RECIPROCAL SILENCES :

A FORMAL CONSIDERATION OF THREE ACCOUNTS

BY WOMEN OF THEIR OWN ANALYSES

Donna C. KLINE

This essay grew out of an on-going research project in the comparison of

descriptions of analyses by patients and by analysts. Comparison of patients' accounts of
their analyses with the more usual case history accounts by analysts leads to the
conclusion that there exists a reciprocal silence between analyst and patient -- when the
analyst speaks (publicly), the patient is silent and when the patient speaks (publicly) the
analyst is silent. Indeed, there is almost a reciprocal effacement of the other in the
relationship. Perhaps more importantly, the professional psychoanalytic literature
systematically lacks information from the only other possible source of data about the
analysis (other than the analyst) the other participant, the patient. Is it possible that
examination of the patient's account of an analysis could alter our view of the
psychoanalytic process?
This paper is about observations; although it is not a plea or proposal for
change, it necessarily raises such fundamental issues about the analytic relationship that it
may stimulate reflections on the possibility and impossibility of altering some aspects of
that relationship. The purpose of these observations is to stir reflection on how the
relationship, or lack of relationship, between the accounts of analyses written by patients
and analysts reflects the nature of the analytic relationship. It may be that the isolation
and distance reflects a necessary component of that relationship; it may be that the
maintenance of post-analytic boundaries is important; but it may also be that that
isolation and distance represents an unconscious adherence to a model in which the
doctor is the one who knows the truth, the only observer whose memoirs have any
validity.
To begin this discussion, I would like to make five preliminary summary
observations.
The first, and most obvious observation is that nearly all analytic case
material consists in accounts of analyses written by the analyst from the analyst's
point of view, although there are, of course, some accounts of analyses written by
patients. I make this observation here to underscore both its obviousness and the
fact that the lack of data from patients is largely unobserved and uncommented on.
Not only does the professional literature in the official journals today almost wholly lack
any accounts by patients, but although analysts regularly publish case vignettes and
patients sometimes publish accounts of their analyses, there is very little cross-
fertilization. It is rare for analysts to discuss the case material written by patients and
perhaps even more rare for an analyst to discuss, in the professional literature, an account
of analysis written by his own patient. Similarly, it is rare for patients to write about their
own analysis where it has also been written about by the analyst. In other words, there is
an almost complete absence of dialogue or even of reciprocal exchange. For example, the
poet HD wrote about her analysis in A Tribute to Freud. (Doolittle, 1974). Some of
Freud's letters are included in the same volume but, if elements of her case are included
in any of his writing (which does not seem to be so), those elements are not integrated
with her work. Thus, despite the existence of a warm personal relationship between that
patient and that analyst, there was no direct dialogue (that is known, or at least, published
explicitly) about her account of the analysis.
One notable exception to the above generalization is the several accounts of
the Wolf Man's analysis where several people -- the analyst, the patient, at least one
subsequent analyst, and two historians -- wrote about the same case. (Gardner, 1971;
Freud, 1914). Even in that situation, there was little direct collaboration; the Wolf Man's
later narrative and Freud's original work were written separately. Another rare exception
is Heller's A Child Psychoanalysis with Anna Freud in which Heller commented, as an
adult, on the clinical notes of his analyst. (Heller, 1990). Anna Freud supplied Heller with
her clinical notes, which includes poems and drawings by him as a child. Interestingly, a
second exception is the two papers "A Child Is Being Beaten" by Sigmund Freud and
"Beating Fantasies and Daydreams" by Anna Freud, both of which arguably are about
Anna Freud's analysis. (Freud, 1919; A. Freud, 1922; Young-Bruehl, 1988) Even in those
two papers, there is no explicit acknowledgement of the identity and relationship of
patient and analyst, although Anna Freud presented her paper to a meeting that her father
attended. (Kline, 1997). In the novel, The Saturday Morning Murders, Gur portrays
incidents of the analytic relationship from a variety of perspectives, including that of a
candidate who finds his analyst murdered in her consulting room, sitting as usual in her
chair, and a policeman who eavesdrops on a follow-up consultation session between a
graduate analyst and her training analyst. (Gur, 1992) Those different perspectives serve
to remind us that the analytic situation has only two direct observers, but can be described
from different points of view, depending on the narrator.
Even Wallerstein's monumental Forty-Two Lives in Treatment, which contains
a good deal of follow up material from the patients, most of the comments from patients
concern the outcome of the treatment and perhaps a brief remark about the treatment.
(Wallerstein, 1986) Although the case material contains some quotations from the
anonymous analysts and some from the patients, particularly in the follow-up material,
the organization and telling of the stories of the analyses is firmly in the hands of the
author of the book. His relationship, if any, with the particular cases reported is almost
entirely obscured or effaced. It may be said that his presentation of this voluminous case
material is more like the stance of the biographer or the traditional novelist.
The second observation is that the accounts by analysands tend to contain
substantially different information from the accounts by analysts, in that the patient
tends to tell the story of the analysis in the context of the events of his or her life at
the time and to provide considerably more detail about the events of the past and
their meaning, while sometimes providing considerably less information about the
day to day progress of the analysis and, as might be expected, less technical
commentary. The insights gained in the analysis are generally presented in the terms
in which they were grasped, which are the immediate, concrete terms of experience,
rather than the language of psychoanalysis.
The third observation is that, of the small number of analytic accounts written
by patients, several concern failed or unsatisfactory analyses. Kim Chernin, for example
wrote about her four analyses; two of those ended abruptly in anger and pain on her
part, with the analyst appearing at best insensitive and at worst arrogant, although
she struggles to liken the sad and angry ending of her fourth and last analysis to the
necessarily transcendent ending of a Zen disciple's study with a master. ( yet when a
client stops coming to us, we seek so much refuge in the theoretical concepts to protect
ourselves, or even as they continue to come and see us, we might deem their anger or
resentment towards us as resistance or transference, but do we ever really sit back to
think that maybe we are somewhere responsible for what the client’s plight? And thus
maybe instead of analyzing their defenses back to them, we should rather stay with that
anger and really empathize.. so how long does one really stay with this uneasy feeling of
anger towards oneself? Don’t we prematurely itch to ‘interpret’ the anger, and lock the
client in confusing ideas? Maybe we do it in the name of strengthening his or her ego,
increasing his tolerance for anxiety? But how many of us actually follow the advice we
preach? How many of us are willing to stay with that anxiety too, anxiety arising from
the fact that the client is mad at you. Yes we can tell ourselves “I have already fought my
demons in my own personal work” but if they are to follow us still in our work with
clients, do we really look at it or just dismiss it by calling ‘countertransference’. The poor
client doesn’t even have so many conceptual ideas to protect himself and we do and how
fair is that. Right now I identify more with the position of a client than that of a
counselor, which is why maybe I wrote what I wrote. But maybe unknowingly and
unfortunately, as I will become a more ‘seasoned’ therapist myself, I would have an
impenetrable air of calmness about me, thanks to all the years of demon fighting. But I
wonder if that render me unable to really understand what my client must be feeling like,
when I would timely end the session, when I would say something like- “you seem angry
with me” and yet have this Buddhist monk like serenity, while my poor client writhes
under my microscopic lens and feels humiliated probably. In those instances will I readily
recall what it felt like to be a client, or will that part of me be conviently forgotten and
buried behind the umpteen number of theories I would have read by then?? I hope to
carry this with me, like a bookmark, “what does the client feel like as a ‘client’”

