. (1997), The Contemporary Kleinians of London. Madison, CT: International 

Universities Press. 

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Psychoanalysis, ed. N. J. Skolnick & S. C. Warshaw. Hillsdale, NJ: The Analytic 

Press, pp. xxiii–xxix. 

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Psychoanalytic Life. Hillsdale, NJ: The Analytic Press. 

Sullivan, A. (2001), This is a religious war. The New York Times, October 7. 

Tansey, M. J. (1994), Sexual attraction and phobic dread in the countertransference. 

Psychoanal. Dial., 4:139–152. 

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211 Central Park West 

New York, NY 10024 

njspsy@aol.com


Diagnosis-of-the-Moment and 

What Kind of Good Object the 

Patient Needs the Analyst to Be 

Commentary on Paper by Neil Skolnick 

⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯ 

Jay Frankel, Ph.D. 

I attempt to clarify Skolnick’s idea that patients should be given the 

opportunity to identify with the analyst’s self, especially struggles within 

the analyst engendered by the treatment process, as he or she analyzes— 

a process Skolnick calls “dynamic identification.” Specifically, I ask 

whether analysts should actively present their own struggles to patients 

or should allow patients to discover this aspect of the analyst’s 

subjectivity in their own time. Skolnick is not explicit on this point. I 

understand the work of developmentally oriented theorists such as Balint 

and Kohut, as well as Skolnick’s own ideas about the importance of the 

analyst’s attunement to the patient’s level of psychic organization, to 

indicate that certain patients need to be allowed to discover the analyst’s 

struggle and limitations only as they are ready to do so. 

This line of thinking leads to a consideration of the question of 

diagnosis, a theoretically uncomfortable concept for many relational 

analysts. I propose the concept of “diagnosis-of-the-moment,” which 

allows us to value diagnosis as a meaningful and clinically useful 

description of a person’s functioning, without minimizing the 

contribution of context, reifying unsubstantiated assumptions about the 

patient, or constricting clinical possibilities. 

KOLNICK SETS HIMSELF THE TASK OF OUTLINING AN OPERATIONAL ANSWER 

to the very important question of how analysts can be good 

Sobjects for their patients. This question is central both for 

⎯⎯⎯⎯⎯⎯⎯⎯⎯ 

Jay Frankel, Ph.D. is an Associate Editor of Psychoanalytic Dialogues; Supervisor in 

the New York University Postdoctoral Program in Psychotherapy and Psychoanalysis; 

and Supervisor, Child and Adolescent Psychotherapy Training Programs, William 

Alanson White Institute and National Institute for the Psychotherapies, New York. 


30 Jay Frankel 

⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯ 

relational thinking about clinical technique and for an understanding 

of the process of internalization in analytic treatment. Skolnick’s 

choice to address the question in “broad strokes” and in a “less than 

comprehensive” manner leaves room for others to engage his ideas in 

an active way. Here I flesh out two interrelated issues that Skolnick’s 

paper raised for me as I read it: whether patients need their analysts 

to be good objects or, alternatively, great objects; and the place of 

diagnosis in our work. My hope is to clarify further the concepts 

Skolnick grapples with. 

Do Patients Need Their Analysts to 

Be Good Objects, or Great Objects 

I see an interesting (and heuristically useful) possible contradiction 

between Skolnick’s thinking about what he calls “dynamic 

identification”—one of the three recommendations he makes about 

how an analyst can be a good object—and the ideas of more 

developmentally oriented analytic theorists such as Kohut (1971, 1977, 

1984) and Michael Balint (1968). Indeed, as I explain later, at certain 

times, in certain treatments, there is potentially a contradiction 

between two of Skolnick’s own recommendations: the idea of dynamic 

identification, and the importance of “empathic attunement to psychic 

organization.” 

