The International Journal of

Int J Psychoanal (2012) 93:515–534 doi: 10.1111/j.1745-8315.2012.00601.x

The Analyst at Work

A very dangerous conversation: The patient’s internal

conflicts elaborated through the use of ethnic and
religious differences between analyst and patient

The beginning
I looked at my new patient, Mr F. He was a man of medium height, with
dark hair and eyes that were a startling blue. ‘‘My brother killed himself,’’
he told me, sitting across from me in my office on a cold and dreary Octo-
ber afternoon. The words hung between us, heavy with what had not yet
been felt or said by him. ‘‘With my gun. The gun he asked me to show him
how to load and shoot with, a few days before he committed suicide. In the
shower of the house we had been sharing here in town.’’ I felt goose bumps
on my arms and wondered if the thermostat in my office was set too low. I
thought: ‘Fuck! Do I really have to deal with this?’ and then, more soberly:
‘How will I ever help this man?’ I said: ‘‘I am so sorry. What a loss for you –
and for your family.’’ Mr F looked away, as though my brief words were
like harsh sunlight in his eyes. I was struck by his inability to accept my
words in some useful way and by his difficulty in expressing his own feelings
about his brother’s terrible and tragic suicide. ‘‘I found him’’, he went on,
‘‘in a pool of blood. I had to call the cops because I couldn’t open the bath-
room door and I was scared. And there he was, sprawled out. His brains
splattered around.’’ I felt an urge to say: ‘‘How awful,’’ but waited. He
shifted uncomfortably in his chair. ‘‘It was pretty awful,’’ he said. I noted
the juxtaposition of the words ‘pretty’ and ‘awful’ and, in an attempt to
contain my own chaotic feelings, decided I would ‘file it away’ for future
investigation. His expression was frozen, the face of one who has been
through an unimaginable experience and has learnt to talk about it without
emotion.
‘‘You speak so calmly’’, I said, ‘‘and you look so composed. But you’ve
been through a horrific experience.’’ He seemed taken aback: ‘‘It has been
terrible. Horrific. That’s true. But I can’t feel much. I feel kind of numb.
Not just about this, though. I’ve been this way pretty much most of my life.
Sort of detached from things – from people, feelings. Very anxious about
being with people socially. And Alex was like that. My brother. Till he was
22, I thought his life was good. He was smart, went to an Ivy League
school, seemed to have it together. But then after he finished college, things
started unraveling. Depressed, socially anxious. Had to be hospitalized for
depression and anxiety. But he’d never been actively suicidal. He had been
on medications but he’d gone off the antidepressants a few months ago. I
know sometimes he took an anti-anxiety pill his doctor had said he could

Copyright ª 2012 Institute of Psychoanalysis

[Note: correction added on 30 July 2012 following initial publication on 1 June 2012. Due to an error during the production process,
the page numbers for this article have been changed. Please use Volume 93, Number 3, page 515 when citing this article.]
516 A. Abbasi

use. But we were doing a lot of self-help things together: listening to tapes,
reading books.’’
Teaching a person with a history of severe depression how to load and
shoot a gun that was easily available, I thought, could hardly qualify as
help. The way Mr F separated certain pieces of reality from others in his
mind was becoming clearer as we spoke. ‘‘You felt you were helping him?’’ I
asked. ‘‘Helping each other,’’ he responded. ‘‘At that time, we were both
quite isolated from other people, didn’t go out much. It probably wasn’t
good for us to live together – but we were both at loose ends and thought
that changing our living situation by living in the same house would some-
how help. It didn’t. We fed off each other’s anxiety and, because we had
each other, we could pretend we really didn’t need to deal with other people.
I think Alex was getting more and more depressed and we didn’t notice. I
didn’t and neither did my parents when they spoke to him on phone.’’ Now,
sadness on his face, a twisted grimace. ‘‘I wish he hadn’t died. I wish I had
known or anticipated what he was going to do. But he waited till that
morning when he knew I would be out for several hours, and then he killed
himself.’’
Thus began the first of three initial sessions that Mr F and I met for, as
we began our work together. I learnt that, at 31, he was two years older
than his brother. The two had grown up in an affluent home. Mr F told me
that, during most of his childhood and adolescent years, his father worked
out of their home, investing in different business ventures with partners. He
described his father as ‘‘a moral man’’, who taught him how to play basket-
ball, but with whom he did not feel comfortable emotionally. He knew that
his paternal grandmother had suffered from bouts of severe depression and
never got serious help for it. He felt his father found it very difficult to be
warm and emotionally connected. He acknowledged that his controlled,
rather frozen demeanor was a way of being like his father, whom he saw as
being strong and masculine in his lack of emotional responses, while his
mother, with her warm, at times ‘‘overly emotional’’ responses, felt ‘‘flaky
and weak’’ to him.
Mr F introduced his mother in the analysis as being very loving, ‘‘always
there for us’’, the warmer of the two parents. She was creative and well
respected as an artist. The parents divorced when Mr F was in his early 20s.
Mr F’s mother left the marriage with many millions to her name, becoming
independently wealthy but continuing with her career at a leisurely pace.
Each parent entered a long-term relationship some time after the divorce
and neither remarried. Mr F thought his parents divorced because they were
not well suited to each other emotionally and were waiting for the children
to finish college and leave home before they divorced. Despite Mr F’s warm
endorsement of his mother, I found her to be a very shadowy figure in the
early part of our work together. Even when I noted this with Mr F, her
presence in the analysis did not become alive and there was not very much
factual material to bolster the image of her that Mr F initially presented. I
decided to wait and see what emerged over time and to pursue an analytic
inquiry as the material permitted.

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 A very dangerous conversation 517

In describing his earlier life, Mr F told me that he had a ‘‘basically good

childhood’’, with ‘‘no financial problems’’, parents who were together, and a
good education. His first childhood home was a large, beautiful, expensive
home in an old, settled suburb of smaller, less expensive homes. It was a
suburb where many Jewish families lived. When he was aged 5, his parents
decided to move to a new lakefront community. Here, he felt that his home
was one of the smaller ones on the lake, not as fancy as the others, and he
felt out of place in the new school where he was one of very few Jewish chil-
dren. He described being bullied by other boys for not being tough and not
being very good at sports. He felt that the community was clearly anti-Semi-
tic and, even though his family did not practice the Jewish religion actively,
they were all deeply connected to Jewish tradition.
I asked at this point what he thought about seeing me, a person who was
clearly not Jewish. He said he had specifically asked his friend, a psychiatrist
who gave him my name, not to refer him to a Jewish analyst since he did
not want to discuss his problems with anyone in the local Jewish commu-
nity, lest the family’s issues become public knowledge. He knew that his
analyst would not gossip about him in the local community, but still felt he
could speak more comfortably with someone who did not know him and
had nothing to do with his family. ‘‘My friend told me you are originally
from Pakistan,’’ he said, ‘‘so that’s actually even better in terms of anonym-
ity for me.’’ I noted he did not say anything at this time about the possibil-
ity, in his mind, of my having anti-Semitic feelings. Another question to
keep in mind, I thought.
Mr F went on to tell me that, after middle school, he moved to a high
school in an area of town where more Jewish families lived, and, very soon,
his parents decided to relocate their home to this new community as well.
However, Mr F found himself feeling lost and painfully different from his
peers. In his struggle to feel better about himself, he asked his parents to
help him have a ‘‘nose job’’ when he was about 16. In response to my ques-
tion about what he thought needed changing about his nose, he said his
nose had seemed too visibly ‘‘like a Jewish nose’’ to him. He then went on
to describe what to him felt like a real and traumatic memory, of not being
fully ‘‘under’’ the effect of anesthesia and hearing the surgeon [male] say to
someone: ‘‘Break it!’’, referring to his nose. The nose he was left with after
the plastic surgery seemed visibly cosmetically altered to him, and made him
feel effeminate. In the senior year of high school, he ‘‘discovered’’ pot. As he
became more and more immersed in using marijuana, his grades slipped
lower and lower. He graduated from high school only because his parents
talked to the school and he was ‘‘helped to make it through to graduation.’’
College proved to be even more difficult to get through. It took Mr F seven
years to finish the journey of his college education, with three detours for
drug rehabilitation (for alcohol, marijuana and occasional cocaine use) and
going through three different educational institutions in attempts to feel
‘‘settled.’’ After college, Mr F did some sporadic work for his mother and
father but could not decide on a profession or an interest in which he could
feel deeply involved. He lived off the substantial interest from a trust fund
that had been set up for him when he was 10, by his paternal grandparents.

