Joyce Slochower, Ph.D., ABPP is Professor Emerita at Hunter College, CUNY; faculty, NYU Postdoctoral Program, Steven Mitchell Center, NTP, Philadelphia Center for Relational Studies & PINC. She is the author of Holding and Psychoanalysis: A Relational Perspective, Psychoanalytic Collisions, and is co-editor (with Lewis Aron and Sue Grand) of De-idealizing Relational Theory and Decentering Relational Theory.

Berta Loret de Mola, Ph.D. in Psychoanalytic Clinic from Centro ELEIA, Master’s in Psychoanalytic Psychotherapy from the Asociación Psicoanalítica Mexicana. She is founder and coordinator of the Master’s in Psychoanalytic Psychotherapy at Universidad Marista de Mérida (Mexico) and a Board Member of IARPP.

Joyce Slochower

Berta Loret de Mola

BLM: I would like to begin with one of the final chapters of your book. Your courage in presenting your ideas reflects a profound commitment to truth and honors the memory of your parents. In this work, we encounter an experienced psychoanalyst who honestly addresses the challenges in our practice, inspiring us to explore rarely discussed aspects of psychoanalysis. You trained as a Freudian psychoanalyst and initially understood its procedures, but over time that model began to feel restrictive. Could you share what led you to see this approach as constraining?

JS: I trained at NYU PostDoc and, while I mostly took Freudian courses, I also explored interpersonal theory and object relations. Coming from a family of Freudian psychoanalysts, I was familiar with the model early on. However, certain experiences in my analytic training highlighted its limitations.

One striking incident occurred during my second year of training. I had a patient who wanted to spend the whole summer outside the city with a new partner. This was before remote sessions were possible, so it meant suspending analysis for several months. My supervisor, a warm but committed Freudian, told me this was not acceptable: “Either she’s in analysis or she’s not.” Feeling I had no choice, I told the patient that if she wanted to be in analysis she couldn’t take three months off from treatment. By saying this rather that opening the question with her (what would the meaning be for her of my agreeing — or not agreeing — to this), I closed down analytic space and triggered a negative transference that negatively affected the treatment. I still feel bad about this.

I had a similar reaction when a close friend, whose newborn baby was in the NICU with a life-threatening condition, was charged by her analyst for every missed session. Despite her distress and attempts to discuss the issue with him, the analyst refused to make an exception to his policy. I was relieved when she quit therapy entirely. I also want to underscore that these are caricatures, even misuses of the Freudian model. I believe that Freudian ideas — indeed that every theory — has positive potential. I’m convinced that one can be a Freudian, a Kleinian, indeed, any kind of analyst, and hold one’s theory lightly.

Still, those and other similar experiences left me determined to privilege individual need over the rules.

Beyond that, a great deal has changed in the field, including in more traditional approaches. I was describing another time, one I’m so glad we’ve largely moved past. What has changed overall, I think, is that few of us today embrace the kind of hierarchical, inflexible approach that was prevalent when I was being trained. And I think that’s largely true across our theoretical differences. So while I identify with the relational approach, I do not think that we’ve got the corner on good work.

BLM: Then you encounter Winnicott. He has been an internal companion through your journey. You incorporated Winnicott’s idea of holding into the relational perspective. Could you share a bit about this development?

JS: I’ll start at the beginning. When I was engaged to be married, a family friend and analyst, Ruth Lax, gave me a collection of Winnicott’s BBC lectures for parents, The Child, the Family, and the Outside World. I fell in love with his ideas and even fantasized about going to London to be analyzed by him. I was so young that I didn’t even know he was dead! I was compelled by his sensitive responsivity to individual patients’ needs. But my deep identification with Winnicott became complicated when the relational movement came into being. I was also inspired by relational ideas and bothered by their rejection of Winnicott. Wanting to bridge the two positions, I developed the concept of relational holding. I wanted to expand the Winnicottian model both clinically and theoretically and theorize its compatability with relational thinking as well as the limits of both approaches.

By invoking the term relational holding, I theorized the coconstructed nature of the holding experience and underscored the ubiquitous presence of the analyst’s subjectivity during holding. I also proposed the analyst doesn’t hold alone: the patient actively, if unconsciously, participates in creating the holding experience. She does this by bracketing those aspects of the analyst’s subjectivity that would disrupt the holding experience. By “bracketing” I mean putting aspects of one’s disjunctive subjectivity in parentheses rather than repressing or dissociating them. This, I’m convinced, is essential in work with some (not all) of our patients; specifically, with those who cannot easily tolerate difference — who become derailed when we break into their own way of understanding themselves. So, I’m suggesting that holding is not something done by the analyst to the patient, because both sides engage in bracketing.