Skolnick uses the term dynamic identification to refer to the analyst’s 

“providing the patient with an opportunity to identify with the analyst’s 

self as he or she analyzes.” In his discussion of dynamic identification, 

Skolnick underlines what he sees as the therapeutic importance of 

the patient’s being offered the opportunity to sense the analyst’s 

struggle with the difficult experiences that the treatment inevitably 

will induce in the analyst. In this way, Skolnick says, patients can 

“identify with the how of recovery [from feeling personally disturbed 

or disrupted] as they gradually internalize and incorporate our recovery 

processes into their selves.” What makes the analyst good, according 

to Skolnick, is not the analyst’s perfection, but his or her devotion 

and commitment and consequently his or her readiness to engage in 

personal struggle on the patient’s behalf and to make this struggle 

available to the patient. To borrow Winnicott’s (1960) phrasing, for 

Skolnick it is better for the patient if the analyst is good-enough, with

Commentary on Paper by Neil Skolnick 31 

⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯ 

certain shortcomings, rather than that the analyst appear to be great 

and above personal struggle and limitation. The idea of an analyst’s 

greatness, Skolnick reminds us, belongs to Klein’s (1946) paranoidschizoid 

position and Kohut’s (1971) idealizing selfobject transference, 

not to reality and more mature forms of thinking. 

In contrast, Kohut (1971) was explicit about the need for certain 

narcissistic patients, if successful treatment is to be possible, to be 

allowed to have their idealizing (or mirroring or twinship) selfobject 

transferences run their courses, without interference by the analyst, 

until the patients become ready to let that transference go. Similarly, 

Balint (1968) wrote about the importance for patients functioning 

“in the area of the basic fault”—his descriptor for narcissistic states— 

to have the opportunity to experience, without challenge by the 

analyst, the kinds of object relationships they instinctively seek out in 

their analyses. The kinds of experiences he said patients might need 

were similar to Kohut’s selfobject transferences. Indeed, Balint believed 

that an analyst must take great care to protect these transference 

experiences for a patient by avoiding saying or doing anything that 

would refute the patient’s subjective experience. To sum up: according 

to Kohut and Balint, there are times when an analyst should not 

interfere with the patient’s seeing the analyst as, in Skolnick’s words, 

“a one-dimensional fiction.” 

As a rule, classical psychoanalysts—who are often less attentive 

than interpersonal and relational analysts to (or place less emphasis 

on) their own inevitable transparency to patients and to their own 

influence on patients (see Ferenczi, 1932, 1933; Hoffman, 1983, 

1998)—try to create a situation where a patient’s transference can 

grow and become elaborated without the patient’s being confronted 

by the analyst’s contradictory realities, whether or not the patient is 

more narcissistic. Supporting this view, Greenberg (2001) has pointed 

out that an analyst’s explicit focus on the interaction between himself 

or herself and a patient may direct the patient’s attention “away from 

private experience” (p. 373) and interfere with “allowing whatever is 

happening [within the patient] to develop further and to deepen” 

(p. 372). 

Skolnick’s idea—that a crucial component of therapeutic action is 

that the analyst offer the patient access to the analyst’s own internal 

struggles—appears directly incompatible with Kohut’s idea that certain 

patients need, for some period of time, to be allowed to idealize their 

analysts as perfect or extraordinary, without being offered evidence


⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯ 

to the contrary; 1 and with the idea that patients generally need to 

be allowed to discover their analysts’ actual subjectivity 

(i.e., not what the patients project), including their analysts’ struggles 

and shortcomings, at their own pace. Indeed, an analyst’s actively 

directing a patient’s attention to the analyst’s own shortcomings may 

undermine these processes. 