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518 A. Abbasi

He described being interested in a couple of girls in high school, but feeling

rejected by them. His first sexual experience was with a prostitute at the age
of 17. ‘‘I paid for it,’’ he said. ‘‘It’s very sad and feels pathetic but that’s
what I felt I had to do.’’ Subsequently, there were a few women with whom
he was in brief relationships, and sexually involved, but Mr F had not been
able to meaningfully connect with a woman intimately for any length of
time. Now in his 30s, he dated occasionally, had a few male friends with
whom he played sports and shared a meal, but there were no significant
intimate relationships with either males or females. He loved his dog Max.
He had last used marijuana about three months before he came to see me.
Mr F made it very clear to me, right from the beginning, that he had no
idea where he would now be living long term. With homes in different parts
of the country and the financial freedom related to not being tied down to
a job in one place, he had often lived in different places at different times,
he said. I asked if he thought that, perhaps, at times, he used the external
moves in an attempt to deal with internal issues, hoping that a change of
scenery would make him feel better or solve some acute psychological crisis.
He acknowledged that indeed this might be so and added that, in his per-
ception, his parents also functioned in this manner, often ‘‘throwing’’ an
external solution at an internal problem.

‘‘And where do we go from here?’’

In the second half of the third session, I talked to Mr F, as I generally do
with most patients who consult with me, about what I had heard from him
and what I was thinking about it. His brother’s suicide was the most mani-
fest monster in the room, I said. That was what had brought him in and
that demanded our utmost acute attention. But his entire life needed our
attention, I thought, given his isolation, lack of purpose, sense of feeling lost
personally and professionally and the dearth of meaningful relationships. I
asked what his own thoughts about treatment had been when he came to
see me. He said he knew he needed help in dealing with Alex’s suicide but
he also felt very scared about where his own life was headed. He had tried
therapy in the past, with a number of different therapists (no analyst among
them, as far as I could gather) but never stayed for any length of time, quit-
ting as soon as he felt a little better.
I felt concerned, not only about the issues I delineated for him, but also
about a certain ‘fusion’ with his now dead brother, as when he referred to
their problems and their solutions to the problems as something ‘‘we had’’
and ‘‘something we did or tried’’. The same lack of boundaries seemed man-
ifest in the notion of the lack of importance of spatial ⁄ geographical bound-
aries and moving from place to place in an effort to ‘‘feel better’’ as though
the external moves had no significance in terms of change and separation.
The lack of a professional identity was significant, as was the lack of signifi-
cant relationships. The history of drug use and issues regarding impulse con-
trol and affect tolerance were certainly on my mind. One of my first
thoughts with him – ‘Fuck! Do I really have to deal with this?’ – suggested
to me that whatever had been stirred up in me by Mr F in terms of my own

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 A very dangerous conversation 519

life and personal conflicts, that first thought was also an early warning
about the very tight intertwining of love ⁄ sexuality and sadism in Mr F’s
mind. Along with all of this, there were flashes of a surprising ability to
look at himself and others, and a warmth that shone through unexpectedly
in his interactions with me. These aspects of his functioning made me feel
optimistic about his capacity to be helped.
I discussed with Mr F that he certainly had many different treatment
options he could pursue or try, but it seemed to me he needed a psychoana-
lytic treatment, five times a week. I shared my thinking about how such a
treatment would hopefully allow him the time, space and safety in which he
could eventually talk about all that needed to be talked about and begin to
understand why he was stuck in the way he felt stuck in his life. A highly
reduced frequency, I felt, would not allow all aspects of his thoughts and
feelings to be fully and meaningfully engaged in a treatment and in a rela-
tionship with his analyst. I was aware that he had no idea where he would
be living and, as such, we did not yet know with whom he would be in anal-
ysis, if he chose to begin such a treatment. The how, where, when and with
whom would need to be sorted out, I said, but I did want to convey to him
what I thought would be most helpful in the long run: ‘‘So, whether it is
with me or another analyst, here, in this state or a different one, now or
somewhere down the line, at some point, I hope you will consider allowing
yourself to do the work that needs to be done, for you to have a less tor-
mented life and, hopefully, a happier one.’’

After the recommendation

We then embarked upon a roller-coaster ride, my patient and I, over the
next few weeks. He wanted to be in analysis and he did not want to be in
analysis. He was going to live here and begin an analysis with me and he
was going to move to three different places and wanted me to help him find
analysts there. He thought I was right and it would help him to talk to
someone every day and he felt I must be thinking he was crazy since I was
recommending he come every day of the week. The fact that I did not have
regular times available immediately was a relief since it meant we could not
begin an analysis right away anyway, but it was also frustrating and hurtful,
because perhaps it meant I was not really interested in working with him.
Was I recommending analysis because I genuinely believed it would be the
most helpful treatment for him or was I suggesting analysis because I knew
he could afford it and I simply wanted his money, like many other people
who had ‘‘befriended’’ him for monetary gains? We were meeting twice a
week at this time, at times I was adding on to my regular schedule, not
quite sure how things would evolve. He was occasionally able to reflect on
his own feelings in a session but very often felt he could not ‘‘follow’’ what I
was saying. It felt too complicated and he could not think it through. He
wondered if the chronic use of marijuana had affected his thinking and
focusing abilities. I wondered how much of what he was experiencing in the
sessions was related to high levels of anxiety about looking at his own feel-
ings and being with me, and how much was the result of other factors,

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520 A. Abbasi

including the chronic marijuana use. We spoke about both possibilities. I

wondered with Mr F if he was trying to tell me that what he took into his
mind and body, including my ideas and words, had the potential of being
very disorganizing and dangerous for him. He said that sounded interesting,
but he just was not sure something terrible had not happened to his brain.
‘‘And perhaps’’, I ventured, ‘‘that would be just punishment for surviving,
for being alive, when Alex is dead?’’ I asked if he thought it might be helpful
also to consult with an analyst who had special expertise in dealing with
drug-related issues. He agreed to this consultation. The consultant felt that
Mr F was certainly showing the kind of difficulties in thinking and focusing
that might be the result of prolonged and heavy use of marijuana but,
having been off pot now for a few months, there were already signs of his
clearing up cognitively. He did not think Mr F needed to be part of a
twelve-step recovery program at this stage and thought that an analytic pro-
cess would be the best route for this patient to understand himself and his
reasons for turning to drugs from time to time. Mr F felt somewhat relieved
about the state of his mental functioning after this consultation, but contin-
ued to wonder if his impaired cognition was simply being minimized by the
consultant and by me. After all, he was living with himself all the time, he
said, and he knew he could not focus and think clearly a lot of the time.
‘‘You’re worried your mind cannot work properly,’’ I said, ‘‘that you’ve dam-
aged something irreparably, like your nose after the plastic surgery; and I
don’t get it. Perhaps I don’t even care.’’ He spoke about his difficulties in
school even as a young kid and the fact that no one had seemed to seriously
want to understand what he might be struggling with.
At this point, Mr F began to feel very depressed, finding it hard to func-
tion on a daily basis. There was a sense of affective deadness in the sessions.
He talked about wishing to die and wished he had died, like Alex, ‘‘who is
out of this misery.’’ Feelings of guilt about his brother’s death emerged, but
very vaguely. He felt he should have done more, thought more about how to
help Alex. He wanted to see me more now, felt the more frequent contact
would be helpful. This seemed related to his feeling a little bit surer that I
could tolerate whatever he was throwing at me. We increased the frequency
to three times a week. He became more depressed. How could he be alive
and getting so much good help, with Alex dead and buried, he asked? Pas-
sive suicidal thoughts came up in the sessions. I felt scared he might kill
himself. He said his parents were scared he might commit suicide. I heard
his identifications with his dead brother and his wish to worry me and scare
me in the way he had felt scared and worried about his brother’s difficulties;
but my attempts to talk to him about this felt unhelpful to him. He felt he
could not even think straight, let alone work with me about his feelings. I
wondered with him now, if in addition to the work we were doing, it might
be useful for him to consult with a psycho-pharmacologist as well, to deter-
mine if he might need to be on medication for a period of time, to help with
his depression at this point. He was reluctant initially and now told me he
had often been prescribed antidepressants in the past but had always gone
off them on his own, without following through with his doctor.

