question of the psychoanalytic approach to sexual delinquents whose behav-iour, often qualified as ‘bestial’ or ‘monstruous’, is in reality the result of anunconscious logic itself underwritten by the necessity of psychical survival inthe face of traumatic situations.

Denise Bouchet-Kervella191 rue d’Alesia, Paris 75014, France

E-mail: denise.bouchetkervella@wanadoo.fr

References

Balier C (1997). Psychanalyse des comportements sexuels violents [Psychoanalysis of violent sexualbehaviour]. Paris: PUF.

Bonnet G (1996). La violence du voir [The violence of the visual]. Paris: PUF.Bonnet G (2005). Voir, etre vu [See, as seen]. Paris: PUF.Bonnet G (2007). Les perversions sexuelles [Sexual perversions]. Paris: PUF.Freud S (1901). The Psychopathology of Everyday Life. SE 6, 61–2.Laplanche J (1989). New foundations in psychoanalysis (Macey D, translator). Oxford: Basil

Blackwell.Schneider M (2006). Marylin, dernieres seances [Marilyn, last sessions]. Paris: Grasset et Fasquelle.

Coasting in the Counter-Transference: Conflicts of Self-Interest BetweenAnalyst and Patient

by Irwin HirschAnalytic Press, Hillsdale, NJ, 2008; 220 pp; $90

Irwin Hirsch’s book inspires both admiration and despair. Perhaps Hirschintends equal measure of each kind of response. His book inspires admira-tion because he describes with shocking directness, and a kind of coura-geous, on-the-ground reportorial verisimilitude, ways in which the analyst’spersonal needs (mostly money, time, and love) can so easily take precedenceover the needs of the patient. One can only applaud this kind of honestyand nod in agreement that personal motivations can and do affect one’sway of working with patients. Hirsch’s contribution adds significantly to ourawareness of how the analyst functions in the day-in and day-out of clinicalpractice.

And yet one feels despair because his directness becomes a vehicle for akind of repetitive self-criticism, as case illustration after case illustrationinvolves Dr. Hirsch’s explicit exercise of self-interest and narcissistic pre-occupation at the ostensible expense of his patients. At no time does Dr.Hirsch break through boundaries that every clinician would agree are sacro-sanct. Instead, he lets us in on his private indulgences that he avers diminishthe work and redound to his benefit at the expense of his patients.

An additional issue is this: Hirsch’s is an atheoretical book, or at leastone deeply skeptical of theory. The writing is clear and evocative, and attimes quite powerful; but it stays on the descriptive level throughout. The-ory is seen solely through the prism of the analyst’s character, as if psycho-analytic theory-building is pass� and without inherent value. Even thechapter devoted to theory is light fare and unsatisfying, as theory becomesyet another symptom of the analyst’s subjectivity.

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The central idea around which the book is organized is ‘coasting in thecounter-transference’. By coasting Dr. Hirsch means the analyst’s… ‘‘choos-ing comfort or equilibrium’’ and ‘‘commonly pursu[ing] their own interestsat some cost to patients’’ (p. 2). The book is organized into chapters – eachtaking up a specific clinical topic that describes ways in which the analyst‘coasts’ and each illustrated with several detailed clinical examples. The top-ics include: a general discussion of the analyst’s pursuit of self-interest; theinfluence of situational factors and preferred relational states on analyticparticipation; the analyst’s character and wish for emotional equilibrium(including a consideration of gender match and mis-matches in analysis);baldness in analyst and patient; psychoanalytic theory and unexaminedcomforts; and two chapters on the role of money in clinical psychoanalysis.

While rich in clinical illustrations, Hirsch’s main point is simple andimportant. In our work, analysts routinely fail to make the effort todestabilize the patient, themselves, or both; instead, analysts prefer the com-fort of settled equilibrium, routine, minimal anxiety, a steady caseload andsteady income. Hirsch writes:

The problem I underscore throughout relates not to limitations of any particulartype of personality or theory, but to analysts’ conscious choice to perpetuate a com-fortable equilibrium and thereby to choose, with some consciousness, self-interest inpriority to a more mutually destabilizing patient interest.