The Patient’s Awareness of the Analyst’s 

Struggle, and the Question of Timing 

An objection from relational quarters to the Kohut/Balint idea of not 

interfering with a patient’s illusory perception of the analyst is that 

patients, especially the types Kohut and Balint worked with, are 

extremely perceptive about their analysts’ psychology, including its 

unconscious aspects—a discovery that dates back to Ferenczi (1932, 

1933). According to this line of thinking, for an analyst to accept a 

patient’s illusory perception amounts to colluding in mystifying the 

patient and sets up a situation in which the patient may be likely to 

hold on to, for instance, an “idealized” perception of the analyst more 

as a kind of unconscious favor to an insecure analyst than because of 

the patient’s own inner need (see Frankel, 1993, 2002). 2 

This objection provides an opportunity to clarify a point made by 

Skolnick and possibly to remove the apparent contradiction between 

Skolnick’s ideas about dynamic identification, as opposed to the ideas 

of Balint and Kohut, and Skolnick’s own discussion of the importance 

of empathic attunement to psychic organization. The unclarified issue 

is, What exactly is meant by offering the patient the opportunity to 

see the analyst’s struggle Skolnick says that patients “need to detect, 

⎯⎯⎯⎯⎯⎯⎯⎯⎯ 

1 

Self psychology, contrary to a frequent misconception, does not advocate that 

analysts actively perpetuate a particular transference; rather, they must monitor their 

countertransference responses as the recipients of an idealized transference (for 

example) and try not to interfere out of their own discomfort with the idealized role 

(Kohut, 1971). The self-psychological position is not that analysts should attempt 

to play a role at all, but that they understand the significance of the role they have 

been assigned by the patient (Clement, 2005, personal communication). 

2 

On the patient’s side, such a move may be a reenactment of the role the patient 

played during childhood: protecting a vulnerable parent by “not seeing” the parent’s 

problems, as well as reflecting a wish to hold on to an idealized image of a parent 

whose flaws frightened the child.


⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯ 

either consciously or unconsciously, that we have jumped into the 

muck like them.” In principle, this statement leaves lots of room for 

patients to discover their analysts’ struggle in their own time, as they 

become ready to do so. In fact, in two of Skolnick’s clinical examples 

we read nothing at all about Skolnick actually speaking to his patient 

or giving any open indication to his patient about his own experience 

of struggle. Skolnick leaves unclarified whether and to what extent 

the analyst, in his attempt to foster dynamic identification in the 

patient, actively presents his struggle to the patient or simply allows the 

patient to discover the analyst’s inner struggle in the patient’s own time. 

There may be no contradiction at all between Kohut’s and Balint’s 

thinking, classical thinking generally, and Skolnick’s idea about the 

importance of being empathically attuned to the patient’s psychic 

organization, on one hand, and Skolnick’s ideas about dynamic 

identification, on the other, if Skolnick’s understanding of dynamic 

identification allows for the possibility that the analyst lets the patient 

discover the analyst’s inner struggle when she is ready, rather than 

pushing it at her. 

Relational Attitudes toward Diagnosis and 

the Concept of Diagnosis-of-the-Moment 

The notion that patients may not be ready to face facts for which they 

have evidence, and may know on an unconscious level, can take us 

more explicitly to the matter of diagnosis. For it seems to be the case 

that certain patients can face unpleasant facts more of the time, while 

other patients approach these facts at a slower pace. 

Diagnosis is an uncomfortable concept for many relational analysts, 

for several interrelated reasons (see Altman et al., 2002). 3 First, 

relational analysts are alert to intersubjective and other contextual 

influences in the clinical encounter. One aspect of this alertness is 

that they understand that analysts are unavoidably embedded in their 

own countertransferences, perceptual biases, and cultural perspectives 

and that these inescapable biases both influence analysts’ evaluations 

of patients and exert an influence on how patients behave. Relational 

⎯⎯⎯⎯⎯⎯⎯⎯⎯ 

3 

Greenberg (2001) has suggested that relational analysts, in practice if not theory, 

have developed their own standard technique, which tends not be differentiated 

according to different patient characteristics.


⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯ 

analysts also appreciate that patients’ behavior and attitudes can reflect 

familial roles, cultural values, and adaptations to their therapists and 

to the meaning that therapy has for the patients, as well as reflecting 

personal psychopathology operating independent of the situation. 

Alongside a theoretical appreciation of contextual influences on 

personality functioning, diagnosis also carries the danger of reifying 

as known what is in reality always partly unknown about another 

person, with the consequence of limiting clinical possibilities. In 

practice, relational analysts tend to avoid thinking in diagnostic terms. 

