Paul H. Ornstein, MD (1924–2017)

Paul H. Ornstein was a leading figure in advancing self psychological psychoanalysis, a theory that catalysed changes in the practice of psychoanalysis. He was a remarkable person and an outstanding teacher, supervisor and clinician. Born on 4 April 1924 in northeastern Hungary, he lived through the most horrifying years of the twentieth century and survived forced labour on the front line in the Ukraine and in the Carpathian Mountains during World War II. His family was killed, all but his father. Before the war, he fell in love with a girl from a neighbouring village, Anna Brunn. After the war, they found each other—she had survived Auschwitz—and they married. Together, they earnt medical degrees from the University of Heidelberg, completed their psychiatry residency at the University of Cincinnati and trained at the Chicago Institute for Psychoanalysis. Analytic training was rooted in North American ego psychology but Ornstein's fateful relationships, as supervisee, colleague and friend, with Michael Balint and Heinz Kohut influenced the psychoanalytic trajectory of his life. He died in Boston on 19 January 2017 at the age of 92.

Ornstein treated patients, wrote, lectured, supervised, taught residents and candidates, mentored young clinicians from around the world and served on many editorial boards. He published more than 100 clinical, theoretical and scholarly articles in several languages, many with Anna Ornstein. Together with Anna, he conducted hundreds of seminars and workshops throughout the world. They raised three children, Sharone, Miriam and Rafael. He is survived by Anna Ornstein, his wife of 71 years, their three children and seven grandchildren. Their children all became psychiatrists. Two also became psychoanalysts, and married psychiatrists, one who is also a psychoanalyst.

Ornstein’s writings encompassed the uses of empathy, the interpretative process, omnipotence in health and illness, “Chronic Rage from Underground,” unconscious fantasy, dreams, the conceptualization of clinical facts and the patient's encounters with the analyst's theory. He wrote on trauma and resilience in Dostoyevski's House of the Dead. He examined “How to Enter a Psychoanalytic Process Conducted by Another Analyst.” He entitled one essay “When Dora Came to See Me for a Second Analysis.” He co-authored with Michael and Enid Balint Focal Psychotherapy: An Example of Applied Psychoanalysis. He edited the four volumes of Kohut's selected writings, The Search for the Self, for which he wrote lucid introductions. Ornstein's selected writings will be published next year.

The use of theory as a tool, for observation, for understanding, and as something negotiable rather than prescriptive, drew Ornstein to Kohut's ideas and to what later became known as self psychology. Kohut's use of introspective and vicariously introspective modes of observation to develop a theory of selfobject functions and selfobject transferences clarified the investigation and treatment of narcissistic personality disorders and disorders of the self. Ornstein joined the impassioned debates that Kohut's work awakened in the 1970s and 1980s. Psychoanalysts argued whether self or subject is the ultimate organizer of experience. They argued about the role of drives, what is sexual or sexualized and the significance of pre-oedipal and oedipal fantasies and events. They argued about pathology as a manifestation of deficit or conflict and they argued whether hostile aggression is primary, secondary or, in either view, always contextual. Self psychology asked, do we use the methodology of introspection and vicarious introspection to define the field of psychoanalysis and to find meanings, or do we use Freud's biological model that holds to an “objective” perspective that also hopes to find causes? In articles, conferences and seminars, Ornstein welcomed and enjoyed the arguments. Disagreements and misunderstandings persist about the theory, the technique and the psychoanalytic Weltanschauung. Many disagreements evaporated, and some self psychological concepts and techniques reappeared, with alterations, in other models. There were controversies within self psychology and self psychology itself has become pluralistic.

Ornstein deepened our knowledge of patients who suffer from narcissistic personality and behaviour disorders and expanded psychoanalytic techniques. He developed Kohut's original contributions, especially the functions of empathy and the conceptualization of narcissistic transferences, later referred to as selfobject transferences within a self-selfobject matrix. He described a basic direction, still often neglected, for analytic treatment; a patient first needs to feel accepted and understood before it is meaningful to understand, and it is only then that a patient and an analyst can work on a structure for the interpretive process (Ornstein and Ornstein 1996). Before his encounter with self psychology, Ornstein wrote that a structure for the interpretative process is built from our sustained efforts at understanding a patient's conscious and unconscious mental life (Ornstein and Kalthoff 1967; Ornstein 1968). Ornstein, more than Kohut and other self psychologists, focused on the way the analyst and patient get to interpretations rather than on the contents of interpretations.

