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Does Discussion of the SettingUnsettle Our Practice?: Replyto CommentaryIlana Laor M.A.Published online: 03 Jul 2008.

To cite this article: Ilana Laor M.A. (2007) Does Discussion of the Setting Unsettle OurPractice?: Reply to Commentary, Psychoanalytic Dialogues: The International Journalof Relational Perspectives, 17:1, 65-67, DOI: 10.1080/10481880701301139

To link to this article: http://dx.doi.org/10.1080/10481880701301139

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Does Discussion of the SettingUnsettle Our Practice?

Reply to Commentary

Ilana Laor, M.A.

In my reply to Susi Federici-Nebbiosi, I emphasize and elaborate on thepoints of agreement between us, as well as the points where our thinking dif-fers. My primary point of difference regards the suggestion that my acceptingYossi for short-term treatment was acquiescence to his request. This is onlypartially true. From his point of view, I offered him a treatment substantiallylonger than the one he wanted, thus I was agreeing and not agreeing to hisrequest simultaneously.

The main idea that I put forth in my paper is that we always construct oursetting together with our patients and that this is, in itself, a therapeutic fac-tor.I share Federici-Nebbiosi’s observation that the setting has undergone agreat deal more change in practice than is reflected in the literature, and thatthere is unease discussing the issue of setting. I offer some thoughts on thisand express the hope that the present exchange of ideas will lead to furtherdiscussion.

FIRST, I WOULD LIKE VERY MUCH TO THANK YOU, SUSI FEDERICI-NEBBIOSI,for your fascinating and thought-provoking discussion. You write,and this is my experience too, that in our dealings with this central

aspect of our work, the therapeutic setting, there is a significant gap be-tween clinical proceedings and the little that has been written on thesubject. You link the scanty discussion regarding this subject to fear ofexposure, our own exposure of how we work and exposure as a profession ofthe changes we are undergoing. These are interesting questions, but theystill leave unanswered the questions regarding the difficulties discussing thesetting and its evolvement alongside the evolvement of our clinical andtheoretical thinking. I would like to continue to open these questions up todiscussion. What is it about talking about the setting that is more revealingthan other aspects about which it is easier to conduct theoretical andclinical discussion, such as changes in the concept of interpretation,

65 © 2007 The Analytic Press, Inc.

Psychoanalytic Dialogues, 17(1): 65–67, 2007

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changes in the position of the therapist from neutrality to involvement, andso on?

I liked the way you replace polarized thinking about stability as opposedto flexibility with a dialectic of flexibility and stability. Indeed, despite theconflictual examples that I present, the central claim in my work and, in myopinion, in Bass’s work too, is that the setting is constructed mutually bythe analyst and the patient, even in cases where this is almost invisible (e.g.,in cases where the patient accepts the setting without question). That is,even in cases where on the surface it appears that the frame that the analystoffers supposedly fits the picture, the main question is how it was mutuallyconstructed and how we will look at this mutual construction in a way thatfacilitates extension of the therapeutic space.

I further emphasize a particular aspect of the second example, whichperhaps was insufficiently highlighted. Yossi requests brief treatment, andwhen I ask about the length of the treatment, he answers three or four ses-sions. In this example, as in the case of Dafna, it was not possible for me toquestion myself more deeply what could, should, would be the right thing todo, I had to respond. My response was not to acquiesce, as you write. Set-ting 3 months of treatment (as I suggested) instead of three sessions (as hesuggested) was, from Yossi’s point of view, a dramatic difference that he didnot entirely accept and that he continued to struggle with throughout thetreatment. However, here too reality is not dichotomous, because on onehand I did not agree to the length of time he set, but I did agree to the treat-ment being brief and time constrained, that is, I simultaneously acquiescedand did not acquiesce.

I agree with the substantial difference between the negotiation in the caseof Dafna and that with Yossi. The negotiation with Yossi is at the beginning ofthe therapy and, as I see it, introduces the question of mutual recognition. Ismutual recognitionadimensionthatdevelops in thecourseof therapy,orcanitalsobeseenat thebeginningof therapy? Inmyestimation, in theexampleofYossi, a meeting of mutual recognition was created from the outset. From thebeginning of therapy, we were two participants who were prepared, in oneway or another, to enter into a negotiation that enabled each of us to meet theotherness of the other, as well as the question of whether it is possible that onesubjectivity will not erase the other but rather enable an open space for playand observation. Is it possible that the idea that mutual recognition is poten-tiallypresent intherapy fromthebeginningwhatmakes talkingabout theset-ting a particularly revealing experience?

I consider the question that you raise regarding the training of profes-sionals a particularly important one. What allows the young therapist more

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freedom and what enables him or her to face the patient more confidently?It is my experience that young professionals have difficulty internalizing themeaning of the setting; it is sometimes easier for them to rigidly adhere to it,and sometimes it is easier to move. Why is it more difficult to internalize theissue of setting than subjects like interpretation and self-disclosure? Thuswe return to the original question of what it is about this subject that makesit so difficult to talk about.

As I think about my response to you, it occurs to me that the subject ofthe therapeutic setting touches on the question of our professional author-ity on one hand, and the question of our professional and financial exis-tence, both as a profession and as individuals. The question of the setting,therefore, has a different standing than other subjects that are supposedlywithin the frame—Bass’s metaphor—or within the house—my metaphor:interpretation, self-disclosure, enactment, and so on. (I resume the dichot-omous division for practical purposes only.) You propose a spatial metaphorof setting as an airport. The airport is both a personal place of meeting and aplace of meeting between cultures, nationalities, and customs. This meet-ing is difficult to put into words, but our discussing it perpetuates its facilita-tion and points, I hope, to the possibility of developing a dialogue that isintrapersonal and interpersonal, that touches on our professional develop-ment and the analytic traditions on which we were raised, as well asintercultural issues.

Thank you once again for the fascinating discussion that enables furtherdialogue and thought.

37 Burla StreetTel Aviv, 69364Israelilanala@netvision.net.il

Reply to Commentary 67

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