But even giving contextual influences their due, and acknowledging 

that it is impossible to know someone else totally objectively and in 

all aspects, all but the most radical postmodernist would accept that 

people do have certain personality characteristics, including personal 

limitations, that are distinctive and that endure over time. Indeed, if 

people’s personality problems were not so predictable, tenacious, and 

resistant to new influences, the idea of analytic treatment would make 

no sense. Diagnosis is an idea that, it seems to me, cannot be given up 

so easily. 

Yet there is also almost always some degree of fluidity in people’s 

functioning. At times a diagnosis can appear to change quickly. The 

familiar concept here is regression. All of us have the capacity to regress 

or shift to more primitive levels of functioning, within a range that 

varies from one person to another and in ways that are responsive and 

more or less predictable according to the situation (see Epstein, 1979). 

Some people are more resilient in the face of potential disruptions to 

functioning while others are more vulnerable (Garmezy and Rutter, 

1983). Acknowledgment of the potential for changeability within each 

of us, combined with the recognition that at any given moment each 

of us is functioning at a certain point on our own regressive continuum, 

leads to the concept of “diagnosis-of-the-moment” (Frankel, 2005). 

Killingmo (1989) has written about everyone’s personality 

containing aspects of both conflict pathology and deficit pathology, 

which interact in complex ways. In the analytic setting, these can 

result in what he calls conflict- and deficit-transferences, each with 

typical characteristics. Which of these is ascendant “is variable . . . 

within one and the same patient from one point of time to another or 

from one area of personality to another” (p. 66). An analyst must 

therefore be prepared to respond differently from moment to moment. 

Killingmo proposes that, when deficit transference is operating, 

affirming responses from the analyst are called for; whereas, when


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transference of conflict is present, the analyst should engage the patient 

in the more traditional exploratory way. 

Indeed, Skolnick, relying here on Kleinian concepts, makes a 

strikingly similar case for technique guided by diagnosis-of-themoment 

when he describes the particular kind of attunement required 

by a patient functioning at that particular moment at a paranoid/ 

schizoid level: “The analyst needs to express empathy for the patient’s 

experience of their psychic level of organization, and a diminution of 

attention to interpretation of psychic meaning.” And he is explicit 

about the diagnostic shifts in the last patient he discusses. 

Davies (2004), from her relational perspective, has also offered a 

conceptualization of what can be thought of as multiple shifting 

diagnoses within the same patient, based on a patient’s particular 

regressive potentials. “Each self–other organization [is seen] as carrying 

the cognitive-affective imprimatur of the developmental epoch in 

which it is organized and set down” (p. 758). Indeed, the relational 

idea of multiplicity of selves (Mitchell, 1993; Bromberg, 1998) seems 

to imply some concept of diagnosis-of-the-moment, whether or not it 

is used to determine technique. Davies’s conceptualization emphasizes, 

in addition to diagnosis as defined by shifting regressed modes of 

functioning along various dimensions, the intersubjective aspects of 

this: the interpersonal context within which each of a patient’s “selves” 

develops and the aspects of the analyst’s self that play a role in evoking 

particular regressed selves in the patient. 4 

⎯⎯⎯⎯⎯⎯⎯⎯⎯ 

4 

A case can be made for questioning any analyst’s standing to diagnose his or her 

patients. Given the analyst’s inevitable embeddedness in his or her own unexamined 

biases and unconscious conflicts, subjective misperception can be mistaken for 

objective assessment. 