In the 1960s, although steeped in North American ego psychology, Ornstein emphasized that essential to the psychoanalytic process and outcome—more essential than his knowledge and skill—was who he was as a person in his “unselfconscious presence” (Ornstein and Kalthoff 1967). He appreciated how our patients act on us, and how we act on them. Throughout his career, he explored how “entanglements” in analytic treatments required changes in him before his patients could change. He recalled Freud's observation, “We have noticed that no psychoanalyst goes further [with his patients] than his own complexes and internal resistances permit” (Freud 1910, 145).

In exploring the analytic resolution of “entanglements” with patients, Ornstein delineated the components of empathic listening: we work our way from our emotional reactions as recipients of a patient's unconscious and conscious feelings and fantasies, into our discovery of what it is like to be the person with these feelings and fantasies. What we learn from this ongoing reflective work we communicate from within the patient's perspective, as best we can, noticing the patient's corrections. To live inside a patient's subjective life, Ornstein emphasized, the analyst has to attentively process the patient's experience. The patient perceives, in complex ways, the analyst's efforts to make sense of his or her experience, especially as it unfolds in the moment, and this becomes part of the analytic conversation. Ornstein stressed that as the analyst focuses on what is active in the analysis, from the patient's perspective, the patient increasingly speaks from within his or her experience, not just speaks about it. We can speak about experience, with insight and effect, overlooking that the analytic conversation lacks the emotional participation and transformative power that is present when we speak from within experience. What we do not experience, we infer, and inference, while necessary, is hypothetical and experience-distant.

Aware that our clinical observations are not theory-free, Ornstein thought it still profitable to differentiate experience-near from experience-distant observations and employ this distinction to compare psychoanalytic theories. He distinguished the immediacy of the microprocess, driven by the analyst's subjectivity and private theories, intuitive, messy and often hidden, from the extended trajectory of the macroprocess, navigated by the analyst's preferred public theory (Ornstein 2004; Sandler 1983). To evaluate an analyst's interpretive work, he urged that we study the microprocess, that we mark the exchanges between analyst and patient that propel or hinder movement in an analysis. Publicly held theories, deployed at the level of the macroprocess, cannot determine the effectiveness of interpretations.

Ornstein recognized the necessity for carefully drawn theoretical maps. In envisioning a patient's inner life, we can become disoriented or misguided. Theory guides us and disciplines our subjectivity. But Ornstein was also alert to how our patients emotionally register our theories, making this an intrinsic part of analytic inquiry. His patients, he said, forced him to take responsibility for his translation of his analytic knowledge into an analytic response. Pushed by his patients, often unintentionally, to redefine what he thought constituted psychoanalysis, he asked, when do our guiding theories become negotiable with our patients? With clinical illustrations, he presented some answers. He defined analysis more by its process than its technique, centred within the patient's perspective.

Ornstein investigated the vicissitudes of narcissistic rage, and its central position in self psychology, with clinical and literary examples. Kohut had defined narcissistic rage as a reaction to existential threats or injuries to the structural integrity of the self. All destructive aggression is narcissistic rage, embedded in context. The term, narcissistic rage, refers to the full spectrum of its expressions, from mild irritation to murderous vengeance. Narcissistic rage is distinct from ambition and self-assertion. Ornstein examined Dostoyevski's Notes from Underground to develop the concept of narcissistic rage. Its protagonist was a well-spoken and perceptive man, who seethed with chronic and silent rage, plotting revenge for slights and wrongs to obtain restitution. His sense of superiority coexisted with his sense of worthlessness and shame. His vindictive rage exploded in actions that outside observers would judge as self-defeating. Dostoyevski depicted his protagonist from within, so we feel his grievance and envy. And we feel his righteous urgency for vengeance as his desperate and timid pursuit to regain lost self-regard (Ornstein 1993). At the same time, his protagonist frustrates, rankles and bores us. Despite his desire to connect with others, he is unable to change. Ornstein asked, what was missing? Why was this self-reflective man unable to change?