A psychiatrist named Wortis wrote a savage account of his analysis with Freud. Wortis
was a medical student who had come to Vienna to study; like many of Freud's patients in
the 1920's and 30's, he was American, but unlike many others, his analysis was funded, as
an experiment, by opponents of psychoanalytic theory. Wortis published his account in
book form only after Freud died.1 (Wortis, 1954) Freeman's first book about analysis,
Fight Against Fears, was an almost adoring account of her first, six year, analysis; in a
later work, The Beloved Prison, she wrote about her three subsequent analyses, raising
the question of why she left her first analysis (which was terminated by the analyst)
unable to avoid a clearly self-destructive marriage.
Despite these differences in substance, a fourth observation is that some
aspects of the formal structure of the narrative tend to be the same, whether the author is
the analyst or the patient. Although there are variations, the formal structure tends to be
that the narrator recounts the case material in the first person and the other
participant in the analysis is referred to in the third person. In other words, the
story of the analysis is told by one party to the process or the other, but seldom by
both and almost never by both at the same time in the same narration. The use of the
pronouns signals that the author is telling the story from his or her point of view and that
the other participant is being described from that point of view; the grammar, therefore,
marks the exclusion of the other person's direct contribution from the construction of the
narrative.2
The fifth observation is that there is little discussion of these analytic accounts
in the professional literature. To be more accurate, a word search for the names of the
authors (Kim Chernin, Lucy Freeman, and Marie Cardinal) in the American
Psychoanalytic Association bibliographic database of analytic literature produced exactly
nothing; further search revealed only two book reviews of the works considered here.3
This is an astonishing result; it means that these women's book-length accounts of their
analysis were and remain more or less invisible. The effacement of the patient, as narrator
and participant, from the professional literature of psychoanalysis is so complete that
when the patient speaks about the analysis in her own voice, the analytic community
responds with almost complete silence.
These observations tend to lead to the conclusion that there is a deep-seated,
perhaps unconscious, resistance to the true sharing of understanding between patient and
analyst. Although the patient's accounts of his or her life, dreams, and inner world
together with the analyst's comments on that material (and, of course, the interaction
between the two people) are the analysis, the two participants remain unable to speak
together about the process outside the consulting room, even in the most indirect form of
dialogue the exchange of views in professional journals. Regardless of whether the
patient writes the story of the analysis or the analyst does, the case history is written from
one point of view and in one voice. The patient may tell us what the analyst thought of
the book (Freeman, 1951) or the analyst may tell us of the patient's consent to the
publication (Dewald, 1972), but there is seldom a collaborative effort in the
reconstruction or description of the analysis. For example, even in Diary of A
Psychoanalysis, where the patient published the analysis expressly to foster his analyst's
theories, the analyst Paul Diehl wrote the introduction to his patient's journal of the
analysis. The introductory material and the journal remain, however, separate. (Diehl,
1987).
There are very few instances in the analytic literature where analyst and
patient both tell the story of an analysis and almost none where they do so in speaking
directly to each other. As noted above, one of these relatively rare instances is the
analysis of Anna Freud by her father. Both Anna and Sigmund Freud wrote about her
analysis, although both of them disguised the identity of the patient and she did not
identify the analyst. Another is collaborative case history is Yalom's Every Day Gets A
Little Closer. (Yalom and Elkins, 1974) In that work, which is discussed further below,
the patient and the therapist both kept journals of her therapy, which they exchanged at
the end of six months. Yalom edited the final book although his patient, a creative writing
student, collaborated on the final product somewhat; his real name is on the book while
she appears under a pseudonym.
I have chosen to consider in this essay three case histories by women Marie
Cardinal's The Words To Say It, Lucy Freeman's Fight Against Fears and The Beloved
Prison, and Kim Chernin's A Different Kind of Listening.4 There are other accounts of
analyses that are perhaps more famous, including the poet H.D.'s Tribute to Freud, The
Freud Journals of Lou Andreas Salomé, and the Wolf Man's response to Freud's analysis
of him, including the commentaries of various scholars. The criteria for selecting these
works by Chernin, Freeman, and Cardinal were that (1) they were not case histories of
analyses with Freud himself and hence were free of the historical clutter of scholarship;
(2) they were reasonably contemporary; and (3) they were all book-length and hence
reasonably comparable in form. Cardinal's The Words To Say It is a novel, but it is openly
a thinly disguised account of her own analysis.5
Although space does not permit me to consider all of the aspects of these case
histories completely, I will focus here on three aspects of the narratives; the role of the
analyst in the writing of the work, the patient's description of the experience of the
analysis (including in particular the patient's description of the simultaneous experience
of the past and the present in the analyst's office), and aspects of the analytic experience
that I believe are often missing from case histories. The latter aspects include the
experience of a failed analysis and the extent to which the patient's experience of the
analysis includes more than the events in the consulting room.

THE ROLE OF THE ANALYST IN WRITING THE STORY OF THE ANALYSIS

The question arises as to why a patient would want to write an account of his
or her analysis, since doing so involves the public disclosure of information that may be
considered shameful or at least very intimate. The analyst's conscious motives are
perhaps more clear he or she ostensibly writes to obtain professional advancement or to
advance the science of psychoanalysis. The patient's conscious motives, and the
relationship with the analyst in the writing, are perhaps different.. Two of the works
considered here, those of Cardinal and Freeman, were expressly written to express the
author's sense of the importance of psychoanalysis and to share the experience with other
persons, to make them understand the value of such work. Chernin's work was written as
part of her effort to work through her feelings about her four analyses.
Most analytic case histories written by analysts contain little or no discussion
of the relationship with the patient to the writing, beyond perhaps an acknowledgement
that the patient consented to the publication. Most candidates, for example, in my
experience do not even disclose to their patients that they are planning to present the
patient's case to their institute or at a meeting. Occasionally, one hears an analyst say that
he or she decided not to present a particular case at a psychoanalytic society meeting
because the patient might be in the audience. Sometimes, relatively rarely in my
experience, an analyst will send the proposed paper to the patient, if the case is
terminated, and obtain the patient's reaction. In that case, the paper serves as the occasion
for following up on the case.
One of the few examples of a collaborative case history is Yalom's Every Day
Gets a Little Closer.6 In that work, the patient and the therapist both kept journals of her
therapy, which they exchanged at the end of six months. It was painful for both to
discover that that patient had addressed her journal entries to Yalom; she referred to
herself in the first person and to him in the second, so that the journal was almost literally
a continuation of the sessions. For example, the patient says of a particular session "I felt
like a dilettante in your office, at first. You were asking me what was on the agenda, what
I wanted to happen." Yalom, however, speaks of his patient/collaborator in the third
person -- of the same session, Yalom says, "Then I tried to focus things a bit, lest we
wander endlessly in the haze so characteristic of time with Ginny. What did she want to
work on in therapy with me?"
Interestingly, in Yalom's journal of that session, he admits to misleading the
patient on the issue of whether he intended to publish the research that they are doing; he
suggested that any publication would be a joint effort and that he hadn't really considered
the issue, which of course he had. I would say that the fact that he had not only
considered the issue but begun writing for an audience of readers (and not for the
audience of the patient) is revealed by the change in voice. When he changes from the
"you" of the sessions to the "she" of the journal, he has already adopted the role of
observing reporter.
An interesting twist on that pattern appears in Behind the Couch; Revelations
of a Psychoanalyst, which was written by an analyst "as told to Lucy Freeman." In fact,
Freeman and Strean collaborated on three other books, one on Freud, and two
psychological self-help books. Yet, Behind the Couch is written in the first person,
although it is explicitly a collaborative effort. The "voice" of the other writer is officially
silent. Moreover, the relationship between Strean and Freeman is not specified was he or
was he not her analyst? In the "Acknowledgements" section, Strean and Freeman claim