Analysts nevertheless do think diagnostically—as their patients need them to 

do. I see no simple solution to this problem. Analysts should approach their diagnostic 

thinking about patients with humility—but not false humility. Limitations on 

certainty do not mean that a well-trained, experienced, and relatively self-aware 

analyst’s diagnostic sense of a patient has no validity. The analyst does have expertise 

in understanding the patient that goes beyond the patient’s understanding of himself, 

in certain ways, even if this is colored and limited by the analyst’s unavoidable biases; 

it does the patient a disservice to act as if this were not so. It seems sensible to treat 

an analyst’s diagnostic thoughts about a patient as at the very least a reasonable 

working hypothesis, which should, in turn, be open to correction as the analyst 

attends to and considers explicit or disguised communications from the patient that 

may constitute commentaries on the “diagnosis” that the patient senses as implicit 

in the analyst’s approach to him or her.


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The idea of diagnosis-of-the-moment allows us to value the concept 

of diagnosis as a meaningful and clinically useful description of a 

person’s functioning, while not minimizing the contribution of context, 

not reifying unsubstantiated assumptions about the patient’s 

personality structure, and thus not constricting the clinical possibilities 

we entertain for the patient. The term also opens the door to thinking 

not only about diagnosing the patient in a particular moment, but 

also about diagnosing the intersubjective moment itself (K. Ebbesen, 

2005, personal communication). 5 Diagnosis-of-the-moment, it seems 

to me, is a concept that most analysts use intuitively, in one form or 

another, naturally adjusting and responding to the patient’s changing 

organization of experience. 

The concept requires us to reframe Skolnick’s essential 

question,“What’s a good object to do” with greater specificity; the 

question becomes, “What’s a good object to do for this particular 

patient at this particular moment, and what is the basis for that 

conclusion” The particular diagnosis-of-the-moment is what 

determines analysts’ choices about whether and how to make their 

own struggles available to the patient. 

REFERENCES 

Altman, N., Briggs, R., Frankel, J., Gensler, D. & Pantone, P. (2002), Relational Child 

Psychotherapy. New York: Other Press. 

Balint, M. (1968), The Basic Fault: Therapeutic Aspects of Regression. London: 

Tavistock. 

Bromberg, P. M. (1998), Standing in the Spaces: Essays on Clinical Process, Trauma, 

Dissociation. Hillsdale, NJ: The Analytic Press. 

Davies, J. (2004), Reply to commentaries. Psychoanal. Dial., 14:755–767. 

Epstein, S. (1979), The stability of behavior: I. On predicting most of the people 

much of the time. J. Personality & Soc. Psychol., 37:1097–1126. 

Ferenczi, S. (1932), The Clinical Diary of Sándor Ferenczi, ed. J. Dupont (trans. 

M. Balint & N. Z. Jackson). Cambridge, MA: Harvard University Press, 1988. 

⎯⎯⎯⎯⎯⎯⎯⎯⎯ 

5 

It might be that some analysts work more effectively when they let themselves be 

idealized, while others may be more effective when they let their struggles show 

more openly (A. Frankel, 2005, personal communication); this, in turn, is likely to 

influence what becomes manifest in a particular patient in treatment with a particular 

analyst.


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⎯⎯⎯ (1933), Confusion of tongues between adults and the child. In: Final 

Contributions to the Problems and Methods of Psycho-analysis. London: Hogarth Press, 

1955, pp 156–167. 

Frankel, J. (1993), Collusion and intimacy in the analytic relationship. In: The Legacy 

of Sándor Ferenczi, ed. L. Aron & A. Harris. Hillsdale, NJ: The Analytic Press, 

pp. 227–247. 

⎯⎯⎯ (2002), Exploring Ferenczi’s concept of identification with the aggressor: Its 

role in trauma, everyday life, and the therapeutic relationship. Psychoanal. Dial., 

12:101–140. 

⎯⎯⎯ (2005), Intersubjectivity in the theories of Ferenczi and Laplanche: 

Conflicting technical implications. Presented at Annual Conference of Division 

of Psychoanalysis (Division 39), American Psychological Association, April, New 

York. 

Garmezy, N. & Rutter, M. (1983), Stress, Coping and Development in Children. New 

York: McGraw Hill. 

Greenberg, J. (2001), The analyst’s participation: A new look. J. Amer. Psychoanal. 

Assn., 49:359–381. 

Hoffman, I. Z. (1983), The patient as the interpreter of the analyst’s experience. 