Ornstein pursued these questions from varied angles in a series of detailed publications that often focused on his patient, Mr K, also an expressive and insightful man, whose rage was “underground” and a central feature of his analysis. These articles, written over 15 years, include his published plenary address to the American Psychoanalytic Association in 2002, and capture many of Ornstein's major contributions. In these articles, Ornstein studied the characteristics and treatment of narcissistic rage, especially rage that is chronic and hidden. He wrote about the analyst's struggles and even repulsion when faced with unrelenting selfobject demands and rage. He grappled with how patients challenge our theories. He continued to reflect on his entanglements with patients in which he had to change before his patients could change. He depicted how analyst and patient find and re-find an interpretive structure for the analysis to advance. He dissected the composition of empathy and interpretation.

Mr K spoke about his rage but did not feel it. It was not self-knowledge he lacked, but a capacity to link his knowledge together. Mr K began treatment with fervent needs and demands, conceptualized by Ornstein in a series of publications, as unconscious curative fantasies. Mr K's curative fantasies crystallized around longings for admiration and affirmation from his analyst that would restore his injured sense of self. Mr K enumerated examples of the rage he did not feel, from his neglected household chores, unpaid bills and unfinished projects at work to his abdications in relationships. His awareness and, eventually, his modified behaviour did not bring enduring change. He hoped for a new beginning but dreaded repeating injurious patterns of relating from which he still derived feelings of connection (Ornstein 1991). Disturbances in the selfobject dimensions of his transference accentuated the repetitive dimensions of his transference. He retreated into indifference. To feel and show his rage without the right response from Ornstein exposed his longings to a void. He was ashamed, too, that to feel his own value, he depended on his analyst's affirmation.

Mr K spoke with discernment about what came to his mind and distressed him but felt anguished disappointment in Ornstein's responses. Mr K was exacting about the accuracy of statements about his subjective world, but he dismissed the importance of his insights or insights arrived at together. What mattered to him was that Ornstein's understanding included what Mr K called “genuine” appreciation of his courage, interpretive skill and excitement when he talked about his disturbing thoughts. It was not important to Mr K that Ornstein's understanding was correct if the analytic neutrality, as Mr K dubbed it, of Ornstein's empathy made him feel unseen and insubstantial. It was as if Ornstein knew but did not feel. Ornstein tried to make sense of this, but Mr K stopped him.

You have to see that it doesn't make sense. Upside down you have to see it. Don't turn it over … It guards you against seeing … My agenda is, will I be accepted with my “No” or not? Or do you have to change my “No” to a “Yes”? I am holding that “No” for survival and the important thing is not how illogical it is. (Ornstein and Ornstein 1994, 984)

Ornstein saw that much of Mr K's rage originated in not feeling accepted for his “no,” only for his compliant “yes.” Mr K expressed his rage in his defiant retreats into apathy. This ingrained pattern of relating to his parents he wished to undo with Ornstein. Mr K's rage was, simultaneously, a desire to extract what he called “dignity payments” for Ornstein's humiliating “arrogance”—and a desire to reconnect to him. He demanded Ornstein see him in an admiring light, especially for his “no.” Although there was much he admired in Mr K, Ornstein retreated from Mr K's relentless demand for “genuine” praise. Ornstein, too, reacted with a “no.” When Ornstein recoiled from Mr K's demands, Mr K was quick to sense it. Ornstein could see that as Mr K retreated, he raised a mirror to his analyst that reflected an image of how his analyst endured him. Ornstein saw himself in this mirror. It was a communication and a retaliation.

Ornstein was unwilling, emotionally and theoretically, to respond to what Mr K called his “extracting behavior.” Theoretically, Ornstein held it neither helpful nor analytic to deliberately meet a patient's selfobject need. It is inevitable that a patient will interpret an analyst's active listening as supplying or frustrating a selfobject need. Change emerges as the analyst and patient understand, interpret and work through the urgency, value and meaning of the need and the effect on both the patient and analyst when the analyst meets, or does not meet, the need. Ornstein realized that his reluctance to respond to Mr K's mirroring needs, as stipulated, arrested Mr K's participation in his own experiences and stalemated the analysis. Even when Mr K pronounced a session good, nothing carried over to their next session. Trust had to be rebuilt each time. It did not matter that Ornstein acknowledged the legitimacy of Mr K's archaic needs; he sensed his analyst's reservation and aversion, and withdrew in silent fury. Ornstein re-examined where, as analysts, we need to limit our responsiveness to a patient's need, although our responsiveness could catalyse the analytic process forward—and without which the treatment stagnates.