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 A very dangerous conversation 521

He then added quietly that he and his parents had met with Alex’s psychi-
atrist after his death and asked why he had allowed Alex to go off the an-
tidepressants, given Alex’s history of depression and their family history of
depression. In a rather flat tone, he said that he and his parents had talked
of suing the psychiatrist. I said I could hear the ominous message he was
sending me. If I suggested he see a psycho-pharmacologist, he felt I was say-
ing he was very sick, and that I wanted to force him to take medication. If I
did not suggest that he be evaluated for medication when he talked about
feeling severely depressed and suicidal, he felt I was neglecting him, not tak-
ing his problems seriously, and he wanted to get me in trouble, to sue me. I
was damned if I did and damned if I didn’t. Did he have any thoughts
about the dilemma he wished to place me in? It felt familiar, he said: he
used to feel the same dilemma with Alex. If he insisted that Alex should get
more help with his increasing depression, or if he told his parents or Alex’s
doctor that he was very concerned Alex might hurt himself, Alex would be
put back in the hospital. Alex had said repeatedly he did not want to be in
the hospital again; he would rather kill himself than go back into a hospital.
If he did nothing, Alex kept deteriorating and, ultimately, did kill himself. I
reflected privately that his intense ambivalence about his brother had made
it difficult for him to decide which avenue to pursue. I said he seemed not
to be sure yet whether I really wanted to see him dead or alive. He was able,
over time, to see the hostility in what he was doing with me, and his tremen-
dous wish to worry me into taking care of him, as though there were no
other way he could or would get such care. He went to see a psycho-pharma-
cologist who prescribed an antidepressant for him. Psychological testing was
also done, which essentially confirmed the clinical findings.
Somewhere over the course of this tough and worrisome period, I realized
I wanted Mr F to go away. I wished I had never agreed to see him in the
first place. I felt scared of him, worried about him, at times intimidated by
him. I felt confused by what he was feeling and unsure about how to help
him in a truly useful way. I realized he reminded me of significant people
who had shaped my earlier life, and of parts of myself that I wanted not to
think about most of the time. These were not reassuring realizations. How-
ever, they brought about a certain relaxation, a sense of being more ‘at ease’
in my work with him. I could see we were both scared of each other and of
ourselves in relation to each other, as well as of our own internal issues
coming to light as we worked with each other. I began to feel a greater con-
viction that we could seriously travel the analytic path together, he and I, if
he decided to stay in town.
Mr F now said he ‘‘wanted to be a five times a week guy.’’ He indicated
he might want to stay in the area and continue an analysis with me. At five
times a week now, using the couch, every moment in the sessions that signi-
fied an emotional connection between us brought heightened anxiety for Mr
F and statements about why he must leave. I asked if he had noticed this.
He acknowledged that he had and that this was a problem he had in all his
relationships. Getting close was something he wanted to do, but then it
scared him, for reasons he could not understand. Along with this, he pre-
sented many external reasons he really needed to move to North Carolina.

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522 A. Abbasi

He asked for a referral. I spent some time tracking down an analyst I

thought would work well with Mr F. He talked to this analyst at length and
promised to call her when he reached North Carolina. Soon after this, he
asked me if I would consider working with him on the telephone after he
moved. I asked what might have made him think of this possibility. He said
he felt more and more connected to me now and felt we did good work
together. I said I thought phone work could be very helpful, if in-person
work was not possible or if two people had already worked together for a
long time and it made more sense for them to finish the work over the
phone rather than for the analysand to transfer to a new analyst, at an
advanced stage of the analysis. In his case, he was moving to a part of the
country where there were many good analysts available, and he and I had
worked together for only a little bit under three months; I understood that
the change would be difficult, but also hoped that it would work out. Mr F
then asked if we could speak together on the phone only during the period
of transition, while he moved and until he finished his consultation with the
new analyst. I agreed to this.

An unexpected development
Mr F ultimately moved to a part of North Carolina that was at a consider-
able distance from the analyst I had suggested to him. He then met with
another analyst and did not feel they connected as well as he and I did. I
shared with him my thought that, on the one hand, he felt deeply connected
to me. On the other hand, he had obviously chosen to go away from the
state where I lived, and where he had the option of staying. The analysts
who were available to him where he lived now, he had made unavailable to
himself either through distance or through a sense of non-connectedness. It
seemed he wanted to be with me, but only at a distance, and to have an
analysis, but from across the country. There must be something quite terri-
fying for him about all of this, I said. Mr F responded quietly and thought-
fully that I might be right. However, he had decided he definitely would not
go to anyone else for analysis, he said. The change felt too difficult, he real-
ized. We were working well over the phone, and would I not consider tak-
ing him into a regular, five times a week analysis over the phone? The fact
was that, almost amazingly, Mr F was more emotionally alive with me in
our phone conversations than he had ever been in person. I thought this
had something to do with the safety he experienced when not actually
together with me, in person. This was obviously something to be under-
stood, as was his wish to have a phone analysis when an in-person analysis
could be available to him. I began to consider the possibility of a telephone
analysis with him. I was aware that both of us might be living out a defen-
sive wish on his part in agreeing to a phone analysis, but felt also a trust in
the analytic process to take us wherever we ultimately needed to go. What-
ever the defensive reasons on Mr F’s part, this beginning was, in some
ways, not very different from a patient who wished to come five times a
week but not use the couch, or who wanted to use the couch but only at a
frequency of three times a week. My sense was that what was being enacted

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 A very dangerous conversation 523

was something quite terrifying, and I hoped we would both be able to do

the work that needed to be done, to understand all that was as yet not
clearly visible in the analysis.
Mr F and I thus began a telephone analysis, five times a week, in January,
about four months after we first met. Two of the times were regular times
that we adhered to every week, on Thursday and Friday. The other three
times, we arranged on a weekly basis, since I did not yet have a full set of
regular hours available. I would offer him either a cancelled appointment
time or add on an hour at the beginning or end of my work day if I had no
cancellations. I told him that I hoped to have two more regular times avail-
able in about six months and then one more in about eight months. We also
discussed that the analytic work would be facilitated if we could meet in
person once a month or at least every other month, and Mr F said he
hoped to be able to do that.