Contemp. Psychoanal., 19:389–422. 

⎯⎯⎯ (1998), Ritual and Spontaneity in the Psychoanalytic Process: A Dialectical- 

Constructivist View. Hillsdale, NJ: The Analytic Press. 

Killingmo, B. (1989), Conflict and deficit: Implications for technique. Internat. J. 

Psychoanal., 70:65–79. 

Klein, M. (1946), Notes on some schizoid mechanisms. In: Envy and Gratitude and 

Other Works, 1946–1963. London: Hogarth Press, 1980. 

Kohut, H. (1971), The Analysis of the Self. New York: International Universities 

Press. 

⎯⎯⎯ (1977), The Restoration of the Self. New York: International Universities Press. 

⎯⎯⎯ (1984), How Does Analysis Cure ed. A. Goldberg & P. Stepansky. Chicago: 


Mitchell, S. (1993), Hope and Dread in Psychoanalysis. New York: Basic Books. 

Winnicott, D. W. (1960), Ego distortion in terms of true and false self. In: The 

Maturational Process and the Faciliting Environment. New York: International 

Universities Press, 1965.


The Action’s in the Action 

Reply to Commentary 

⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯ 

Neil J. Skolnick, Ph.D. 

Points of agreement and discrepancy between Frankel and Skolnick are 

addressed. A good measure of the disparity was traced to a basic 

misunderstanding of the concept of Dynamic Identification, which 

Frankel, at times, took to mean something akin to an analyst’s selfdisclosure 

of her or his struggles, instead of the internalization of the 

selfobject interaction in the analytical context. The question of state 

diagnoses is considered with an emphasis on reconsidering the concept 

of regression. 

O KEEP IN STEP WITH FRANKEL’S DISCUSSION OF GOOD OBJECTS AND 

great objects I will start my reply by assuming the persona of a 

Tgreat object. And as the great object that I assume I am, I 

would like to extend my appreciation to Frankel for his careful reading 

of my paper. I particularly value his thoughtful comments aimed toward 

comparing, contrasting, and integrating my ideas with other theoretical 

strains. He correctly understood the heuristic value of my setting down 

ideas in broad strokes. This allowed him to extrapolate from my 

technical recommendations and make comparisons between my ideas 

and those of others, principally Kohut, Balint, and the Classical 

Psychoanalysts. 

I will now continue as just a good object and address points of 

agreement and disagreement between myself and Frankel. Frankel 

presents Kohut’s ideas (1977, 1984) regarding the idealizing 

⎯⎯⎯⎯⎯⎯⎯⎯⎯ 

Neil J. Skolnick, Ph.D. is a Clinical Associate Professor of Psychology at the New 

York University Postdoctoral Program in Psychotherapy and Psychoanalysis; Faculty 

and supervisor at the National Institute for the Psychotherapies, the Institute for 

the Psychoanalytic Study of Subjectivity, and the Westchester Center for the Study 

of Psychoanalysis, as well as a number of regional psychoanalytic training programs 

throughout the country. 



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transference and holds them up in contradistinction to my idea of 

dynamic identification. Toward this end Frankel first refers to dynamic 

identification as the analyst’s actively directing the patient’s attention 

to the analyst’s own short comings. He holds that up as “contradicting” 

Kohut’s recommendation that the analyst should not interrupt a 

patient’s idealizing transference and that patients should be allowed 

to discover the analyst’s less than perfect subjectivity in their own 

time. This claim would indeed be correct if it accurately represents 

what I mean by dynamic identification. It does not. By dynamic 

identification, I am referring to all the activity that takes place between 

patient and analyst, of any nature, not just the analyst’s less than 

perfect subjectivity. This might include, but is not limited to, the 

analyst surviving a patient’s attack, an analyst making a mistake and 

demonstrating a (often unspoken) recovery with a patient, an analyst 

apologizing to a patient. These and countless other examples take place 

in the conscious and unconscious interacting arena between patient 

and analyst. I further hold that the patient, over time, internalizes 

these interactions, thereby expanding and strengthening his/her self. 