Ornstein observed that when we attend to the psychoanalytic process at the level where its most momentous therapeutic elements wait, we have no settled theory or reliable technique for our participation. (He was not dismissing sound clinical judgement.) We join what Ornstein called a second dialogue. We begin anew to know and do through our “unselfconscious presence.” His knowledge, theory and empathic listening perspective were indispensable guides but further analytic progress with Mr K required changes in himself. This requirement that the analyst also change occurs in all meaningful analyses.

The analysis did move forward again when Ornstein could convey more spontaneously how he understood his own contribution to a shift in Mr K's engagement, describing what he noticed in himself and Mr K. Often this meant that Ornstein confirmed he was withholding. Mr K could feel his effect on Ornstein and was slower to retreat. This recognition of difficulties between them he felt as acceptance and now what Ornstein said made more sense to him. When he could experience his analyst emotionally register him, he felt, temporarily, his own presence. Feeling freer to detail his longings for admiration, Mr K also felt freer to detail his anger at Ornstein, still more in words than in feeling, and Ornstein was freer to accept and witness it. Mr K said that this witnessing made his rage—and him—real. Disruptions continued, as did Mr K's rage, but it became easier for both Mr K and his analyst to detect and repair disruptions, to feel connected, and to feel more.

Early years and encounters

Paul Ornstein, at the age of 15, left his home in Hajdunanas, and his chedar and anti-Semitic gymnasium, to study at a Rabbinical Seminary in Budapest on the first day of World War II, as Germany invaded Poland. He did not want to become a rabbi; he wanted a secular education and to study literature, archaeology and philosophy. He tutored to send money home to his family when anti-Jewish laws prohibited his father to work as an accountant. At first, his psychological mindedness developed through novels, poetry and handwriting analysis. At the Rabbinical Seminary, an older student organized a study group to read Freud's Interpretation of Dreams and two books by Hungarian psychoanalysts, Ferenczi's Thalassa and Theodor Reik's Ritual. It was Reik's book that first opened for Ornstein a startling psychoanalytic perspective because of its focus on his everyday life as an observant Jew. He decided, at age 15, to become a psychoanalyst.

On a visit home, he fell in love with a 14-year-old girl, Anna Brunn. In March 1944, Germany invaded Hungary. A postcard from Anna said only that she was being deported; he heard nothing more. Adolf Eichmann commandeered for his headquarters the Rabbinical Seminary where Paul was in school. As Nazi soldiers watched, the rabbi asked Paul to lead the prayer at the final service. From the Rabbinical Seminary, Eichmann deported more than 440,000 Jews, most of them to the gas chambers in Oswiecim (Auschwitz) in Poland. Paul was conscripted into forced labour and transported to the Eastern Front in the Ukraine to build roads, tank traps and landing strips. In the autumn, the Soviet army breached the front line. He and his fellow prisoners, caught between the Soviet and Axis armies, confronted increasing artillery fire. Worse, he knew, with the approaching winter and their thin clothing and diminishing rations, they would soon freeze or starve to death. Without news from his family, subjected to brutal treatment, he refused to believe in God. On Yom Kippur, although they were starving, the religious prisoners fasted. Infuriated, he ate the rations in front of them. Later, he appreciated that by fasting, they preserved a feeling of continuity and pride.

Ornstein wrote about the significance of omnipotent fantasies throughout the life cycle, as a driving source for an individual's personality and creative expression (Ornstein 1997). He developed his ideas about the energizing force of omnipotent fantasy using clinical and personal examples. He described how, during the war, afraid he would die from hunger or the cold, or the artillery fire or the cruelty of the prison guards, his omnipotent and unrealistic fantasies fuelled his confidence that he could outsmart the slave labour system, outsmart the guards, and survive. Survival, Ornstein wrote, was random and improbable, but his omnipotent fantasies sustained his belief that he could take his fate into his own hands and it was up to him whether he survived or not. In slave labour, he imagined that although he was unwashed, he had lice and he was a Jew fleeing through land farmed by anti-Semitic peasants, he would charm a pretty farmer's daughter with his cleverness and daring and she would fall in love and hide him. Ornstein wrote that this fantasy was critical to even thinking of escape, because if he had nowhere to escape to, escape was futile (Ornstein 1997). Later, safe, he allowed that his fantasy of the farmer's daughter was preposterous, but while in slave labour, he focused on its possibility, and this motivated him to act. His unrealistic confidence, when his fellow inmates were numb, kept him vigilant and pushed him to exploit accidental openings for escape. When a possibility failed, he thought only of forging a better plan. One day in September 1944, the Axis armies on the Eastern Front panicked and fled into the Carpathian Mountains. Prisoners ran behind the troops heedless of the orders to shoot prisoners who did not stay and dig trenches, hoping to escape. Correctly, as it turned out, they feared the Soviet army as much as they feared the Axis armies. As they came under fire and ran, Paul forgot his jacket. In its pocket were photographs of his family and Anna. Paul and a friend stopped, crawled back 200 metres to the front line, under Katyusha rocket fire, and retrieved his photographs and his jacket. Twice he tried to escape from his slave labour battalion. In his third attempt, on a forced march with thousands of men to the Mauthausen concentration camp, he succeeded, and reached Budapest, still occupied by the Nazis.