Clinical material from analytic sessions

The following sessions are from May, about five months after the formal
analysis began. During these five months, Mr F came to see me only once,
for about a week, and we met for eight sessions over five days (meeting
twice on a few days). After this one visit, he said he did not want to come
every month or every other month. In attempting to understand this, he
spoke about the painful feelings that leaving me after that one week evoked
in him, as well as the terrible sense of being needy enough to have to get on
a plane – ‘‘and come see you just for a few days.’’ I continued to work with
him to understand the many meanings of this.
In earlier work (Abbasi, 1997, 2008), I explored certain facets of the ana-
lytic work involved in working across the boundaries of ethnic, religious and
cultural differences between analyst and patient, and the impact of such dif-
ferences on the analytic work. The material below, from Mr F’s analysis,
gives us another opportunity to study how vivid external differences between
patient and analyst can be utilized (as can any other external reality) by the
patient as a vehicle for expressing his deepest conflicts.

Session 1: Thursday
Mr F began by saying: ‘‘I feel I don’t have anything to talk about today.
Almost as though I have no thoughts.’’ A couple of minutes of silence fol-
lowed. Then: ‘‘My mother’s in town these days. We went to see a movie. It’s
called A Prophet. A French film with English sub-titles. I’m wondering if
you’ve seen it.’’ Another pause. ‘‘Have you?’’
I said I had not and asked what it might mean to him either way, my hav-
ing seen it or not having seen it.
He said he wasn’t entirely sure, but thought that mostly it was because, if
I had seen it, he would not have to tell me the whole detailed story. Since I
hadn’t seen it, he would. ‘‘It’s about a Muslim man in prison in France.
He’s an Arab. And there’s an old Corsican guy in the same prison, who’s
an imprisoned gang leader. He needs to have another prisoner killed because
this prisoner might testify against the Corsican’s gang later. So he tells the

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524 A. Abbasi

young Arab, the hero, that he has to kill the other prisoner, otherwise his
men, the Corsican leader’s men, will kill the hero.’’
‘‘Not much of a choice there,’’ I said.
‘‘Exactly!’’ Mr F exclaimed. ‘‘I thought it was cruel. So this poor guy has
to make a fake deal with the other Arab – the target – that he would go
into the other prisoner’s cell and perform oral sex on him and pretend that
he would do it in return for drugs, as though he really wants drugs. When
actually, he’s just terrified of being killed himself and feels he has to prove
his loyalty to the Corsican Mafioso. After he gets inside the cell of the other
Arab, he slits his throat, his carotid artery. There’s a pool of blood, blood
everywhere.’’
I felt a slight physical shudder in my body, and a sick taste in my throat. I
thought of Mr F’s brother in a pool of blood, when Mr F found him dead.
I waited.
‘‘And this Arab man, the hero, then becomes like the go-to guy for the
old Corsican. The Corsican protects him in prison, arranges a job for him
there, more freedom inside the prison. All in return for the Arab doing his
dirty work for him. But gradually, more and more Muslim prisoners come
to this prison. I don’t quite remember why that happens, but the Muslim
prisoners start outnumbering the Corsicans. And the Arab hero becomes
their leader. He becomes more and more powerful, with the other Muslim
prisoners now like his own gang, while the old Corsican’s gang shrinks in
numbers. In the end, the Arab guy walks out free, a gang leader in his own
right, and the Corsican is left in prison.’’
‘‘Humiliated?’’ I asked, wondering about Mr F’s assessment of the situa-
tion he had described.
‘‘Yup, definitely humiliated. Defeated. Not at all powerful at the end. It
was a good movie. You should see it. It was gruesome in parts, but very
gripping. I think you would enjoy it. I think the Arab is called a prophet
because, supposedly, he has dreams and he uses those dreams to understand
what he is feeling or what he should do.’’ Mr F laughed, a slight, sheepish
laugh: ‘‘That actually reminded me of you, of what analysts do. Work with
dreams.’’
‘‘You’re linking me to that young Arab Muslim man,’’ I said, ‘‘who was
put in an impossible situation at the beginning of the movie. He was
damned if he did and damned if he didn’t, when told to kill the other Arab
prisoner.’’
‘‘It was an impossible situation,’’ Mr F acknowledged. ‘‘That’s what made
it so fascinating. That’s why I think you would enjoy the movie. The inter-
play between the characters. Who is doing what to whom, how things
change. My mother liked it. We were both glad we chose that movie.’’
‘‘And who made the choice?’’ I wondered.
‘‘It was chance,’’ he said. ‘‘We went into this small movie theatre after we
had lunch and this movie happened to be the next one playing at that time,
so we just bought tickets for it and watched it.’’ After a moment, he added:
‘‘It’s quite a story. A lot of bloody violence and killing – a lot of betrayal.
Most of all, I thought, betrayal. The hero betrays the other Arab who

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thinks he’s going to get his dick sucked in return for drugs, and ultimately
the hero betrays the old Corsican man who’s controlled him and used him.’’
‘‘Yes,’’ I said. ‘‘The very, very dangerous things that can happen when two
people are closely, intimately involved. They can hurt each other beyond
belief, control and humiliate each other and even kill each other – not a
quick, easy killing, but a horrible, sadistic death, slaughtered like an ani-
mal.’’ I paused and wondered to myself if it was the right time to link this
to Mr F’s own conflicts. Then I wondered about my wondering. I realized I
was afraid that my offering Mr F my ideas about what he was telling us
might in itself be an act of analytic sadism on my part, in response to his
indirect expression of sadistic, murderous hostility and rage towards me. I
was aware, too, of the powerful presence of his mother on the analytic hori-
zon in this session, long overdue and a welcome sign, I thought, of his try-
ing to approach his complex feelings about her. I heard the homosexual
feelings and anxieties, as well as the references involving the younger man
defeating the older one. I decided to address what seemed to me the most
important issue. I said: ‘‘You’re telling us about some of your own very
frightening feelings about what happens in an intimate relationship between
two people. It takes me back to the beginning of our work together, your
terror about starting this analysis, this relationship with me. Would you be a
five times a week guy, or was it safer to be a once or twice or three times a
week guy? What would allow both of us to be together and still survive?’’
There was a very brief silence. Then Mr F surprised me by saying: ‘‘I am
thinking maybe the phone sessions made it easier for me to continue an
analysis with you. Would I have been able to do this in person all the time?
Or would I have quit soon after starting with you, like I did with so many
therapists before?’’
‘‘Could we really be in the same room, day after day, without ultimately
slitting each other’s throats?’’ I asked, feeling now that, despite my earlier
trepidation about what how much he was ready to hear and understand
about his own sadistic and murderous feelings, Mr F and I were obviously
in the same neighborhood emotionally.
Mr F said: ‘‘And that really makes me think now maybe you were right
when you said last year that I was frightened of something; and that’s why I
was choosing to go away from Michigan. Maybe California is better because
it’s safer this way. I try so hard to avoid coming to see you. I could come to
Michigan for the entire summer but I don’t want to. I really don’t want to.’’