I derive this idea from Fairbairn’s (1946) concept of dynamic structure, 

probably one of his most central tenets. Briefly, Fairbairn proposed 

the idea that the stuff we have inside our psychic inner world is not a 

cornucopia of objects. Instead what we internalize and identify with, 

what gets built into our psychic structure, are object relationships, self 

and other dynamic configurations. So in fact, we do not offer up our 

struggles to a patient. We do not direct a patient to dynamic 

identifications. We offer up ourselves in all the ways that we interact 

with the patient, consciously and unconsciously, ably or ineptly, in 

struggle or not. Also, we do not allow patients to discover our 

subjectivities on their own. The dynamic identifications spring from 

the patient and analyst interactions, including interactions of our 

subjectivities. 

While patients do discover our inner life, as Kohut holds, they do 

so in the interaction and not on their own, as Frankel holds. These 

then are the dynamic interactions that get woven into a patient’s 

expanding self (or Fairbairn’s “central ego”) 1 during analysis. As such, 

it is but a short stretch to consider that when a patient is involved in 

identifying with the analyst, he or she is actually identifying with an 

⎯⎯⎯⎯⎯⎯⎯⎯⎯ 

1 

See Rubens (1994) for a comparison between the ego and Fairbairn’s self.

Reply to Commentary 41 

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active dynamic structure. Frankel appears to grasp this point when he 

appreciates that the patient is not acted upon to accept a dynamic 

identification, that dynamic identifications are not put in his or her 

face. Instead, in the way I conceive it, patients are inherently part of 

the process of dynamic identification when they interact with the 

analyst and internalize the interaction. When we engage patients 

repeatedly in a similar fashion, over similar issues, over periods of time, 

psychic structure is created in the patient through the accumulation 

of dynamic identifications. For example, when an analyst is attacked 

with vitriolic rage day after day and the patient experiences with the 

analyst that the analyst is not annihilated and maintains durability, 

the patient can gradually, through dynamic identification have greater 

confidence in the analyst’s strength as well as a more measured 

confidence in their own waning omnipotence. And similarly, they gain 

an increased confidence in their own survival strength and a 

diminution in the perception of the analyst’s omnipotence. The patient 

becomes identified with both subject and object of the interaction. 

Regarding the issue of diagnosis, I am largely in agreement with 

Frankel as he finds similarities between my concept of dynamic 

identification, “multiplicity of selves” (Mitchell, 1993; Bromberg, 

1998), “multiple shifting diagnoses” (Davies, 2004), and “diagnosisof 

the-moment” (Frankel). Allow me to add one point and take issue 

with another. Melanie Klein (1935) took special pains to label her 

developmental phases or psychic organizations “positions” so as to 

emphasize their fluid, nonfixed nature. She argued further that the 

two basic modes of psychic organization (paranoid/schizoid and 

depressive) could shift back and forth, in bi-directional fashion. She 

and her subsequent followers held the goal of psychoanalytic treatment 

to be the enabling of a patient to exist and function relatively more of 

the time in depressive position functioning than in the paranoid/ 

schizoid position. Ogden (1986) pushed this idea a step further when 

he argued that the paranoid-schizoid position exists over the course 

our lifetimes in dialectic tension with the depressive position. Each 

position both defines and negates the other and, furthermore, the 

tension between the two follows us throughout life. Both Klein and 

Ogden posit a model of development that does not rely on a lock-step 

progression in which a person reaches a higher level of functioning 

only to put to rest earlier levels except during regression. Instead, 

“positions,” while reached sequentially in development, exist in tension 

with each other for a lifetime, with a “normal” person shifting between


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them depending on an array of contextual or internal factors. This 

issue provides a good segue into the point with which I take issue in 

Frankel’s discussion. To state the last line first, I believe it is time for 

analysts to reconsider an understanding of the term “regression.” When 

considering the movement between dynamic identifications, Kleinian 

positions, Davies’s multiple shifting diagnoses, Bromberg’s multiple 

states, or Frankel’s diagnoses-of-the-moment, any movement can best 

be describe as circular, with no point considered forward or back to 

another. This is markedly different from the back and forth of a 

regression model, which decidedly locates a regressed point back from 

or lower down than a nonregressed state of being. 