During the siege of Budapest, he found refuge in the crowded basement of the Swiss Consulate annex, a former glassworks factory. He worked for the Zionist underground and brazenly walked about Budapest without a yellow star. Defying the curfew one day, he ran into a Nazi patrol and nearly lost his life. Within the relative safety of the Swiss Consulate, he realized, survival no longer demanded daring. With this jolt to his omnipotence, he admitted his vulnerability and forged a less heroic plan for survival: hiding. He could adjust his hubris. Paul said that although demeaned by the German and Hungarian Nazis, he never felt humiliated. In addition to his “omnipotent self-confidence,” he preserved his dignity and initiative because he felt an inner continuity with his life and values before slave labour. And he felt pride in being a Jew. After the war he was determined to pursue his pre-Holocaust dreams: move to Palestine, go to medical school, become a psychoanalyst and marry Anna, if she had survived.

When the Soviet army took over Hungary, he set out on foot for Hajdunanas to find his family and Anna. Arrested by Russian soldiers and forced to work, this time in a Soviet labour battalion, he escaped at night to his hometown. Strangers were living in his home. No one knew of his family or Anna. Earlier, he had heard how his sister had died in Budapest in an allied bombing raid. With few choices, he and a companion left for Romania where Paul enrolled at the University of Cluj Medical School. Six months after the end of the war, while in medical school in Cluj, he learned that his three younger brothers and mother were murdered in Auschwitz. In the same week, he received from Budapest two telegrams. One telegram was from his father, who had survived a six-month death march to Mauthausen (keeping a daily account in a tiny pocket diary now in the Holocaust Memorial Museum in Washington); the other telegram was from Anna, who had survived Auschwitz with her mother. Hiding in a freight train, he returned to Budapest.

Paul and Anna married in 1946. Paul began his second year of medical school at the University of Budapest as the Communists, backed by the Soviet Union, usurped power. They escaped to the West. Paul studied at the University of Munich for a year and then, with Anna, at the University of Heidelberg, where they studied medicine. Their classmates were defeated Nazis, some wearing their military pants or boots. Granted refugee visas to the United States in 1951, Paul relinquished his dream of living in Palestine. In America, few residency training programmes accepted immigrants, so they worked in hospitals in Delaware, New York, New Jersey and Massachusetts until the chair of psychiatry at the University of Cincinnati, Maurice Levine, a psychoanalyst, recruited them in 1955. They made Cincinnati their home.

As a psychiatric resident in Cincinnati in 1956, Paul met Michael and Enid Balint, beginning a relationship with them, first as a student, then as a colleague and friend. He described his relationship with Michael Balint as transformative. Michael Balint, originally Mihaly Bergsmann, was born in Hungary in 1896, an analysand and student of another Hungarian analyst, Sandor Ferenczi. He had trained with Bion and was president of the British Psychoanalytical Society. The Balints travelled from London to Cincinnati as Visiting Professors yearly from 1956 until Michael Balint's death in 1971. Balint's detailed descriptions of archaic transferences, using the imagery of his patients, intensified Paul's interest in psychoanalysis and prepared him, he said, for Kohut's conceptualization of selfobject transferences. Paul described an exhilarating six weeks in the Dolomite Mountains writing a book, with Michael and Enid Balint, in which they attempted, without sacrificing depth, to use basic principles of psychoanalysis for brief treatments. The result was Focal Psychotherapy: An Example of Applied Psychoanalysis, a book that stimulated interest in time-limited dynamic treatments (1972). Paul wrote, in his introduction to a reprint of Balint's Basic Fault, that he admired Balint as a teacher because he did not insist on teaching but instead encouraged learning and independent discovery, and this characterized his approach with patients (Ornstein 1992).