Session 2: Friday
‘‘I’m thinking seriously about taking a trip to Israel,’’ Mr F said as the ses-
sion began. The last session still fresh in my mind, I wondered about the
meanings of this new plan on his part. He told me the approximate dates he
would be away in June for this trip, about 12 days in all. (I realized that the
first anniversary of his brother’s death would be very soon after he returned
from this trip and that he would be coming into town for the stone-laying
ceremony. He had told me about this several days ago and said he would
like to arrange, as we had done before when he came to Michigan, two ses-

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526 A. Abbasi

sions a day if possible, during that time.) He then added other dates he
would be away in July, for a family event. I noted that the new dates he was
canceling were in addition to cancellations he had already given me for ear-
lier in June, related to a wedding he would be away for. Most of these
cancellations were now in addition to the four weeks I would be away over
the summer. What were his thoughts about this, about all the time we would
not speak together?
Seemingly unperturbed, Mr F said he thought I would be happy for him,
since part of what we had been talking about in our work was his isolating
himself from interactions with other people and not living his life fully. ‘‘So,
I’m glad I feel like going,’’ he said. ‘‘I haven’t wanted to travel for fun in
quite some time. My friend Rick is going. It’s a trip arranged by the Jewish
Federation. We have the option of staying in Istanbul for a few days on the
way to Israel and we’re going to do that. I’ve been checking hotels in Istan-
bul online. Trying to figure out where to stay.’’ Silence. ‘‘I was thinking you
might know something about Istanbul. Maybe you’ve been there.’’ He said
he thought I probably had, since I was originally from Pakistan, a country
close to Turkey. ‘‘I’ve been looking at places to visit in Istanbul. Lots of pal-
aces, mosques, churches. Some of the palaces look interesting. I’m kind of
fed up of churches. Seen too many of them on trips to Europe.’’
There was a brief pause, after which he said that talking about Istanbul
yesterday made the fact that I was from Pakistan, and a Muslim, suddenly
more real for him. He wasn’t sure why. Was it that for some reason, he
could now allow himself to ‘know’ what he had already known? Something
about his trip to Israel was connected to this sharper recognition of the fact
that he was raised Jewish and I was a Muslim. ‘‘I wonder how you feel
about the idea that terrorist attacks by the Muslims are caused by the
USA’s bad foreign policy?’’ he asked. ‘‘That if America had a different for-
eign policy, with more room for recognizing the plight of Palestinians and
other Muslims, maybe 9 ⁄ 11 would not have occurred.’’
‘‘And maybe you are not sure what my policy is, when it comes to discuss-
ing how you feel about the differences between us?’’ I suggested.
He let out a long breath: ‘‘Whew!’’ A moment’s silence. ‘‘This is starting to
feel like a very dangerous conversation’’, he said. A silence again. ‘‘I feel sud-
denly afraid of offending you. I’m thinking this could get ugly between us.
What if we don’t agree about the way we think about terrorism and terror-
ists? Maybe you do believe it is all the fault of the American government,
that if only America were more in touch with the suffering of Muslims, the
Muslim terrorists would not need to attack and hurt people in order to send
a message. I mean, yeah, I can see that Muslims suffer in many ways, but I
don’t agree with the idea that the answer is to go around making suicide
attacks on innocent people and killing them off.’’ Another silence. ‘‘I feel
you might withdraw from me now. That, as my analyst, you would try to
talk to me about this but, deep inside, at a personal level, you would pull
away from me. Cut me off.’’
‘‘Or even cut off your carotid artery?’’ I asked. ‘‘As in the movie you spoke
about yesterday. And there would be pools of blood in the analysis.’’

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‘‘God, yes,’’ he said, sounding relieved. ‘‘Like we might do that to each

other if we don’t agree and if we get into a real fight.’’ He was quiet,
seemed to be reflecting. I noticed his silence with him. ‘‘I was thinking about
Alex,’’ he said, the tone of his voice low, sad. ‘‘We used to have a lot of
fights when we were kids. I’d try to provoke him. He would get upset and
start retaliating. But I was bigger physically, so I could easily shove him
down, push him around. I feel so bad thinking about this now. I was really
mean to him.’’
‘‘It’s tough to think how much you hated this brother of yours at times,’’ I
said.
There was a break in his voice when he spoke. ‘‘I feel like I want to cry,
but I can’t. He was always so good, Alex was, at every damn thing he did.
Right from the time he was a kid. Bright, bright, bright. That’s what they
all said about him. My parents, his teachers. I couldn’t keep up with him
academically. I struggled. They said maybe I had ADD, couldn’t concen-
trate. I don’t know what it was. But I was physically more coordinated and
better at sports and at fighting him and other boys. And then of course I
barely made it through high school and Alex got into an Ivy League
school.’’
‘‘More to hate him for,’’ I said.
‘‘Yes,’’ he acknowledged. ‘‘I mean, I said all the right things and did all
the right things. But I must have resented him.’’
‘‘Must have,’’ I echoed. ‘‘It’s something you can consider only in the
abstract, as a remote possibility.’’
‘‘Who likes to think they hated their brother?’’ he asked angrily.
‘‘It’s terribly distressing for you,’’ I said. ‘‘So hard to think that the
brother you loved and tried to help was also the brother you hated and
wanted to hurt. And everything is made more real, more dangerous, because
Alex really is dead.’’
‘‘I introduced him to pot, you know,’’ Mr F told me.
I said I had not known, that this was the first time he was telling me this.
‘‘After he graduated from college,’’ Mr F said. ‘‘He was kind of lost. Sud-
denly, he didn’t know what to do with his life. He worked for my parents a
little bit. Wandered around. Didn’t feel comfortable being around people. A
lot like the way I felt. So I suggested he try pot to loosen up. It made me
relax. Maybe it would help him. He could never stop after that. Couldn’t let
go of the pot. I’ve thought so often maybe that made him more depressed
over time, led to his suicide. It’s a horrible thought.’’
‘‘That maybe you are really responsible for his death, his suicide,’’ I said.
‘‘You introduced him to pot; you even showed him how to use the gun he
shot himself with. It’s as though you pulled the trigger on him, without
touching him – like the Corsican man in the movie who used the Arab to
do his dirty work. He kept his hands clean and the blood of the murdered
man was splattered only on the Arab. But the Corsican, who arranged the
murder, stayed at a distance, and clean.’’ I heard Mr F draw in his breath.
Then, very quietly, he said: ‘‘That is awful. But it’s true. I feel so guilty
sometimes. I feel like, somehow, I actually killed Alex.’’ He was quiet for
some time and then reflected: ‘‘Alex was such a happy kid. My parents

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528 A. Abbasi

really seemed to enjoy him. I had so many anxieties. I don’t know what that
was about. I used to throw huge tantrums, throw myself on the floor, appar-
ently couldn’t be consoled. Would cry and cry.’’
I said it sounded awful, wondered how old he was in these memories.
He said somewhere between the ages of 2 or 3 and 8 or 9. ‘‘Must have
started soon after Alex’s birth,’’ he commented. ‘‘My mother would be
beside herself. She’d walk away from me, throw up her hands. I remember
her saying: ‘I don’t know what to do with you.’ My father would be there at
times, looking on. He would ask my mother: ‘Where did we hatch him
from?’ No one knew what to do with me, and I felt completely out of con-
trol, not knowing what to do with myself.’’
I sat listening to Mr F, to this sad new information that was coming up.
He was talking in this session, not only about his envy and hatred of his
brother and his beginning to recognize his guilt about his death wishes
towards this bright, engaging brother of his; he was also speaking now
about a profound level of emotional distress he had experienced as a
young child and the lack of help in managing this distress, which was
heartbreaking to listen to. His initial descriptions of his wonderful mother
and his slightly removed, but ‘‘moral’’ father were now being fleshed out
with painful realities. His sense of himself as ‘‘too much’’, an out of con-
trol, alien monster who had been hatched from some strange egg, rather
than feeling like his parents’ loved child, was palpable. I said as much to
him. ‘‘You must have felt like such a burden,’’ I added, ‘‘and so fright-
ened.’’
He sounded moved when he spoke: ‘‘I think I just decided over time that
the only person I could really rely upon was me, myself.’’
‘‘And maybe that’s why it was so tough to begin an analysis, to rely on
me. And maybe that’s why you need to be completely unworried, unaffected
by the fact that between all your new cancellations and my existing ones,
we’ll lose many weeks of time together over the summer,’’ I said. ‘‘It’s as
though it’s of no consequence to you.’’
He thought for a few moments and answered: ‘‘I’m like that with every-
one. I see that about myself. I know I do this with other people, behave as if
they don’t matter to me, and their being away, doesn’t matter either. When
in fact, it does. But it feels so weak, to say that, to think it. Needy. I guess
like that alien monster you were talking about. So I pretend it doesn’t mat-
ter at all. I become superficial and removed with people, like I could take
them or leave them.’’
‘‘Rather than knowing that you feel you could so easily be left,’’ I pointed
out. ‘‘I think you feel you were a little terrorist when you were a kid and
you might be a big terrorist now, and that, like your mother, I wouldn’t
want to have anything to do with you when you’re so full of hurt and rage
and the wish to destroy.’’