There are a number of advantages to this circular model, two of 

which I’ll put forth here. As I see it, redefining the concept of 

“regression” can allow us to de-pathologize the organizational state a 

patient is in. I have frequently noted that some patients, when existing 

in the abstractless shattered slivers of a part-object world, can garner 

actual advantage from the perceptions of their state. Oftentimes it 

can herald the construction of a more integrated whole object world. 

Winnicott (1954) regarded “regression” as a forward-seeking trend 

aimed at seeking more benevolent conditions and objects in a patient’s 

world so that “true self” functioning may resume. Also, redefining 

regression might allow analysts to be empathic for the current 

organization of the patient’s psyche, particularly a paranoid-schizoid 

state. Analysts will more easily identify with a patient’s depressive 

position functioning. By contrast a patient in a paranoid/schizoid 

organization will be regarded as regressed, or primitive, or too disturbed 

to identify with. This allows the analyst to remain a safe distance from 

the patient’s now objectified “pathology.” To consider different 

organizations of state as dialectically constructed (Ogden, 1986), and 

existing in tension (Benjamin, 1992), allows the analyst to more freely 

identify, and be empathic with, all organizations of a patient’s psyche 

without the stigma that identifying with a state called “regressed” could 

bring (though I must remark that paranoid-schizoid is probably even 

worse. Once again, our language begs revision). As noted in my article, 

apprehending a patient’s position in the here and now can guide 

intervention. The issue of reconsidering regression is obviously a more 

extensive and complex issue and task that needs greater time and 

voice than this response to a response allows.

Reply to Commentary 43 

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Frankel ends his response to my article by extending the question 

of, “What’s a good object to do” to, “What’s a good object to do for 

this particular patient at this particular moment and how do we come 

to that conclusion” That my ideas raise more questions than they 

answer is high praise. 

REFERENCES 

Benjamin, J. (1992), Recognition and destruction: An outline of intersubjectivity. 

In: Relational Perspectives in Psychoanalysis, ed. N. J. Skolnick & S. C. Warshaw. 

Hillsdale, NJ: The Analytic Press, pp. 43–60. 

Bromberg, P. M. (1998), Standing in the Spaces. Hillsdale, NJ: The Analytic Press. 

Davies, J. M. (2004), Reply to commentaries. Psychoanal. Dial., 14:755–767. 

Fairbairn, W. R. D. (1946), Object relationships and dynamic structure. In: Psychoanal. 

Studies of the Personality. London: Routledge & Kegan Paul, 1952, pp. 137–152. 

Klein, M. (1935), A contribution to the psychogenesis of manic-depressive states. 

In: Love, Guilt and Reparation and Other Works, 1921–1945. New York: Free Press, 

1975, pp. 262–290. 

Kohut, H. (1977), The Restoration of the Self. New York: International Universies 

Press. 

⎯⎯⎯ (1984), How Does Analysis Cure ed. A. Goldberg & P. Stepansky. Chicago: 


Mitchell, S. (1993), Hope and Dread in Psychoanalysis. New York: Basic Books 

Ogden, T. H. (1986), The Matrix of the Mind. Northvale, NJ: Aronson. 

Rubens, R. L. (1994), Fairbairn’s structural theory. In: Fairbairn and the Origins of 

Object Relations, ed. J. S. Grotstein & D. B. Rinsley. New York: Guilford Press. 

Winnicott, D. W. (1954), Metapsychological and clinical aspects of regression in 

the psycho-analytical set-up. In: Through Paediatrics to Psycho-Analysis: Collected 

Papers. New York: Basic Books, 1975, pp. 270–295.

What's a Good Object to Do? - PsyBC

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