(p. 41)

If the analyst is in need of patients or worried about income, an issueHirsch discusses again and again, the analyst may interact with patients inways that protect his caseload or income at a patient’s expense (often liter-ally). It is not that Hirsch believes analytic work is possible without such‘failures’. He spends a lot of page-time showing how ubiquitous these fail-ures are – whether it’s the analyst ‘spacing out’ and not listening to hispatient; or failing to take notes on a difficult case; or not pushing a pas-sive ⁄ dependent patient for fear he will leave treatment or improve. In achapter that has special personal significance for him, Hirsch describes theways in which his premature baldness, or the baldness of one of hispatient’s, is not addressed for years, because of Hirsch’s self-describedshame about his hairless pate. Hirsch’s point is that the analyst must havethe courage to take up these failures or lapses. And yet Hirsch describesways in which analysts (himself most specifically, since most of the casesdescribed are from his personal caseload) do not make the effort to addressthese issues or ‘failures,’ in order to maintain the status quo. In an impor-tant sense Hirsch is describing a kind of subtle ‘gas-lighting’: the patientseems to know something is amiss, some unspeakable desire of the analyst isbeing fulfilled, but no one is saying anything about it.

Hirsch demonstrates the value of making such effort, of destabilizing thebalance, since almost always the analytic process is deepened, the patientmakes progress, and the analyst feels justifiable satisfaction. But in spite ofthe obvious upside for the analyst’s challenging himself and his patients toconfront the difficult and disturb the extant equilibrium, Hirsch describes

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himself as rarely rising to the occasion. Instead, he is silent with certainpatients, competitive with or needy of them, by turns insecure, greedy, fear-ful, anxious and obsessive. I am not making an inference about Hirsch’scharacter. He is quite willing, and in fact encourages us, to see him this way.For example, he writes in relation to a patient he calls Maury: ‘‘Over theyears that I saw Maury, it became evident to me that my hair loss hadexceeded his, and then I no longer had the advantage of the element ofyouthfulness. I began to think that I perhaps fooled myself from the begin-ning – that Maury had always had more hair than me … It felt to me thatI had caught up with Maury in age, or even passed him, and that I wouldbecome ill or infirm, or even die, before him’’ (p. 148). Or, regarding hispatient, Jill: ‘‘I felt that by not sexualizing her, I was being a new and goodobject, though I also knew that I was seriously abusing Jill by my retreatfrom her’’ (p. 69).

One is left with an odd feeling of incomprehension: how is it that an ana-lyst so attuned to the subtle ways in which his own needs confound thequality of his work seems not to learn from this knowledge? I myself cameto believe that Hirsch’s analytic work is better than what he describes, andin order to make his basic point he feels the need to exaggerate his ownproblems in simply being an analyst. And because our literature is so bereftof the things about which Hirsch is writing, he is going out of his way toemphasize the ways in which the analyst coasts. Further, Hirsch often makesastute clinical points, such as the following: ‘‘[T]he analytic ideal of strongemotional presence can lead to analysts’ inordinate neediness for patients’reciprocal involvement’’ (p. 74). Whole theoretical enterprises are based onthis ‘‘analytic ideal’’.

It seems to me that Hirsch is right to emphasize the important role theanalyst’s needs have in influencing the development of an analysis. And bydoing so he asks each of us to confront ourselves, our own ways of practic-ing, and the tendencies in each of us we are willing, through complacency,to indulge.

But it is hard to know how far to take such self-examination, because inan important sense it can become an infinite regress, as one ostensible need,seemingly divorced from the patient, leads to yet another need, and thenanother, leaving the analyst as a thorough-going self-gratifier, onanistic,alone. So one’s worries about money come to be related to worries aboutcase-load, fee-setting, frequency of visits, and length of time between ses-sions – all aspects of practice the analyst controls or predominantly deter-mines. The analyst’s willingness to interpret along certain lines – to dare to‘disturb the universe’ – is influenced by many of these apparently more prac-tical concerns. One can see how this goes and, in seeing the ongoing-ness ofthis kind of worrying, one also gets a glimpse of the central problem withthis book and the thinking behind it.

Though descriptively rich and resonant for the practicing analyst,Coasting in the Counter-Transference is stuck on the ground floor of first-person experience. Dr. Hirsch, so unwilling to move the level of abstractionup at least a notch or two, leaves the reader in a kind of undifferentiatedphenomenological space – undivided, unscaffolded, and unsupported by any

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meaningful theoretical perspective. I will give you an example. If there isone basic issue that runs through everything Dr. Hirsch considers in hisbook, it is the role of money in analysis. And here is one place among sev-eral that the book could be greatly expanded. The issue is not money per se.The issue is whether money is a symptom, or instead a crucial element, ofthe way clinical practice is structured. Almost all professional clinical prac-tice – whether psychotherapy, medicine or law – is fee-for-service. The moreyou work, the more you get paid. You don’t get paid if you don’t work.This basic structure could be said to motivate all the issues Dr. Hirschdescribes. As he himself writes: ‘‘I … suggest that analysts’ anxiety aboutincome is the single greatest contributor to compromised analyses’’ (p. 157).Here, the fee becomes the site of symptomatic narcissistic investment. (Onecould argue that psychoanalysis, as an ongoing intellectual enterprise, isdoomed because it lives or dies by this private practice, fee-for-servicemodel). The issue of money – its complexity and multiple dimensions –would be an important discussion on which to embark, so rarely are theseissues discussed in our literature. Should the entire structure of clinical workbe re-thought? Hirsch implies that it should, but only on the level of indica-tion and complaint, bemoaning that money has the central role it does, andshowing us how it influences the analyst’s choices.