Lucy Freeman's book, Fight against Fears, was the first to be written by a patient about a
complete psychoanalysis. Behind the Couch is the first book in which a psychoanalyst
reveals his own thoughts, feelings, fantasies and memories as he sat listening to the
patients over the years the first book about how an analyst feels as he sits behind
the couch.'
(pp. vii -- vii).

We might want to ask why even this limited description of their relationship to
each other (as writers about psychoanalysis) is relegated to the relatively obscure
acknowledgement section of the book, as if the question of their relationship were
unimportant. Even in this explicitly collaborative effort, the voice of the patient and the
voice of the lay author are effaced.
Cardinal describes vividly the process of writing The Words To Say It. She
began to write the story of her analysis in notebooks and then to transcribe the notebooks
into typescript. The process of identifying herself to herself as a writer was a central
feature of the latter part of her recovery in analysis. She identifies the pages of the
transcribed notebooks as "even the most important thing I have ever done in my life." She
gave the transcript to her husband to read; he read it avidly, with complete attention, and
wept at the end. His reading was part of the mending of their relationship, of her healing.
Cardinal frankly describes, however, the condescension and scorn of the
people to whom she mentions her analysis, their tendency to deny her illness and their
passion in rejecting analysis. She says "To make them understand and to help those who
lived in the hell where I also lived, I promised myself that I would some day write an
account of my analysis, and turn it into a novel in which I would tell of the healing of a
woman as like me as if she were my own sister." (p. 248). She describes the termination
of her analysis in a lovely dialogue in which she thanks the analyst for freeing her from
her madness and they say to each other:
'You don't have to thank me, it's you who came here to find what you were
looking for. I could not have done anything without you.'
'Goodbye, Doctor.'
'Goodbye, Madame. I'll be here if you need me. I will be happy to hear how
you're doing if you consider it necessary to tell me.'
Inviolable little man, so he's going to maintain the role to the end.
(pp. 294 to 295)
Cardinal concludes her book with the following words, themselves a tribute to
the "doctor who helped me to be born:"
The door closes behind me. In front of me, the cul-de-sac, the city, the
country, an appetite for life and for building as big as the earth itself.
(p. 295)
Yet, the role of the book in the relationship with the analyst is not mentioned
at all. Is the book perhaps the communication back to the analyst as to "how you are
doing if you consider it necessary to tell me"?
Freeman also described the process of writing the two books considered here.
In the last pages of Fight against Fears, she said
In asking why about many things, I had to ask why I wrote this book. I will let
my unconscious get away with only so much these days. In typing out this last sentence
my fingers wrote the word 'conscious' instead of 'unconscious' as thought to let me know
who is still boss oh, well, perhaps a less tyrannical boss than before.
***
This book represents all my needs that writing fills attention, approval, love.
It also stands for my need to crusade for economic freedom. . .
***
I took my worries [about what people would think] to John [her analyst]. 'I
don't think I should write it. It's immodest.'
'It's probably your way of dancing," he said.
He wanted me to wait until the analysis had jelled, as he put it.
***
I complained to John I had been as honest as I knew how yet I felt many
things were left unsaid.
'You couldn't put everything into one book or two books or a dozen books,' he
declared.
This book could never be finished, I thought, just as analysis is never finished.
(pp. 349 350)
In The Beloved Prison, she reveals that she showed the manuscript to John,
her analyst, and he refused to alter anything, insisting on treating it as her work. She also
reveals in that book that her last analyst encouraged her to write it. In The Beloved
Prison, interestingly, she reveals the names of her analysts, in contrast to the
pseudonymous "John" of Fight against Fears.
Chernin does not tell us much about the relationship of her writing to the
analysts, but she does describe a related topic of her writing in the analysis and her life as
follows:
When the mother [Chernin] emerges from her downstairs room. . . to great the daughter
when she comes home from school, the daughter knows this is a ghost mother who has
spent the entire day in a world between worlds. . . neither awake nor asleep, feverishly
writing poetry, which is always sent to the [second] analyst, who always responds.
(p. 80)

In those few sentences, we can see how the relationship with the analyst
becomes linked with the act of writing and at the same time integrated into the patient's
daily experience of life. I have not seen a similar account by an analyst about the
relationship of the writing of a case to the patient or the analysis. A possible exception
would be Akreet's Tales of A Traveling Couch, in which the therapist revisits some of his
more fascinating patients and writes about their current situation, the therapy, his present
life situation, and the visit in one account. Moreover, that situation can be compared with
the similar one of Lucy Freeman who took notes in part because her analyst did not.

THE STORY OF A LIFE THE EXPERIENCE OF RECOLLECTION IN

ANALYSIS

One of the differences between a patient's story of an analysis and that

written by an analyst is that the patient is not constrained by the formal constraints
of the analytic case history. For example, the patient is free to describe the blending
of past and present in the analytic session.
Chernin describes her third analyst as a person who does not like her but who
she has come to respect. In the following long quotation, she movingly describes the
experience of transference, the growth of insight, and the recollection of the past.