Paul met Heinz Kohut as a first-year candidate at the Chicago Institute for Psychoanalysis. Kohut taught a two-year theory course on Freud and ego psychology. While admiring Kohut's eloquence and erudition, Paul described his pedagogy, which discouraged discussion, as “dreadful.” Paul graduated from the Chicago Institute in 1966, 27 years after he decided to become a psychoanalyst at the age of 15. After graduation, he began a four-year supervision with Kohut. Paul was an original member of a group, along with Anna Ornstein, Arnold Goldberg, Michael Basch, Ernest Wolf, John Gedo and Paul and Marian Tolpin, organized by Heinz Kohut to develop his theory, later known as self psychology. Paul said that he recognized his disappointments in Kohut but also had a healthy idealization of him in the form of appreciation; he felt enriched by Kohut's contribution to his own learning and understanding. Paul also saw the need to clarify and reconceptualize Kohut's ideas. He observed that self psychology, never unified, inevitably pursued different directions.

I met Paul 34 years ago, when his daughter, Sharone, my future wife, brought me to a Seder at her parents’ home in Cincinnati. Her family celebrated Passover with Paul's closest childhood friend from Hajdunanas and his family. Their fathers had been friends and the two families have celebrated Passover together for 67 years. Paul read from the Haggadah in a fluent and sonorous Hebrew. He paused often to draw us into discussions or arguments. Early into my first visit, Paul gave me a tour of his library, where books from floor to ceiling and double rowed advanced out of his study, mounted the stairs onto the landing and spread into the second-floor hallways. I could see the Standard Edition, bound sets of the International Journal of Psychoanalysis, the Journal of the American Psychoanalytic Association, the Psychoanalytic Quarterly, numerous other journals, books in English, German, Hungarian and Hebrew, books by psychoanalysts of every persuasion, by philosophers, Jewish thinkers, literary critics, historians and novelists, among whom Dostoyevsky and Kafka had pride of place. It was a tour in-depth, because he enjoyed discussing the books I noticed and because I had to pull books out to see the books hidden in the second row and because he loved searching for a book he could triumphantly pull from a back row thanks to his personal system of cataloguing. He was a wonderful reader. Books engaged him personally and intellectually. If a book did not engage him, he wondered why this was so and whether the difficulty was with him or with its author. I bought the books he recommended. Soon, I noticed that after I talked about a book, the next time Sharone and I visited, it was on a shelf. We talked about many things but mostly about psychoanalysis. He picked up our conversations where we had left off. That he did this so naturally was intensely moving to me.

In 2000, at the age of 76, he retired from the University of Cincinnati College of Medicine where he had been Professor of Psychiatry and Professor of Psychoanalysis and moved to Boston, closer to his children and grandchildren. In Boston, he was a Lecturer in Psychiatry at Harvard Medical School and a Supervising Analyst at the Boston Psychoanalytic Institute. He continued to supervise and write. He conducted seminars on the works of Dostoyevsky and Kafka. It reminded him of the Rabbinical Seminary in Budapest when he and his classmates read Freud, Ferenczi and Reik.

When Paul arrived in the United States, he was diagnosed with idiopathic pulmonary fibrosis. This limited him in the last years of his life and worsened after a bronchial infection made him hypoxic. Recovering, he was aware he could no longer remember very well. Because of Paul's enduring sense of himself and his relationships with those close to him, and his remarkable optimism, he contended with this loss without bitterness or despair. At age 88, he stopped writing but he continued to read, literature and history, in English, Hungarian and German. He reread books that were meaningful to him but that he could not remember because, he said, he still understood and took pleasure in what he read. He said he wouldn't mind living to 100 if he could read and enjoy his family.

Near the end of his life, Paul said,

Psychoanalysis is more than a profession, and more than a set of ideas to aid us in the healing of the mental anguish and pain that create problems in living. It is a view of the world and of the self in depth. We cannot put on and take off our special “theoretical glasses” at will to see the inner world of our patients. These glasses become a part of us. We acquire a specific psychoanalytic view of the human condition mainly through the psychoanalytic transformations in our own selves. We can and should be ready to change our theories as new experiences demand it. However, these changes have to go hand in hand with a requisite internal change. Otherwise these remain a “mere technique” and not an emotionally meaningful part of a human interaction in which our “professional self” has to participate as fully as possible. (Ornstein and Epstein 2015, 152–3)