Summary of the period between the second and third session

The next two sessions are from a few weeks later in the analysis, in the
month of June. In mid-May, I told Mr F that I would have regular times

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 A very dangerous conversation 529

available on Monday and Wednesday, beginning in July; and that, in Sep-

tember, I would have a regular hour available on Tuesday. If the times
worked for him, these three hours could be regularly added on to the two
regular hours we already had on Thursday and Friday.
Mr F responded with a by now familiar anxiety, very similar to the anxi-
ety he had when starting the analysis. He was glad the regular times were
available, he said. This arranging sessions week by week was a nuisance. It
made it difficult for him to plan his life. However, the idea of having five
regular hours felt ‘‘scary,’’ he said, and ‘‘like being tied down to a schedule
too tightly.’’ We began to explore what he meant by this, what it evoked in
him, what felt so frightening. Issues of power and control came up, of being
the subjugated one, at the mercy of the other, imprisoned. My mind went
again to the movie he had mentioned earlier and, feeling that there was
more to learn there, I saw the movie A Prophet. I was struck by the fact
that, in telling me what he remembered of the movie, Mr F had completely
left out a number of powerful components of the story. One of these was
that, when the young Arab prisoner (commanded by the older Corsican
man to kill the other Arab prisoner) entered the cell of the intended victim,
ostensibly to give him a blow job, he had hidden in his mouth a razor blade
with which he ultimately slit the other man’s throat. So the very mouth he
was supposedly going to use to ‘suck’ and ‘suck up to’ the other man was
also the mouth that carried in it a lethal weapon: all while our hero safely
paced his cell in solitary confinement. I kept in mind this new information,
which was not directly from the patient, but was in fact a communication via
omission, in his narration of the story of the movie (rather like elements of a
manifest dream that a patient ‘forgets’ in the first recounting of a new
dream, or the elements of a manifest dream that a patient describes, but
does not associate to – often the most emotionally laden aspects of the
dream.)
As the departure date for his trip approached, Mr F began to talk about
my cancellation policy, which I had discussed with him when we began. The
way I work is that, once a patient has regular times, I ask him to take
responsibility for paying for his times, so that, if he cancels, I charge for the
session unless I am able to use the hour, or we are able to reschedule to a
time that works for both of us, or we both agree that the patient’s cancella-
tion was unavoidable. For the first time in our work together, Mr F spoke
now openly about his ‘‘annoyance’’ about my policy, wondering if I would
charge him for the two regular times we had, while he was away.
The sessions that follow are from the beginning of a week, Tuesday and
Wednesday sessions, arranged the week before. We had not spoken on Mon-
day because that was a national holiday for Memorial Day. The two regular
hours on Thursday and Friday had been cancelled by Mr F a few weeks
ago, for an out of town family event. His trip to Istanbul ⁄ Israel was sched-
uled for three weeks later. So the two sessions that follow were preceded by
a three-day long weekend and were to be followed by two missed sessions,
because of Mr F’s cancellations.

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530 A. Abbasi

Session 3: Tuesday
‘‘I’m worried’’, Mr F announced, ‘‘about my trip to Istanbul and Israel. You
must have heard what happened yesterday with the Turkish flotilla trying to
get into Gaza and the response of the Israelis. I thought, of all the times for
this to happen, it has to happen just before my trip! Now I’m not sure if I
should go or stay.’’
I thought this statement summed up one of his most important conflicts
about relationships.
‘‘I mean, I don’t know if it’ll be safe. It could be quite dangerous still.’’
Silence, then he said: ‘‘And I’m not even sure I really understand what a flo-
tilla is. Like a boat, perhaps not a very big boat. Or something different?
Do you know what a flotilla really is?’’
I felt his direct, urgent question had a lot of anxiety behind it and he was
trying to deal with it by having me answer his question. I said: ‘‘You wish I
could define things for you, tell you their meaning.’’
‘‘Well, it’s all very confusing,’’ Mr F responded, ‘‘and it sounds like you
want me to figure this out for myself. That this is one of those questions
you might not answer directly, because you feel something’s up with me and
you want to wait and see what it is.’’ He laughed a little. ‘‘Right?’’ Pause.
‘‘There are all kinds of opinions about this. Groups that say the Israelis are
crazy, vicious, came down too hard on the Turkish activists and the other
people in the flotilla. And groups that say no, Israel was protecting itself,
that the activists were not just taking in aid for humanitarian reasons. The
activists really wanted to break the Gaza blockade and Israel was in danger.
It’s hard to know who to believe.’’
‘‘Hard to know who’s dangerous,’’ I commented, ‘‘and who is in danger.’’
‘‘Yes! I wonder what are you thinking about all of this? More and more, I
am reminded of your being a Muslim. You’re not an Arab, but certainly a
Muslim. What does all of this mean to you? Who are your people, really?
Certainly not the Jews.’’ A long pause. ‘‘For some reason, I am thinking
about the two times I’ve cancelled later this week. I wonder if you were able
to use those times so I won’t have to pay for those. I don’t know what will
happen about these two regular times when I am away later in the month,
when I go to Israel and Istanbul, if I do go.’’ A brief pause.
I waited.
‘‘I’ve been wondering if I should just give up even these two regular times
that I do have with you, if I’m going to have to pay for them. Then I think
that might be a stupid thing to do, because it was so hard to begin with
you, to have even these two times with your schedule being so tight, and
now you’re finally able to offer me all regular times, which will make life
much more predictable and manageable really; so why am I having such a
hard time with all of this, wanting to give up even what I have?’’ Silence. ‘‘I
met some friends for dinner yesterday. Found myself feeling very self-con-
scious and uncomfortable as we talked. Finally, I became quiet. I was so
worried about what to say. Wasn’t sure I could say what I was thinking and
could I speak my mind? I left early. It was all quite awful.’’ Another brief
silence. ‘‘It was my friend Mel. His wife Nancy was speaking about getting

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a tattoo of Mel’s name on her neck, where it would always show. I laughed
and said: ‘I don’t think that’s such a good idea. You might regret doing
that.’ They might have understood that what I meant was, what if they are
no longer together down the line, and his name is tattooed on her neck for
all the world to see? It could be very awkward. But it might have sounded
as though I was warning them they might break up, maybe hoping they
would. There I was with them and their three kids, and I am single. It was
nice of them to invite me for dinner, and then I say these things that sound
mean. What if Mel gets really offended? Wish I hadn’t said that.’’
I wondered in my mind about the implication, for him, of the man’s name
on the woman’s neck, a sign of possession and of belonging; and right
under that spot, the carotid artery, the vital blood vessel that had been
fatally cut in the movie he had told me about. And what of his envy of their
life together, while he was alone, ‘taken’ to dinner by them? He sounded ter-
rified that his envy, his jealousy and his hostility had leaked out in a very
hurtful way; that his words could cut other people to the core, like the blade
in the mouth of the Arab in the movie.
‘‘So dangerous, ‘‘I said, ‘‘to speak your mind. Hurtful remarks can come
out of your mouth. They can cut people, ruin relationships, including the
one between us.’’
He responded with feeling: ‘‘I don’t want to hurt you. I don’t want you to
be offended. You’ve helped me at such a tough time in my life and you keep
trying. You seem to have hope in what we are doing in the analysis, even
when I don’t. I don’t want to sound unreasonable about this Israel ⁄ Gaza
thing. I also don’t want to be or appear ignorant. Or prejudiced.’’ After a
silence, he said: ‘‘Yeah, well, maybe the Israelis did the right thing, going in
to attack the flotilla; but maybe they attacked innocent people or they were
too vicious in their response. See, that’s what I feel so confused about. I feel
I can’t tell for sure. Maybe if I read more what the papers are saying about
this, I would know more and then I could decide who is to blame, who was
at fault. It feels like a sensitive issue because you are not Jewish. Not only
that, you are Muslim. I am worried about what you feel about all of this
and what if it’s very different from what I feel?’’
‘‘And what then?’’ I asked.
He gave an uncomfortable laugh, which I wondered about with him since
it seemed so incongruous.
He acknowledged he was feeling anxious. It all felt too risky, he said, in
ways he did not really understand.
‘‘Too risky between us,’’ I thought aloud with him. ‘‘That’s what seems to
be involved in speaking your mind with me. Our external differences make it
easier to explain away why things feel so dangerous between us. After all,
how could a Muslim and a Jew ever agree about anything like this? But
there are other issues here as well that you are angry about, and scared to
feel angry about. About my cancellation policy, what it means to you if I
use your hours or don’t, having to pay to keep regular hours with me. And
my absences, like this three-day weekend we just had, that are not in your
control. You don’t feel our relationship is robust enough for you to say

