Fred Busch responds:

I will only give a brief response to the discussions of my book by my three colleagues, as I’m sure we will come back to many of their ideas. However, I did want to say how very appreciative I am that they were willing to take the time to engage with my book. Each reviewer has contributed brilliantly to our psychoanalytic knowledge, and also given enormous efforts to the International Psychoanalytic Association and their own Societies.  

An author can only hope that a reviewer of one’s work can deeply engage with it, and this has been fulfilled to the maximum in these reviews. That colleagues from three different traditions also find this book a valuable contribution is especially gratifying, as one of the themes in the book is a growing common ground on matters of technique amongst diverse perspectives. Further, that each reviewer was able to find ideas in this book that added to their own perspective, or shed new light on a particular issue was very rewarding.

My basic grounding in ego psychology and the Structural model will always be a basic part of my thinking. However, my journey in the last fifteen years into the thinking of other psychoanalytic cultures [1] has deepened my understanding of psychoanalysis, and has led me to elaborate and re-think many ideas regarding the psychoanalytic method.

In the compelling conceptualizations from French psychoanalysis, especially the work of Andre Green and the French Psychosomatic School, I was able to see parallels in how we see free association, working in displacement, and certain types of non-representational thinking in patients across the diagnostic spectrum. It was Aisenstein’s (Aisenstein and Smadja, 2010) brief introduction to the work of Pierre Marty, and “the significant step Marty took in understanding psychosomatic patients: it was not a question of looking for the content to give sense to the somatic symptoms but rather of observing the inhibition or failures of psychic elaboration that proceed or accompany them’”(p.343 italics added) that helped me think more about my own conceptualizations about the need to work more concretely with patients, as Marty recommended with psychosomatic patients. 

Few psychoanalysts have immersed themselves in different psychoanalytic cultures as much as Dr. Elias M. da Rocha Barros. His reconceptualization of my ideas into his own language was constantly edifying. When reading his commentary I wished I could have included it in my book. He has a way of phrasing his ideas that adds emotional depth to the movement from a thinker without thoughts to symbolic thinking. For example, “Put another way, knowledge through an emotional experience of how the patient is being is far more important to generate transformation than being informed about who he is”. I also found it surprising and gratifying to see the connections he made between my work and other Latin America authors. I hope he will elaborate on his idea that “that during the session, as in life, the patient is always in a state of “becoming” and never in a fixed state of being”. It has been my understanding that patients come to analysis because they are in a permanent state of regressive solutions, and while they come to change we are constantly working with the fear of change.

For the last sixty years Otto Kernberg has been one of the most important thinkers in psychoanalysis. His wide-ranging contributions include: his ground-breaking work of the treatment of severe character disorders; an innovative capacity to reflect on psychoanalytic education and psychoanalytic organizations; his own attempts to reflect and integrate the views of different psychoanalytic cultures, just to name a few. As with the other reviewers Dr. Kernberg’s immersion in my book is gratifying, along with my feeling he understands what I’m getting at when he says, “ Busch has, in fact, carried out the same role within ego psychology that Betty Joseph and André Green have carried out within the Kleinian and the French psychoanalytic approaches: they are radical, innovative, and effective developments of psychoanalytic technique”. While Kernberg agrees with my approach of interpreting “in the neighborhood”, he believes that a more general principle would be to interpret what is affectively dominant in a session. I agree, and in fact can’t imagine an intervention that would be in the patients “neighborhood” without it being affectively meaningful. I agree with Kernberg’s addition that “that an initial diagnostic assessment is very important in all cases, regarding indications as well as contraindications of psychoanalysis, and the need to diagnose those conditions that definitely, and sometimes urgently, require other treatment approaches”.

Unfortunately this response is longer than expected. However, before ending I wanted to thank Dr. Marcus. Everything I’ve said about the reviewers’ readiness to involve themselves in my work, and “get it” applies to his introduction

Again, I want to thank the all of you for helping us begin the conversation so brilliantly.



Aisenstein, M., Smadja, C. (2010). Conceptual Framework from the Paris Psychosomatic School. Int. J. Psycho-Anal.,        91:621-640.


[1] Under the guidance of my wife and colleague Dr. Cordelia Schmidt-Hellerau