I also expanded the Winnicottian model by extending the concept of holding beyond the realm of dependence and describing the ways that holding may be useful when we confront many other difficult affect states, like narcissism, hate, or ruthlessness. We hold dependent patients in ways that reflect aspects of the way we hold our babies, but we also hold narcissistic and hateful patients in ways not unlike our attempts to respond to our older kids at times. For example, with narcissistic patients who cannot engage, we try to hold by bracketing our boredom, irritation, or judgmentality without withdrawing or using interpretations that would excessively disrupt their experience. With hateful patients we hold by accepting their rage without retaliating and without withdrawing. In all these instances, we do our best to bracket our disjunctive subjectivity while remaining an alive presence in the consulting room. I want to underscore that I see this way of working as usually temporary; I aim toward intersubjective dialogue and freer use of my subjectivity. I focus on holding only in clinical moments when my patient is consistently unable to engage with that difference without becoming massively derailed.

BLM: Your book encapsulates three decades of work on the ideals and limits of psychoanalysis, focusing on often unspoken aspects. Despite psychoanalytic rules that largely prohibit extra-analytic contact, forming friendships with former analysands post-analysis is common. This is a significant issue, but it is frequently overlooked in clinical reflection. Why has the psychoanalytic community remained largely silent on this matter?

JS: Well, first, we can’t really answer that without asking, how is it that analysts so frequently break these boundaries, not only with former analysands, but also with current ones? Our termination model regards the end of analysis as the end of contact between the two. Yes, perhaps we receive a Christmas card from an ex-patient, a request for a check-in session, or a birth announcement. But we’re not supposed to maintain ongoing contact once the treatment ends. Yet it’s quite common for more sustained kinds of contact between the two to follow termination, especially when the patient is herself an analyst.

This is inevitable, of course, in small towns. But it also happens in large cities like New York. We run into former analysts or analysands at meetings, conferences, and other kinds of social events. Sometimes these contacts are sort of one-offs. But sometimes they open the door to ongoing social contact. I’ve seen it happen dozens of times. And yet, while we gossip about it, we rarely interrogate it — its meanings or clinical implications. This has created a kind of underground to the psychoanalytic field. It’s time we examine and theorize the consequences of these post-treatment relationships, to explore both the down and the upside of them. I underscore that I’m talking here about non-sexual post-treatment relationships.

In the book I also go a bit out on a limb by suggesting that it’s not inevitable that becoming friends with an ex-patient is a bad thing. Yes, it certainly can be; it can undermine the treatment experience, leave transference factors unexamined, invite all kinds of dynamic and interpersonal problems. But perhaps not always. I suspect that there are also times when this kind of transformation reflects maturation on the part of both patient and analyst, a move beyond separation-individuation and toward dyadic maturity. The problem is, we don’t interrogate it, we condemn it, or ignore it, rather than asking why this keeps happening and what we might be missing about its impact.

BLM: How can we address and manage rumors within institutions, especially concerning who is breaking boundaries with patients, given that no action is taken? What would you suggest we do to elaborate on this issue and find solutions?

JS: First, I don’t think we will ever fully solve this issue; boundary violations occur in every context — psychoanalytic, political, social. What we need to do, I think, is begin by acknowledging this and then interrogating what underlies these boundary violations. We could explore what kinds of post-analytic contact undermine both the analyst and the patient, and what may actually reflect progress. There’s an analogy to parenting implicit here: while, as parents, we do our best to contain aspects of our experience rather than overburdening a child, there are times when a grown child becomes our friend, when we choose to express our feelings to them. Because something core to the relationship has moved beyond dependence and toward intersubjective engagement. Might the same occasionally be true of a few of our ex-patients?

Beyond this though, our field has massively failed to protect patients and ex-patients from boundary violations that do undermine the treatment. In most of the U.S., only patients can file legal complaints. Yet, for obvious reasons, patients rarely report boundary violations. No one else has the right to report, and many feel unable even to name the issue.