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532 A. Abbasi

what’s really on your mind about all of this, and for me to be able to hear
that, know that and still be here with you, for you.’’
There was a long period of silence. I could hear his breathing, more even
now, compared to when he had laughed nervously a few moments before.
‘‘When you said that just now, I had images of my mother when I would
have tantrums as a kid. She couldn’t deal with it, with me. I see her walking
away, her back to me, withdrawing from me. That felt like a punishment.
There were other times when she was more directly angry, she’d yell. But
mostly it wasn’t that. More than anything, she seemed scared of my anger,
and that frightened me. Why couldn’t she deal with me in some good,
strong, helpful way? Why did she back off so easily? It’s as though she
couldn’t set limits and she didn’t know how to soothe me either.’’
‘‘Perhaps you wonder what it would have been like if she had been bolder
in her love and bolder with her limits,’’ I ventured.
‘‘Wouldn’t that be something,’’ he said, sounding moved.
‘‘And you want that from me,’’ I said, ‘‘for me to be bold both in my love
for you and in the limits within which we can be together. Will you wear me
down with your anger about paying for your times, and I would say, fine,
then go ahead and give up the regular times, I can’t deal with you?’’
‘‘It sounds silly, stupid,’’ he said, ‘‘but I feel if you really loved me, you
would hold my time for me, no matter what.’’
‘‘No matter what,’’ I echoed. ‘‘That’s exactly it. I would have your name
tattooed on my neck, imprinted on my schedule, in all the time slots you
wanted, preferably free of charge. I’d love you, no matter what.’’
His voice was low, subdued, when he spoke. ‘‘Too much, these feelings,’’
he said. ‘‘I feel like I’m going in too deep.’’

Session 4: Wednesday
In this session, the patient revealed that many years ago, before the woman
Nancy married Mel, she and the patient had a sexual relationship, a fact
that added further complexity to the feelings he had described the day
before. He also spoke of feeling rushed to have an orgasm when with a pros-
titute, who he felt did not want to give him enough time. This led to
thoughts of feeling ‘‘blockaded’’ from his mother after his brother was born,
and to his worries that I would get impatient with him, and his longing for
me.

Postscript
Following the work described above, about a year into our work together,
Mr F started dating again, which he had not done for a number of years.
His sexual feelings and fantasies started coming into the analysis more viv-
idly. He shared with me that he felt very vulnerable after sex, as though all
his feelings were raw and open. Not using condoms made him feel every-
thing more acutely and pleasurably, but it also felt more dangerous, as
though he were like a naked wire, exposed to high winds and the danger of
burning out. I said he would then also electrocute the person he touched. It
was becoming clearer and clearer that the telephone wire between us, and

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 A very dangerous conversation 533

the distant connection it allowed, was like an analytic condom. In his mind,
this way of being together kept both of us safe from being electrocuted and
destroyed by feelings that might be too pleasurable or too destructive. He
now told me for the first time that he used to have thoughts, when he was
seeing me initially in person, that some day he would start crying about
Alex’s death, and that I would be tempted to reach out from behind him,
while he was on the couch, and to console him by touching him. The idea
had felt unbearably exciting and terribly dangerous. Leaving and then talk-
ing to me over the phone had felt like an enormous relief. And what, I
asked, about his tears about his brother’s suicide? This led to a revisiting of
Mr F’s immense sense of guilt and responsibility over Alex’s death, with
one particular session where he felt very close to tears, but could not cry. It
seemed all wrong, he said, that he was alive, could think, feel, date, have an
analysis, enjoy his money and the money that came to him after his broth-
er’s death.
On the Monday following this session, Mr F announced that he had
decided to decrease the frequency of his analytic sessions to three times a
week. He wondered how much notice I might need so that I could fill the
hours. He didn’t want me to suffer an unexpected loss of income. This five
times a week stuff was feeling like too much and breaks between sessions
would be helpful. I listened quietly, then said that I was struck by the inten-
sity of his terror and his wish to make me the needy one who had more to
lose than he did if he cut back on his analytic sessions. I asked if he had
truly disconnected his announcement today from what we had been discuss-
ing over the last few sessions. He said he could not remember what we had
been talking about the previous week, but gradually started remembering
and could acknowledge the connection. However, he said, he still wanted to
try the three times a week. It would make him feel ‘‘less crazy.’’ I said I
heard great fear on his part, of continuing to delve into feelings that were
becoming more clear now and I thought that a reduction in frequency
would be a powerful action designed to keep him out of touch with these
very important feelings. We could certainly talk about his fears, I said, but as
his analyst, at this point in the analysis, I could not participate in this new
arrangement he wanted to create. Mr F was furious. ‘‘What are you saying?’’
he asked. ‘‘Are you going to stop working with me?’’ I said I had not said
that. I had said simply that I could not participate in the arrangement he
was suggesting. We could talk about his wish to have such an arrangement,
but for me to actually agree to implement such an agreement would go com-
pletely against my current understanding of all that would be left unex-
plored and simply lived out, by decreasing the frequency now. ‘‘You want to
control me,’’ Mr F raged. ‘‘You can disagree with me, but still see me three
times a week, can’t you?’’ I said I thought that actually, he wished to control
me, and that in fact, he had started by setting up his analysis in a particular
way for protective reasons we could understand more clearly now. We were
no longer at the beginning of our work together, he had the advantage of a
year of treatment, we were getting into deeper material, it was frightening
him, and instead of allowing our work together to help him with these fears,
he wanted to deal with these fears by cutting back on his analysis. How