Sometimes, very occasionally, when I tear my eyes from the Persian rug, she has a look
of wondrous concentration on her face. Then what I am saying matters. She may not like
me, but she listens. Because she listens, this strange landscape of self-reflection, this
inner world I am cultivating, starts to take on recognizable features. It is not exactly
like clearing ground or felling a forest or cutting a path through a primeval waste. It is
more like the birth of a world observed from a considerable distance. Mists, fogs, rays of
light, recrudescence of shadow, patches of brilliance, the emergence of forms.
I am playing in the Bronx park, in the sandbox. My sister is sitting on the bench.
Whenever I look up, she makes a funny face at me. That means she has not forgotten
me. . . . Suddenly my fingers dredge up something marvelous. It has been buried away in
the sand. . . . It is I, I alone, who have been gifted with the copper penny. . .
Maybe that was the day I first realized I was special . ..
Years pass while these patches of memory are returning. During these years I seem, at
times, to be suspended under water. I develop a pain in my knees, I am short of breath. . .
This means I am again. But I know that in my small world of self I am moving
backward in time, getting younger.
A man in the Bronx park has told me I am a cute little girl.
(pp. 73 75)

In these lines, we see the experience of recollection, therapeutic alliance,

and insight happening simultaneously. The recollection of the past, the
understanding of the meaning of those memories and the transference do not occur
discretely but as one holistic experience.
Cardinal gives a similar description. Cardinal's primary symptom was an
endless flow of blood from her vagina; her reason for going into analysis was a sense that
her problems might be treated by some means other than surgery, hospitalization, and
drugs. Cardinal describes her experience of analysis in the lyric language of the great
writer. The following are quotations taken from several sequential pages of the book:

I realized that I had avoided coming to the point. I was annoyed with myself for not
plunging right into the waves of the Thing, thick with filth, horror, putrefaction . . . . And
yet what came to the surface at the doctor's was rather sad, really rather nice., . .
Then came the day when, having continued to sort out faded memories, I made an
imperceptible but important departure.
I still spoke of my search for gifts worth of my mother. . .
The child came to join me in the cul-de-sac. I was looking for skin tanned by the sun. . .
her desire to please. One more time she lay down beside me, in me.
The doctor's office is my room. I am ten years old. On the ceiling is a little tan lizard . .
. I am hot in my bed . . Oh, Lord forgive me, I am unable to come close to You; my head
is full of sin. I don't like to wear gloves. .
After a moment, I'd leave my hiding place, find the paper tube hidden under my blouse,
and piss standing up like the boys, or try to, aiming through the cone. . . .
At the end of the cul-de-sac, reliving these moments feeling them exactly as they'd
happened twenty years before, I understood that the motion I made to fit the tube to my
body, . . were the same as what I did when checking the flow of blood. . .
(pp. 96 to 101)

Thus, Cardinal tells us of the experience of reaching a deeper level in the

analytic work of recollection. She recreates for us simultaneously the experience of the
small girl and the adult analysand remembering the girl. The transition to the analytic
understanding of the link between the forbidden pleasures of masturbation and the
imitation of boys and her primary symptom is made seamlessly.
In the above long quotations, we can see that as the analysand writes about the
analysis, her attention and recollection shift fluidly from the remembrance of things past
to the recollection of the experience of remembering in the analysis to the experience of
transference in the analysis. If these accounts are representative of the recalled experience
of an analysis, one might say that the patient, in recollecting the analysis at length,
remembers it as a fluid blend of the subjective experience of the analyst in the
transference, of the past as considered or understood in the analysis, and of the vivid
recollection of the past.
 ASPECTS OF THE PATIENT'S EXPERIENCE THAT CASE HISTORIES DO
NOT CAPTURE

THE APPROACH TO THE OFFICE

One of the more striking aspects of The Words to Say It is the way in which
the location of the analyst's office comes to represent the process itself. The opening lines
of the book are the following:

The little cul-de-sac was badly paved, full of bumps and holes, bordered by narrow,
partly ruined sidewalks It worked its way like a finger between private houses of one or
two stories, pressing one against the other. The little street stopped at iron gates
overgrown with scraggly vines. The windows revealed no sign of life within. It might
have been the country; nevertheless it was the heart of Paris, in the XIVth
arrondisement. . . . This quiet corner of the city must have dated back fifty years, for there
was a modernistic feeling in the mismatched architecture o the dwellings. Who lived
here?
(p.1)
She goes on to say
For seven years, three times a week, I traveled this little street on foot to the end, as far as
the gate on the left. I know how the rain falls here, how the inhabitants protect themselves
from the cold. I know how, in summer, a life which is almost rustic establishes itself with
geraniums in pots and cats sleeping in the sun.
(p. 2)

For the patient, the approach to the office, the waiting room, and the
ritual of leaving are all part of the analytic experience. When we think about it, for
the patient, every session begins and ends with the journey to the office and the
leaving of the office or, perhaps, extends to the contemplation of the upcoming visit
and the reflection on it afterwards, while driving home or back to work. Yet, unless
some particular issue arises in the analysis about this part of the experience, we do
not read about the analyst's office in the professional literature. We have all read
about Freud's consulting room and seen the photographs of the famous couch, the
collection of antiquities, and the street of Berggasse 19. For most analyses, however,
we do not know anything at all about the setting in which the analysis took place,
unless the analyst chooses to mention some association of the patient's to one feature
or another of the office. It is as if the analysis could have taken place anywhere, as if
the setting were unimportant.7 ( that was so not the case with me. Even so, when sir
moved to that new place, it was a new different him, whom I didn’t like much, just as I
didn’t like the new building with all its modernity and yet not much of a space to put me
at a distance from him. And on the contrary, the lush green path that leads to his home
now, his old home, that to me is as alive, refreshing at times, moving at other times,
picture like sometimes just as the session is. Only my old setting has been lost forever
maybe now.)
 If we conceive of the analysis as a process which could take place anywhere,
if, in other words, we conceive of analysis as a scientific process taking place, so to
speak, in any laboratory, then the environment is irrelevant, as irrelevant to the analyst's
case history narrative, as a surgeon telling us the color of the walls of the operating room.
If, however, we think of the analysis as in part a subjective experience, then we are
missing the setting in which the experience takes place, a setting which, for the patient, is
part of the experience.
The setting of the analysis contains, for the patient, also the encounter with
other patients. Cardinal says, for example,

Autumn, winter. The cul-de-sac was forever damp full of puddles, poorly lit. It happened
sometimes that I would cross paths with the clients who preceded or followed me,
bundled up, hugging the wall and hurrying. We exchanged glances we considered
anonymous, but we knew all the while that we were the sick and that we shared the
same doctor, the same couch, the same ceiling, the same flawed tapestry, the same
stupid gargoyle on the top of the same fake beam on the other side of the couch. We
belonged to the brotherhood of the lost and the trapped. They also moved between suicide
and fear, as though between two policemen.

If the waiting room is set sufficiently apart physically from the consulting
room or if the analyst waits for the patient in the consulting room, then these interactions
may be invisible to the analyst. The analyst comes to her work every morning, one may
assume, and leaves each evening; if she works in her home, the approach to the office
may be entirely different from that of the patients. Her analysands come and go at
different times; for the analyst, the approach becomes, we may say, invisible. An analyst
once told me the following anecdote. He had arranged to meet with a prominent analyst
in another country. The other analyst practiced in an office in his home. The house was
obviously lavish and elegant, approached by a long drive past the stone walls that
bounded landscaped grounds. The office, however, was entirely bare of any
ornamentation, containing almost nothing but a desk, chair, and couch. The other analyst
explained that he believed strongly in the preservation of the analyst's anonymity. That
anonymity, obviously, was solely in contrast to the analyst's experience of his own home
through which he passed on the way to the office; the disclosures of the exterior of the
house and the grounds had become invisible to him. The writings of patients remind us
that they may have remained part of his analysands' daily experience.
Chernin vividly describes returning to her second analyst, twenty-five years
later to ask him why he let her leave on a long trip that was obviously rooted in
resistance. She says

