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Cast The First Stone Ethics in Analytic Practice

Edited by Lena B. Ross and Manisha Roy
Reviewed by Gary Ahlskog, Ph.D.

This intriguing title is fair warning that the reader is about to encounter a paradox: Just as this famous response from Jesus does not endorse adultery, neither does it endorse reflexive conventional punishment. So too no endorsement of sexual acting out in psychoanalytic work is implied by recognizing that the conventional tendency simply to blame and punish offenders oversimplifies the human condition and, by so doing, falsifies it. Analysts, more than most, are presumably attuned to this paradox, yet anyone who has participated in adjudicating a case knows that an ethics committee is not a likely place to encounter sophisticated ethical reasoning. In this book, the foreword, by Adolph Guggenbuhl-Craig, and the introduction, by the editors, clearly reaffirm the premise that sexual acting out between analyst and patient is untenable. That established, they and 14 more Jungian analysts have gone on to contribute a collection of essays that raise a spectrum of questions:

Has the metaphor of transference become so reified that analysts can assert without reservation that the adult analysand remains forever in the position of an irresponsible abused child? (Guggenbuhl-Craig)

Considering everything psychoanalytic theory has to say about the centrality and reality of relatedness, is not an ethical shallowness apparent if all this is to be set aside where sex is concerned, in deference to a collective code that claims higher authority? (John R. Haule)

Might analysts be revealing a touch of tunnel vision when they argue that the professional relationship can never become personal, since the very model of the training analysis employed by most institutes routinely permits this in-house shift among its own members-apparently without documentable disasters? (Luigi Zoja)

In the light of our field’s general inattentiveness or ignorance when it comes to helping impaired colleagues (which makes Joseph Wakefield’s essay on primary, secondary, and tertiary methods of care unique in this collection), how can we avoid the countertransference trap of using “ethics” to rationalize behaving like an aggressor toward an impaired colleague, thereby failing to be ethical in our very own deliberations? (Verena Kast)

And-as Freud (1915) implied in his “Observations on Transference-Love”- the focus on sexuality may bypass the main problem, which is rarely sexuality per se but disappointment in any unsuccessful ending. Similarly, Zoja discusses the parallel issue of extracurricular financial transactions between analyst and patient and questions whether we actually operate de jure according to informed ethical prescriptions. Or are our de facto “ethics” rather like a Darwinian method of simply singling out those who were less adept at preserving a harmonious outcome?

These questions are perceptive, timely, fascinating, and important. As June Singer remarks in an anecdotal essay about her training experiences, “Somehow, with the conferring of the analyst’s diploma, you were supposed to know” (p. 7) the answers. I daresay all of us are already aware that a diploma provides no answers. I now add that reading this book offers answers that are, well, all over the place.

Given that these essays are not endorsing sexual acting out but questioning the depth of wisdom in our responses, the responses in this book include a restatement of conventional thinking (Florence C. Irvine), emphasis on community standards (Henry Hanoch Abramovitch), a tangential description of healing practices in another culture (M. Vera Buhrmann and G. S. D. Davis), several intriguing discussions of the Jungian concept of the Self, and-in some essays-no answers at all. Not that any author is obliged to have answers to such complex questions, but too many essays in this book fail to arrive at a relevant, intelligible point. Most are too short (e.g., Rosemary Gordon; John Steinhelber). Sometimes the reader wades through a description (or redescription) of issues only to turn the page and find that an essay has ended in a cacophony of heavy metaphors (e.g., transformation or new perspectives”). Other essays (e.g., Lena B. Ross; Maria Teresa Rufini) fall prey to the bugbear of offering a poignant literary analogy and then stopping-thereby failing to connect the analogy to the substance of our dilemmas. If by chance the primary intent was to make readers think for themselves, then some essays succeeded way beyond this reader’s expectations.

There are exceptions. An essay by Fred Plaut reconsiders ethical principles in the light of the nature of psychic functioning and concludes with the insightful recommendation that analysts “who have the slightest doubt about their relationship with a patient, whether in love or hate, are [ethically] bound to consult a colleague and this is important-not [be charged] a fee” (p. 66). Manisha Roy describes the psychic journey of a patient coming to grips with the meaning of an affair with her high school student. Haule and Zoja reexamine the foundations for ethical reasoning in the context of a broader understanding of the self. Kast is articulate and persuasive in showing that, owing to the vicissitudes of countertransferential pressures, a fact-finding committee and an ethics committee need to be separate entities. Most successful of all in integrating the concept of the Self and erotic dilemmas in actual clinical practice is the essay by Ann Belford Ulanov (who, I hasten to add, happens to be my administrative supervisor at Union Theological Seminary as well as a colleague).

Ulanov begins by cautioning that special temptations lurk within the popular notion of intersubjectivity, since “the dangers of ignition or denial increase if we equate the field with the Self’ (p. 127). Then her explication of the concept of the Self (i.e., psychic reality, the being fully engaged in living but not reducible to ego or object relations) arrives at this thesis statement: “The alternative to repressing or acting out an erotic field lies, I think, in orienting the analysis around one summarizing question: What is the Self engineering?” (p.133). In other words, it is essential to grasp eventually what unconscious, archetypal, and potential expansion of life is contained in the erotic conflict, provided it is neither run from nor mistranslated into action. In one of her examples, the Self’s engineering turns out to involve a clarification of the analyst’s own contemptuous fear of union. Insofar as analysts truly believe that the ego serves the reality of the psyche, then erotic conflict in all its awesomeness inexorably implies a rearranging and expanding of the personality, even in those dangerous moments when the patient has touched the analyst’s wounds and the analyst “cannot clearly mark out what belongs to whom” (p. 132).

Taken together, the aggregate essays in this book become a timely illustration of how unfinished our profession’s thinking is on this subject. Even if analysts believe that the psyche exists, the rest of the culture is on an entirely different wavelength. At stake in this discussion are the lives of patients and analysts, extraordinary sums of money, and perhaps the future direction of our entire profession (since the conventional clamor for more effective repression is no more an authentic response to our human condition than is acting out). The questions must be addressed. These authors have begun the task.

Freud, S. (1915). Observations on transference-love. S. E., 12, 157-174.