Copyright ª 2012 Institute of Psychoanalysis Int J Psychoanal (2012) 93

534 A. Abbasi

could I, in good faith, agree to this? There was a long silence. Then, in a
somewhat resigned tone, Mr F said: ‘‘So what are you going to do? Wait by
the phone on the days I am going to cancel?’’ I said that sounded like a very
good idea. ‘‘You’re nuts!’’ he exclaimed. ‘‘What kind of a crazy analyst are
you?’’ A silence and then, cautiously, Mr F asked: ‘‘And are you going to
charge me for those sessions when I don’t call?’’ I said, yes, he had that
figured out correctly too. I heard Mr F laugh, a puzzled, uncertain, but
almost relieved laugh. ‘‘That is ridiculous,’’ he declared. Another silence.
‘‘You are being ludicrous. Do you know that?’’ I stayed quiet, listening. His
voice broke. ‘‘Why do you care? Why do you even care so much?’’ A long
silence ensued. I found myself thinking of lines from a poem by an Urdu
poet, Jon Elia: ‘‘Kis ko fursat kay mujh say behas karay, aur saabit karay kay
mera wujood, zindagi kay liye zaroori hai [Who has the time to argue with me
and to prove that my existence on this earth is necessary?].’’ I realized that
my turning, in my mind, to my mother tongue, and thinking of a piece of
poetry in which the poet speaks of the anguish of never having felt certain of
being wanted and loved, was related, in some way, to Mr F’s conflicts and
what they were stirring up in me. After several minutes, Mr F spoke. ‘‘My
mother’’, he said, ‘‘could not deal with me. I would swear at her when I was
nine, ten. Sometimes about simple things like why she put so much milk in
the macaroni and cheese. She’d apologize or get mad, but could never figure
out what might be helpful for me, what would help me control myself.
Finally, my dad intervened. They took me to a therapist. He suggested time-
outs. It was like my parents had found the magical solution. I could calm
down and my mother could separate herself from me, instead of continuing
to get into it with me, or trying to calm me down without success, because
she really didn’t know how. It certainly decreased the terrible fights we used
to have.’’ I wondered if the reference to too much milk in the macaroni and
cheese referred also to his rage about not having received enough of the good
stuff (a metaphorical ‘milk’) from his mother. I said: ‘‘So the reduction you
were suggesting was going to be like these helpful time outs, designed to keep
us from getting into what you imagine would be terrible fights between us,
sooner or later, if we continue getting closer. Similar to the painful, repetitive
fights between you and your mother, with your father a very hazy presence in
the background – a father who would appear from time to time, to help in
crises, but not as an effective and helpful presence consistently.’’

Aisha Abbasi, MD
5720 Bloomfield Glens, West Bloomfield, MI 48322, USA
E-mail: abbasimd@sbcglobal. net
References
Abbasi A (1997). When worlds collide in the analytic space: Aspects of a ‘cross-cultural’ analysis.
Paper presented at the winter meetings of the American Psychoanalytic Association, December
1997.
Abbasi A (2008). ‘Whose side are you on?’: Muslim psychoanalysts treating non-Muslim patients. In:
Akhtar S, editor. The crescent and the couch: Cross-currents between Islam and psychoanalysis,
335–50. New York, NY: Aronson.
Elia J (1991). Beyasbaat. In: Shayad, p. 78. Karachi, Pakistan: Elia Academy.

Int J Psychoanal (2012) 93 Copyright ª 2012 Institute of Psychoanalysis

ijp_93_3_prelim_Layout 1 7/27/2012 3:03 PM Page 1

Publisher’s Apology
The International Journal of Psychoanalysis Volume 93, Number 3
Due to an error during the production process, issue number 3 was erroneously assigned
page numbers starting on page 271, which is the same start page number used for issue 2.
The issue was published in print and online before the error was spotted, using these
incorrect citation details.

Following consultation with the Editor, Dana Birksted-Breen, and colleagues at the
Institute of Psychoanalysis and Wiley, it has been decided to correct the publication
details for issue 3.

We have therefore undertaken to amend the page numbers for all the published articles
in issue 3, and replace the online version of each article, as well as reprinting and
redistributing all copies of issue 3 to subscribers.

On the following page we reproduce the full Table of Contents for issue 3, showing the
corrected page numbers (and indicating the original incorrect page numbers, which
have been struck-through).

When citing any articles from Issue 3, please use the corrected pagination details as
shown in the table of contents attached. For instance, for the first article in the issue,
please use:

Abbasi A (2012). ‘A very dangerous conversation’: The patient’s internal conflicts

elaborated through the use of ethnic and religious differences between analyst and
patient. Int J Psychoanal 93: 515–34. doi: 10.1111/j.1745-8315.2012.00601.x

Instead of the erroneous

Abbasi A (2012). ‘A very dangerous conversation’: The patient’s internal conflicts
elaborated through the use of ethnic and religious differences between analyst and
patient. Int J Psychoanal 93: 271–90. doi: 10.1111/j.1745-8315.2012.00601.x
The Publisher apologises to the authors, readers, and subscribers to The
International Journal of Psychoanalysis for this mistake, and for creating any
confusion regarding citation to the articles in this issue.
ijp_93_3_prelim_Layout 1 7/27/2012 3:03 PM Page 2

The International Journal of Psychoanalysis Volume 93, Number 3

Corrected table of contents (the incorrect page numbers have been struck-through)
THE ANALYST AT WORK PANEL REPORTS
A very dangerous conversation: Reports of panels held at the 47th
The patient’s internal conflicts Congress of the International
elaborated through the use of ethnic Psychoanalytic Association, 489-516
and religious differences between Mexico City, 3–6 August 2011 733-760
analyst and patient 271-290
A. ABBASI 515-534 FILM ESSAY
A commentary on ‘A very dangerous Seduction, Receptivity and the
conversation’ by Aisha Abbasi 291-300 ‘Feminine’ in Peter Greenaway’s
L. V. DE POSADAS 535-544 The Pillow Book 517-538
A review of ‘A very dangerous N. RAY 761-782
conversation’ by Aisha Abbasi 301-315
C.CHABERT 545-559 OBITUARY
PSYCHOANALYTIC THEORY AND TECHNIQUE Isidoro Berenstein (1932–2011) 539-546
Current developments in the practice of J. PUGET 783-790
individual psychoanalytic psychodrama
in France BOOK REVIEWS
M. CORCOS, P. JEAMMET, A. MOREL, 317-340 The Crisis in Psychoanalysis: In
C. CHABERT, A. C. DE LARA 561-584 Search of a Lost Doctrine by Ahmed
The unreachable object? Difficulties Fayek 547-550
and paradoxes in the analytical C. GARIEPY-BOUTIN 791-794
relationship with borderline
patients 341-362 Toward Mutual Recognition: Relational
I. RUGGIERO 585-606 Psychoanalysis and the Christian
The colourless canvas: Representation, Narrative
therapeutic action and the creation by Marie T. Hoffman 551-554
of mind 363-385 S. LEAVY 795-798
H. B. LEVINE 607-629 Freudin jalanjäljillä [In Freud’s
Has infantile sexuality anything to do Footsteps] edited by Minna Juutilainen,
with infants? 387-403 Ari Takalo 555-557
B. SALOMONSSON 631-647 A. PERAKYLA 799-801
CHILD AND ADOLESCENT PSYCHOANALYSIS The How-To Book for Students of
Reflections on psychoanalytic technique Psychoanalysis and Psychotherapy
with adolescents today: Pseudo- by Sheldon Bach Psychoanalytic
pseudomaturity 405-422 Technique Expanded: A Textbook on
V. S. MONDRZAK 649-666 Psychoanalytic Treatment by
Delusional development in child autism Vamik D.Volkan 557-561
at the onset of puberty: vicissitudes of N. MCWILLIAMS 801-805
psychic dimensionality between Uprooted Minds: Surviving the Politics
disintegration and development 432-448 of Terror in the Americas by Nancy Caro
F. BISAGNI 667-692 Hollander 562-564
HISTORY OF PSYCHOANALYSIS E. ZARETSKY 806-808
Sigmund Freud and Otto Rank: debates A Disturbance in the Field: Essays in
and confrontations about anxiety Transference–Counter Transference
and birth 449-471 Engagement by Steven H. Cooper 564-569
F. P. OBAID 693-715 M. WILSON 808-813
INTERDISCIPLINARY STUDIES The Christopher Bollas Reader
John Cage and W. R. Bion: An exercise in Introduction by Arne Jemstedt,
interdisciplinary dialogue 473-487 foreword by Adam Phillips 569-574
A. ABELLA 717-731 S. GROARKE 813-818