I had finished my twenty-five years of analysis by then. I still missed him. No one had
ever taken his place. The part of town in which he lived, slow, sunlit streets of stately
houses, as I drove through them on my way to him, still seemed a world beyond any
world I could inhabit. Analytic time had stopped. In its serene frozen duration even I
was unchanged, although I had grown twenty-five years older.
***
I sat in the analytic room, unchanged these twenty years, the books exactly where I
thought I remembered them, on the top shelves the boxed recordings of Mahler's
symphonies, one of which he had wondrously given me at the end of a difficult
session so many years before. I wondered if he had replaced it. I did not turn my
head to find out.
(p. 80)

After Freeman's analyst dies, she returns to her consulting room. The maid
(another forgotten part of the patent's analytic experience, i.e. a part that would not
normally appear in a case history by an analyst) lets her in, understanding her need to
revisit the place. Freeman describes the green carpet, the wood paneling, and says "I
could not bring myself to walk across the room to the spacious beige couch on which I
spilled out my sorrows. I stood in silence, not daring to feel, not wishing to move any
closer. I say stiffly on a chair. . .." (p. 175). Like Chernin and Cardinal, she remembers
tiny details of the room, such as the Chinese figurines. With the permission of the maid,
she chooses as souvenir of the analyst a beige purse, an object belonging to the analyst
that is the same color as the couch.
It may be objected that these matters are either irrelevant to the analysis (and
hence, properly left out of the analyst's case history) or would have come up in the
analysis. I would respond to that argument by suggesting that the prominence in the
patient's mind of the setting of the analysis might alert analysts to the role of the setting,
whether or not it produces any particular material that is spontaneously addressed in the
analysis. On a more theoretical level, perhaps the consulting room, which is so
familiar to analyst and patient, becomes a backdrop that they both share and
appreciate the importance of in their shared experience but that the analyst,
consciously or unconsciously, declines to share with his colleagues, when he or she
writes up the case for a paper, either because he believes that it is theoretically
irrelevant or because there simply is no place for it in the rigidly defined literary
genre of the analytic case history. In other words, what is actually an important
shared part of the experience becomes invisible to the professional reader, as if it
didn't matter. ( maybe the room setting in itself can be thought of as an analytic
third, both the analyst and analysand view it differently, the room, an entity of sorts
in its own accord is also a part of the work constructed, and thus again, a different
kind of work for each. The analyst might be more aware of the technical aspects of
the room maybe, eg, the curtain poll that seems loose and might fall any moment, or
the anger and irritation with which the curtains have been arranged, to wall of a
part of her life, of herself and shield it from the hungry glance of the clients. Thus
the session space is always confined by anger, from one end, anger at having to cover
the messiness, anger at the possibility of being ‘exposed’, anger in terms of the clips
that had to be used to ensure the client couldn’t peek through. Thus a part of the
room has already become a chastising person of sorts, not allowing the client to
come through, see through to the other side. And the other corner of the room
doubles the feeling of shame and embarrassment for it’s a mirror, it mirrors a part
of the client and the therapist and the angry curtain wall mostly. So here we have a
room full of chastisement and embarrassment, the two feelings that the therapist
carries predominantly. Resorting to what one knows, owing to the technical
aspects…what does the client have? A window on her right with soft light coming
through it, and a good view to offer. A stool just by the foot, carrying tissues and
water bottle, things which probably anger the client sometimes, and maybe comfort
her other times. Maybe its too much in the face and thus too embarrassing, but any
farther away, and it might not be there at all as if for the client. A deceptively
comfortable couch cum bed which isn’t all that comfortable. Not as comfortable as
the therapist’s red swirling chair atleast. So instead of sighing, or cracking her
knuckles, she swirls instead. Guiltily ofcourse, for not being able to provide similar
comforts to the client, though an apparently bigger sitting place, stool and carpet at
her disposal. Hoping that is enough of a compensation. I am sure the room has its
own moods too and affects too, the moods changes with the changing clients and the
affect well might change every moment to moment. So when it gets too difficult to go
along, the several cushions lined up behind the client seem pleasing to the eyes. And
so does the glint of light pouring in from the farther corner of the room, which gives
away the time of the day too at times and thus the comforting thought, that the hour
is about to end)

REELECTIONS ON FAILED ANALYSES

Ex hypothesi, all of these works are the reflections on an analysis after it has
ended. However, that mere statement misses the point that these case histories show how,
if at all, the analysis continues to function in the patient's life. The most striking example
of this occurs in Chernin's work, where two of the analyses may be considered to be in
some sense failures.
Her initial encounter with analysis took place in England and was clearly a
failed analysis, if indeed, given the shortness of the attempt, it can be considered an
analysis at all. Although Chernin says of it "That is the end of her first psychoanalysis,"
suggesting that she regards it as an analysis, she does not count it as analysis in referring
to her other analyses, as the first, second and third ones.
Chernin describes her first analysis in the third person, regarding the young
woman who began that analytic work as so profoundly different from her as to be almost
another person. She describes the beginning of that analysis in the following paragraphs.
She has come to the analyst's house in London from Oxford. Her feet are wet, because it
is raining and she "hasn't lived her long enough to know when to carry an umbrella. She
is reading the directions to the house on the back of a wet envelope. The author notes:

Walking up the drive to her analyst's house (memory says: a stately house), she is, apart
from the wish to starve herself and to die, a patchwork person with no compelling, central
design to her. If all goes well, when she enters this, she may become a aware of this
condition.
Unfortunately, everything goes wrong. She doesn't like the large, cool, forbidding woman
who answers the door. She feels foolish when she has said hello and the psychoanalyst
hasn't answered. She doesn't know what to do with her smile, an awkward survivor of
their shipwrecked greeting.
(p. xxix)
 The patient talked extensively about the death of her sister, when she was four
and one-half years old. Then, in the twelfth session she ran out of things to say. She felt
relieved at having talked about the sister's death. The analyst said, "I noticed that you
came late to our session this morning." (p. xxxi) The patient felt profoundly
misunderstood. As she remembers the moment, years later:

To the girl, this means she has done something wrong. Doesn't the analyst know
about the trip up form Oxford, the dreary youth hostel, the having to get up without
an alarm clock, the confusion of the underground, the inability to read the maps, the
wet trip across London to the suburbs, where all the houses and all the streets look
the same, so that she, who does not have a sense of direction, needs to keep following
the crumpled directions on the handwritten map she is terrified to lose because she
would be ashamed to ask for new directions, thereby admitting she has not managed
to learn the way? . . [The analyst] is aware, it seems of her patient's resistance to
being there, not what she has already gone through to get there.