On the other hand, there is a significant body of literature that is purelypsychoanalytic that grapples with the symbolic nature of fees as means ofexchange, making the fee a central element in the foundation of the clinicalencounter. Patients have to pay to speak. This is the essence of theexchange. Without it psychoanalysis cannot function. So the fee-for-servicemodel, rather than being something to confront as a symptom ⁄ problem, isin fact central to our work, in that the analytic frame, in which safety ismaintained through the careful attention to boundaries, cannot functionwithout it. Lacan often said that if patients pay a fee that is too low relativeto what they can afford, then ‘‘they pay with their symptoms’’.1 This isbecause money has a symbolic value that goes beyond the practical or nar-cissistic; and psychoanalytic symptoms are structured symbolically throughmeanings, representations, and conflicts. I raise these aspects of money toshow how much more there is to say about the issue. Instead, Hirsch stayson the level of personal feeling, in his case shame, greed, and guilt.

More importantly, Dr. Hirsch does not describe in any detail a view of apsychoanalytic unconscious as a limit on the analyst’s (and patient’s) narcis-sism. Repeatedly, what is lacking in the cases described is any sense of athird term, a way of conceptualizing analytic therapeutic action other thandyadic, ego-to-ego, transference and counter-transference, projection andcounter-projection. The analyst, as he says at one point, should ‘‘enhance’’the patient (p. 70). He in fact derides the concept of ‘‘thirdness’’ as a ‘‘toooften intellectualized concept’’ (p. 82). For Hirsch, everything in clinicalwork seems to be of equal value – the analyst’s feelings about money, or

1‘‘Everyone knows that money doesn’t just buy things, but that prices … have the function ofneutralizing something infinitely more dangerous than paying in money, namely owing somebodysomething’’ (Lacan, 1988, p. 204).

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how he compares to his patient regarding a particular character trait, orhow desired he feels by a female patient, or how he feels embarrassed abouthis baldness, or his worries about losing a particularly winning patient – allof this seems to be considered the essence of the matter, if only the analysthad the courage to discuss the issue in one way or another with the patient.

It is certainly true that all analysts struggle to some extent with similarnarcissistic issues. And as Hirsch advocates, the analyst must find one way oranother either to move beyond them, or to put them into words so the treat-ment is deepened. Yet, for Hirsch there seems to be little else – the patient issimply one element among several in a totalizing narcissistic field. The ana-lyst and patient appear to be equal players full of feeling, worry, and anxiety,moving closer to each other or further away. For me, what is missing in thispicture is at least the following: (i) an asymmetry in the analytic relation thatsets up a direction to the treatment, a gradient of desire and transference; (ii)foregrounding what the patient actually says; (iii) privileging unconscious for-mations such as dreams and slips; (iv) conceptualizing the impact of thepatient on the analyst independent of the analyst’s narcissistic concerns; (v)the patient’s remembered history; (vi) moments of the uncanny or surprise.All these elements provide perspective, ballast, and purchase in an otherwisenarcissistic, imaginary word of similarity and difference.

Coasting in the counter-transference happens, no doubt. More often thanwe would like to admit. Irwin Hirsch is to be commended for elaboratingsome of the ways in which the analyst falls short – the ways in which hetakes care of himself, rather than going beyond himself and his comfortlevel to reach his patient meaningfully. But psychoanalytic work has morethan one or two dimensions. It has three, at least, if it is worth its name.This third dimension, the area of the symbolic, the unconscious, that placeof alterity that upsets both participants through its ubiquitous and agitatingeffects – that dimension is missing from Dr. Hirsch’s book.

Mitchell Wilson2960A Piedmont Ave., Berkeley, CA 94705, USA

E-mail: mdwmd@comcast.net

Reference

Lacan J (1988). The seminar of Jacques Lacan. Book II: The ego in Freud’s theory and in the tech-nique of psychoanalysis, 1954–1955. New York, NY: Norton.

Chaplin: A Life

by Stephen WeissmanArcade Publishing, New York, 2008; 315 pp; $27.99

This is a biography of a true genius, Charles Chaplin, written by a psycho-analyst who has spent many years exploring the life and works of his sub-ject. It is a fascinating, although not a full, biography – rather an attempt atpsychobiography that should prove satisfying to the general public as wellas to psychoanalysts.

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