We need to bring this issue into the open, to make space for us to talk about it with curiosity rather than judgment, to explore the up – and downsides of this phenomenon. And to create opportunities for acknowledgment and repair. I’m thinking about something like the South African Truth and Reconciliation Committee. If individuals who have tortured and murdered their neighbors were sometimes capable of both acknowledging and attempting to repair their real crimes, why can’t we create a safe space within which analysts who seriously violate boundaries do the same? I’m talking about a process that is not essentially legal but, instead, interpersonal. Yes, our professional bodies sometimes must suspend the analyst’s license to practice. Some, in fact, violate professional norms in such egregious ways that this is necessary. But beyond that, we need to have conversations as a profession that both deepen our understanding of the dynamics driving these violations and consider their dynamic meanings, rather than simply condemning them. Self-examination at the institutional level would allow for both personal and communal accountability. It would open the door for introspection. Is that pie in the sky or might we be ready to move this way?

BLM: You write about minor ethical transgressions in patient relationships, suggesting they may stem from analysts not making room for their own personal needs. What would you recommend?

JS: I think the answer is individual. The overarching idea is that we analysts are people — we have needs, we have bodies, and we need to make space for this. For example, I’m very kinetic. Sitting all day isn’t easy for me. So, I build in time for physical activity, like running, biking, or going to the gym. I take vacations, I no longer work at night. It’s about recognizing our limits and not pretending we’re invincible. For others, self-care may involve making time to have lunch with a friend. The details aren’t important; what’s key is that we acknowledge what we each need to feel nourished and supported while doing this work.

BLM: We may design for ourselves a terrible way to live.

You highlight the importance of reintroducing the concept of resistance within our work in relational thinking. Historically, resistance has been used as an accusation towards the patient. Why do we need to rethink the concept of resistance?

JS: I think early (not current) relational theory sometimes went too far. Many believed that addressing our subjectivity would eliminate a patient’s “resistance.” That everything is co-created. I don’t think that’s true. We’ve all encountered patients we cannot help, where no amount of self-analysis, interpretation, confrontation, or self-disclosure moves the work. And I’m convinced that not everything is intersubjective. For example, I’ve had more than one experience of taking on a new patient whose last treatment failed. The patient seems lovely and I’m sure I can help. But after months or years of trying, I encounter a version of what derailed the previous treatment. Sometimes this happens because I made a misstep similar to that of the previous therapist, but sometimes it’s not. I think we need to acknowledge that there are people with whom we simply cannot effect change.

BLM: The third part of your book is deep. It is written with humor and sincerity. It underscores the need to theorize and reflect on the fragility of aging. Although this is not the way you write it, it led me to think that a state of extreme dependence is not the same in childhood as in old age, and it led me to contemplate my own aging. It is followed by a poignant chapter on mourning. These chapters offer a profound emotional and holding experience. How was it for you to write them, because they are very emotional and moving.

JS: Thank you, I’m glad to hear that. Writing both chapters was, indeed, emotional. I wrote the aging chapter when I was 65. It felt like the perfect time: I wasn’t old yet, but I had become aware of aging in a new way. It was freeing to write. I’ve always valued calling a spade a spade and avoiding platitudes or denial. Having dealt with my parents’ aging, I was thinking about my own future. It wasn’t upsetting but liberating.

For the mourning chapter, I use my own experience within the Jewish tradition, but I emphasize that the chapter is not specifically about Jewish ritual — it’s about a universal need across religions and cultures to commemorate loss. I came to this after my father died when I was 39, and I then experienced shiva for the first time and discovered how therapeutic a process it can be. I became convinced that we need to do more than move on from loss, we need to commemorate our losses across time, to integrate memories rather than emphasizing decathexis. Even decades after my parents’ death, I find opportunities to commemorate their absence to be healing and therapeutic. It’s time we theorized this.

BLM: In the last chapter, you discussed writing and its challenges. Writing exposes us but also helps develop our thoughts. Do you have any advice for those starting out in psychoanalytic writing?

JS: I do, and it’s the advice I was given years ago by a mentor, Larry Epstein. Just write up a case, the narrative of the case. Don’t start from theory — start from experience. Then you can theorize the material. First write, then read. If you read too much first, you may feel like there’s no point in writing because it’s already been said.

BLM: Great advice. I will finish with the final paragraph of your book where you write your personal credo:

“Hold your theory lightly and do your best to remain open to its limitations. Study, question, doubt. Try to retain an ethical stance when expediency would invite you to close your eyes or give in to desire. Above all, enact that ideal by aiming to offer yourself, your wisdom, and your care to your patients ahead of your beliefs, your rules and desires, and your theory, while simultaneously acknowledging the impossibility of this ideal.”

Thank you, Joyce, for your book and your time!

JS: And thank you, Berta, for your thoughtful and penetrating questions. It’s been a pleasure!