(did I commit the same mistake somewhere with Pragiti. Now if I think about it, I realize
that sir in his comments here or there always gave so much weightage to my travelling
bit, though it wasn’t ever as much a hassle for me)
(p. xxxi)
The patient poured out a flood of half-formed explanation. The author, speaking decades
later, says
Of course, I have no idea what that analyst was thinking. I wouldn't want to appear
to be judging her after all this time. No doubt she was simply behaving as she'd been
taught, with a detached, neutral attitude, diligently commenting on resistance. . Now
she has just said, "Our time is over." The girl leaves the house. That is the end of her
first psychoanalysis. ( reminds me so much of urvashi mam, how she treated my aunt,
probably my aunt felt this way too, to be ridiculed at the hand of a younger person…how
would sir have dealt with her differently? I don’t know.)
(p. xxxii)

It is possible that the analyst could have written a clinical vignette about
this failed analysis, and we may imagine that the analyst might even have perceived
that significant pragmatic difficulties in the patient attending the sessions, especially
if analyzed unsympathetically, might have resulted in a premature termination.
Absent extraordinary luck, or a communication from the patient, the analyst cannot
know, however, that that empathic failure will be part of or perhaps prefigure the
patient's nearly lifelong search for an analyst who will meet her need to feel
understood.
Moreover, as a reader, we realize that we have only viewpoint on an
experience shared by two people. We may be inclined to feel that the analyst behaved
correctly and that the patient was not analyzable. If we were critical of classical
technique, we might take this vignette as an example of the limitations and even silliness
of that technique which treats the resistance in being late but ignores the patient's
commitment to the process as embodied in her extreme efforts to attend the sessions. We
don't know, however, whether the analyst knew of the patient's travail and decided to
make what was intended as relatively neutral comment or whether the analyst was,
essentially, an unsympathetic fool. As with any account of the past, we don't know
whether the event happened as occurred or is profoundly distorted by the patient's
defenses.
Similarly, Chernin portrays her second analysis as prematurely terminated.
Contrary to the first failure, however, she feels close to the second analyst. It apparent
from the material that the transference continues in that Chernin returns to the
neighborhood of the analyst's office in San Francisco years after the termination and still
hopes to see the analyst, still feels the same emotions that she felt on approaching the
office when she was in analysis.
By the time of her last analysis, Chernin has been training as a psychoanalyst
herself and has begun to develop ideas that analysis can be a "different kind of listening."
At first, she finds the sessions in which she expresses this ideas "highly exciting." (p.
174). Eventually, however, Chernin experiences her third analysis (actually fourth, if we
count the failed London attempt), as follows;

He seems to fly out against my argument before I have had a chance to formulate it. He
interrupts me in my associations to my dreams, is less calm than usual, less reasoned, his
arguments seem somewhat heated, as if there is an investment in them I had not
perceived before.
(p. 176)

She becomes increasingly angry. The analyst persistently describes their

discussions in the sessions as "playful" which is not the way she experiences them at all.
They "make repeated efforts to understand what is happening." (p. 179). They disagree
over the meaning of a dream, which the analyst interprets as the patient challenging the
analyst's authority; she sees it as a dream about trying something new. She consults other
analysts about her perception of the analyst's anger and his refusal to acknowledge that he
feels any anger. She describes the sessions in these words:

I come to every session resolved to get to the bottom of things analytically. He too
seems resolved to set out on a positive note. I can feel his good will, the effort to meet
me halfway. We start out quietly musing in an analytic vein. Ten, fifteen minutes
into the session, the heat is on, my voice is rising, his is getting tighter, colder, more
controlled.( that is exactly what I was afraid of with sir, only his voice wouldn’t
simply get tighter but louder too)
(p. 184).

Eventually, in a fit of anger, she asks him what he thinks. He says "I have
nothing further to say." She responds "Well, then, neither do I" and walks out of
the session and out of the analysis. ( the so called dignified silence, one of the best
defense of therapists I guess) She notes "Endings come fast, they tumble over their own
heels, they are a downhill business."
In The Beloved Prison, Freeman describes her three analyses after the one
described in Fight Against Fears. The first book gave the general impression that
Freeman was "well" at the end of her first analysis. Thus, in the later account, Freeman
implies that her first analysis was incomplete in some important respect. Her third
analysis, however, she frankly describes as a failure. The analyst knitted during sessions,
ate dinner during sessions, forgot appointments, and revealed aspects of her personal life.
At one point, Freeman felt that the analyst "had practically called me a prostitute." Even
more painfully, the analyst flatly denied that an event in the patient's life had taken place
as she remembered it. Freeman became a participant in the New York analytic
community through her writing, which included reporting on conventions and so on, as
well as writing scholarly books about Freud. Late in The Beloved Prison, she reveals that
her third analyst was regarded as "senile" by the analytic community at the time of her
analysis.8 When she angrily asked one of her analyst acquaintances why no one told her
or warned her, instead of referring her to this woman, her informant responded in effect
that no one had wanted to face up to the situation.
There is a temptation even as I write these lines to comment on the pathology
of patients like Chernin and Freeman who go through four analyses. But that temptation
can lead to the disavowal of the data, that is, to a rejection of data about a person who
experiences analysis at its painful worst. If we focus on psychodynamic speculations
about why this particular patient could not work in two of four analyses, we run the risk
of losing the sheer information in these descriptions this is what it feels like to be
involved in a failed analysis, this is what it feels like to be the patient when the patient
experiences the analyst as unempathic and believes herself to be profoundly
misunderstood, this is what it feels like when very classical analytic technique is
experienced by the patient as cold denial of the patient's reality.
The importance of this data is, simply, that it is information from the only
other observer of the process and that it is so often missing from our discussions.
Accounts of failed analyses are rare in any event, but even when a candidate at a
psychoanalytic institute, for example, tries to explain why a patient did not continue
in analysis, it is usually in terms of the patient's analyzability or the underlying
pathology or resistance or whatever.( exactly what I was saying above) Chernin's
description, however, is from the viewpoint of the patient and, despite her own
analytic training, it is written phenomenologically, in terms of the experience. It
could have been written in terms of her own narcissism, in theoretical terms of the
rejection of the classical image of the analyst as neutral, or in highly critical terms of the
analyst's ability. Instead, Chernin focuses on describing the dialogue as she recalls it and
the feelings that she felt, including her feelings about the position that she attributes to the
analyst.
Given the underlying sense of failure in all of Chernin's analytic experiences
and at least two of Freeman's, one might be tempted to ask if all of these analysts could
so profoundly fail to deal with these patients. Chernin herself tries to give us some
understanding of her state of mind at each stage in order to convey the sense in which
each analyst could not help but fail to address fully her needs.
Again, I find myself tempted to infer that Chernin was simply too disturbed,
perhaps too narcissistic, to be analyzed. I said earlier that we wonder whether her
experience was colored or distorted by her resistance. Again, the temptation to speculate
in that vein is inherently a tendency to discount the data solely because, I believe, it
comes from the patient. If Chernin's London analyst had written up the vignette of a
patient who could not tolerate even the mildest inquiry into lateness as resistance, we
would not leap to the conclusion that the analyst's personality defects drove the patient
away. It seems to me that our temptation to explore Chernin's pathology shows how
differently we read the account of the patient as opposed to the account of the
analyst. Whatever we may feel about a particular analyst's character, we do not (or
should not) automatically rush to discount his theory or his description of his cases. In
fact, in most cases, we do not know enough about the analyst (unless he is Freud about
whom we have a wealth of biographical information or unless she is a colleague whom
we know personally) to make well-grounded inferences.
Cardinal's book is expressly about a successful analysis. The book is dedicated
"to the doctor who helped me be born." She describes her apparently very classical
analyst's technique in the following words:

