What's a Good Object to Do? - PsyBC

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Psychoanalytic Dialogues, 16(1):29–37, 2006 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. 29 © 2006 The Analytic Press, Inc.
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
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