When I got there, I'd close my eyes and the trifles, which had their importance, to be sure,
yet were not at the heart of the Thing, would come alive. . . The little man said nothing of
any importance. He opened the door: 'Bonjour, Madame.' He'd have me come in. I'd lie
down on the couch and talk. At a certain point he interrupted me: 'I think the session is
over.' Out of the corner of my eye, I had seen him look at his watch two or three times
before speaking, as if he were refereeing a game. I stood up. 'Au revoir, Madame.'
Nothing else. His face impassive, his eyes attentive but without sympathy or
involvement. Later, he would sometimes pick out a word from the jumble of my
monologues and say 'Such and such a word, what does it make you think of?' I would
take the word and unravel the thoughts and images attached to it. Most of the time, this
word was the key to open a door I had never even seen. This gave me confidence. . ..
(Pp.94 - 95)

When the doctor asks her about the word for the essential element in her
fantasy or hallucination, "tube," she responds

It irritated me to hear the words said. I saw what he was going to do with them: tube
equals paper spigot, exit from my mother's womb. It wasn't that.. . . I had wanted to get
up and get out of there. He exasperated me, this silent little jumping-jack with his
imperturbability, and the peace of mind of the initiate.
(p. 147)

Cardinal's description of the successful application of traditional technique

should not surprise those of us who believe in the efficacy of that technique. Yet, this
description of the subjective experience of that technique has, I believe, something to tell
us about the analytic experience. Coupled with the bitter anger of Chernin's descriptions,
it reminds us of the theoretical puzzle as to why some analysands profit from the use of
such technique and others suffer from it unprofitably.

RESPONSE TO THESE ACCOUNTS IN THE PSYCHOANALYTIC

LITERATURE
 I have been able to find very few references to these accounts in the standard
psychoanalytic journals. A search by name of the American Psychoanalytic Association's
computerized on-line index turned up no references at all; research by hand revealed a
few brief book reviews. (Taylor, 1953; Freud, 1996). An updated bibliography of patients'
accounts of their mental illness has recently been published with the suggestion that such
narratives might contain useful information. (Sommer, et al. 1998)
The review of Freeman's Fight against Fears has a condescending, if not
critical, tone, a critical attitude which extends even to the analyst indirectly. Taylor wrote

This is the patient's story of her analysis, or what purports to be an analysis, which was
carried on for over four years. It makes rather wearisome reading: for somehow or other
the negative transference seems to have been nearly by-passed.
***
The therapeutic result is, on judges, somewhat similar to what one might expect from a
successful series of out-patient interviews or what can sometimes be accomplished in a
lucky consultation or two.
(Taylor, 1953, p. 166).

The tone of condescension is marked; I wonder if Taylor would have so

worded a review of an analyst's book length account of a four-year therapy that was
regarded by the analyst as an analysis. Interestingly, however, Taylor notes that Freeman
might have been "pushed" into taking notes of her analysis in part "by the open admission
of her analyst that he never took notes and that was that, i.e. he apparently made no
exploration of what that might mean to her." (Taylor, 1953, p. 166) In that insightful
point, Taylor captures the reciprocal silences that this paper addresses; the
writer/analysand writes in the face of her non-writer/analyst's unanalyzed, but explicit,
refusal to do so. The image that only one of the two will record the analysis or write
about it and that the existence of a narrative or record is not to be discussed or analyzed is
a vivid one.
Sophie Freud reviewed A Different Kind of Listening. (Freud, 1996). Again,
there is a flavor of condescension in the review. Freud writes, "[Chernin's] quest for
psychic healing, or perhaps spiritual salvation through psychoanalysis, persists over 25
years, and beyond that, in modified form." (Freud, 1996, p 481) Midway through the
review, she notes "I fear that the reader of this review, like the reader of this book, is
becoming weary at this point, but you must bear with me through one more analysis of 8
years' duration." (Freud, 1996, p. 483). Again, I wonder if a reviewer of a book by the
analyst of four analyses would be so candid about the boredom of reading four analytic
case histories; Freud notes that Chernin had "become what else? a psychoanalyst
herself, simply switching roles from patient to listener." (Freud, 1996, p. 485). For most
of us, psychoanalytic training involved more than switching roles from patient to listener.
Freud observes that Chernin evolved a view of psychoanalysis as "[T]he birth of the self
through story-telling. . [is]the fundamental psychoanalytic act." Freud, however, then
goes on to claim that Chernin "seems to repeat with her patients the interminable nature
of her own experience." (Freud, 1996, p. 485).
Here, as with Freeman's book, the failure of an analysis seems to present a
basis for depreciating the analysand/author instead of an occasion for examining, from
the patient's point of view, what it is that makes an analysis a failure, although Taylor
does note that Freeman's books "shows how unsatisfactory some analyses can be."
(Taylor, 1953, p. 166).

CONCLUSION

We can see in the above material that for some patients the force of the
analytic work is sufficiently strong that the patient feels driven to write an entire book
about the experience.9 We cannot know whether some of the material in these works, such
as the experience of approaching the office, was addressed explicitly in the analysis or
not, because the author does not always tell us. The books are often unclear on what was
discussed with the analyst and what was simply processed by the patient, then or later.
Some of the material, such as the on-going effect of the analysis years later, clearly was
not covered in the analysis and may never have been mentioned to the analyst at all,
unless he or she read the book.
Moreover, we do not know what the analyst thought of these portrayals of
their work. In The Words To Say It, we are not told whether the analyst read the work in
manuscript or even knew that it was being written. Freeman showed the manuscript of
one book to her analyst; that book was adoring of his work and the impact on her life.
(Freeman, 1985) He, who never took notes, declined to comment on the manuscript.
Chernin is silent on whether she discussed her book with her analysts. In other
words, we have with these patients' accounts of their analysis the same situation as
with an analyst's case history; only one person speaks. Given the lack of comment in
the professional literature on these narratives, the silence of the profession is nearly total.
It is as if the patient and the analyst must be reciprocally silent about their interaction;
after the sessions are over, only one may speak, while the other remains forever silent.
In the analysis, traditionally, the patient talks more than the analyst, who
limits himself or herself to an interpretation or observation. The analysis consists largely
in the patient's stories of the past, and present, of dreams and of feelings in the analytic
session. The case histories written by the analyst are the analyst's story of the telling of
those stories plus the tales of his interpretations. If the patient writes an account of the
analysis, it will likely lack the theoretical cast of the analyst's work, even if the patient
has become an analyst, and will tell the story of the analysis as it occurred in a life. It will
be the story of the interpretations as heard by the patient, not as intended by the
analyst.
The differences in the stories told by patient and analyst and the
profound separation between the telling of those tales seems to me inestimably sad
and strange. (soo true)It is as if the participants in this intimate process must at the end
keep their secrets from each other, as if the analyst cannot bear for the patient to hear
what he would say to his analytic colleagues about the hours that he and the analysand
have shared and as if, simultaneously, the analysand must speak at last independently of
the analyst to describe the analysis itself. Perhaps writing together would be as if the
patient were to rise off the couch and face the analyst, and the analyst were to speak at
last. ( well that is probably of significance in classical psychoanalysis. I just wonder now
that if anyone else like Urvashi mam was my therapist instead of sir, then I would have
been in a world of pain. At the most I would have been in a little awe of her and
admiration, but would have always carried the hurt for being kept at such a great
distance. To be a client in a pure classical psychoanalysis, what a deprived position would
that feel like..and I wouldn’t ever go beyond this that how can someone whom iam trying
to get so close to and telling everything, treat me soo cooly and indifferently. ) One might
say that the continued separation in the formulation of these narratives marks a healthy
continuation of the different roles of doctor and patient so that the analytic role so that the
patient can always return to the analyst qua analyst and qua patient. One might also say
that it marks a profound unwillingness to truly know what the other experienced in the
relationship.
I am not, of course, altogether unaware of what a traditional rationale for the
separation might be. One might say that the nature of the analytic process requires that
the patient be left with some ignorance and idealization about the analyst, so that the
patient takes away from the analysis only what the analyst thought therapeutically useful
to tell the patient. It is worth being clear, however, that the interchange that is lacking in
the above narratives does not necessarily encompass boundary violation disclosures by
the analyst about his or her personal life, for example, although a fully reciprocal account
of the analysis might encompass such disclosure.10 Hypothetically, however, one can
imagine (and Irving Yalom and Ginny Elkins more or less carried out) a collaborative
exchange about the analysis, where the disparity in disclosure, the boundary, between
patient and analysis was maintained with regard to the analyst's life but discarded with
regard to their respective thoughts about the analysis. The lack of exchange between
Freeman and her first analyst over the taking of notes, and the apparent failure to deal
with that issue in the analysis, as well as his deliberate non-involvement in the
manuscript, would seem to be an example of the use of the boundary and the analyst's
neutrality to close off consideration of the possibility of reciprocal understanding.
I have spoken informally to analysts about the relationship of their writing of
case material to their patients. Two have told me that they shared the manuscript with the
analysand (after the analysis had ended) and that the discussion of the material deepened
the relationship and amounted to a kind of follow-up more like a satisfying closure.
In reflecting on these facts, I was also led to wonder what role the gender of
the narrator had in the silence of the analytic community; was the ignoring of these
women's accounts of their analysis a continuation of the chauvinistic disparagement of
the female patient that is exemplified by Freud's cavalier dismissal of Dora's reaction to
her analysis?11 It is difficult to answer this question; Wortis' account of his analysis with
Freud is almost equally ignored. Certainly, there does not seem to be more attention given
to accounts by physicians (Wortis) or analysts (Chernin). One interpretation would be that
the drive to ignore the patient's account is stronger than any other factor.
When I presented a version of a related paper last year, two responses from
senior analysts seemed to me to capture the extent to which information about analysis
from the patient's point of view is disregarded or discounted. One said, in effect, "Oh,
yes, a study like that [comparing the accounts of patients and analysts] was done by some
psychologists some years ago and all they found out was that there was nothing of
interest in what the patients had to say." Another said, "Oh, yes, every patient wants to
write the story of their analysis with their analyst. It's pure narcissism, the sense that
there's something interesting about their particular analysis." That perception is, if one
reflects on it, somewhat paradoxical what the patient has to say is necessarily the raw
material of the analysis, and obviously, some analyses are of some interest to analysts
since some are written about by analysts, yet the worth of the patient's view apparently
ceases the moment the session is over. The analytic profession's sense that knowing what
patients think and feel about their analysis is either uninteresting or irrelevant implicitly
includes the view that the analysis basically belongs to the analyst, that the patient's
experience exists only as grist for the analyst's work, and that the shared experience of the
analysis is not, and must not be, shared at all once the hour in the consulting room is over.
On that view, the talking cure necessarily takes place in a brief communication between
reciprocal silences.12

1. Interestingly, while in Vienna, Wortis was exposed to another new psychiatric method
insulin-coma therapy. He introduced that therapy to the United States, and Shorter claims
that Wortis was delayed in publishing his results by the opposition of the psychoanalyst-
dominated psychiatric journals, so that he initially published in a neurology journal.
(Shorter, 1997)
2. Even in relatively candid works by adherents to the intersubjective theory of the
analytic process, in which a great deal of material about the analyst could be revealed, the
story of the analysis is largely told by the analyst or the researcher, not by the patient,
except as the analyst recounts what the patient told the analyst.
3. I am deeply indebted to Ms. Judy Kash, Reference Librarian, Menninger Clinic for her
skillful research in finding these reviews. Any oversights in the literature search are, of
course, my own, as the limitation of the research to English language journals.
4. Even the choice of a term to refer to the story of an analysis revealed the theoretical
difficulties. Is a novel about an analysis properly called a "case history"? It seems to me
that the terms "case history" and "clinical vignette" should perhaps be reserved for works
by analysts about patients because I believe that those writings constitute distinct literary
genres and the identity of the author may be part of the genre. On the other hand, to so
restrict the use of the terms may give the impression that the work of the analyst is more
"true" or more "scientific" or more "objective" than that of the patient, which is not an
assumption that I wish to embrace.
5. Moreover, the fact that a patient transforms their analysis into a novel is itself a point
of some interest.
6. I have been told that a research project was conducted some years ago in which various
analysts and their patients wrote accounts of the analysis but I have not yet located that
work. Some follow up studies, including to an extent Forty Two Lives in Treatment,
include abbreviated accounts of analyses by both analyst and patient but these were
written separately and combined in one narrative by the author of that work.
7. Interestingly, analysts' popular writings frequently contain more information about
their office, as if in acknowledgement of the fact that ordinarily the setting of events
being written about is part of the narrative.
8. She wrote two books on Freud, for example, which were reviewed at far greater length
than her book on her own analysis. (Freeman, 1981; Freeman and Strean, 1981; Strean,
1982; Mendel, 1982)
9. I am aware of only a few case histories by analysts that are equally long, among which
are Dewald's The Psychoanalytic Process: A Case Illustration and the various Wolf Man
narratives. There are also popular works on psychiatric cases that are book length.
10. That is, a complete account of an analysis might encompass two parallel narratives
about two lives and their interaction, in which the impact of the analysis on the patient's
life and its role, if any, in the analyst's life were fully disclosed. I have in mind here, for
example, the countertransferential question of whether the analysands of candidates
intuitively discern the importance of their completing the analysis to the analyst's career.
11. One can see one of the issues in the construction of this sentence; should it be written
"his analysis of her" (suggesting that the analysis belongs to Freud) or "her analysis"
(suggesting that the analysis belongs primarily to the patient)?
12. I am not unaware that the reader might wonder whether I want to write about my own
analysis with my analyst but that is a topic for another day. Or, perhaps, for working
through by writing about people who write about their analyses.

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