Commentary on Victoria Todd's paper. Saving the treatment: affect intolerance in a boy, his parents, the mental health community, and his analyst".

Ms. Todd's paper illustrates both the value of the analytic frame and the relevance of a flexible approach in response to the external reality. In this case, the impingement of the outside environment became an ongoing threat to the analysts thinking and to the development of a safe and predictable therapeutic relationship. Ms. Todd's narrative of Joey's threeand-a-half year analysis emphasizes the impact of external interference on the analyst's capacity to experience difficult affects with and for the patient. In addition, it highlights the importance of recognizing and working through one's countertransference resistance. This commentary focuses on Ms. Todd 's work with Joey, so I will only refer to her work with his parents and other providers as it is reflected in her analysis.MS. TODD BEGINS BY ESTABLISHING AS THE FOCUS OF HER PAPER THE impact of what she calls an "affect-intolerant society" on her work with a young child. Her narrative reflects a struggle to stay within the analytic frame while "translating" psychoanalytic understanding and technique to parents and other professionals. One can't help but wonder about the impact that having to constantly "defend" one's work has on one's ability to "stay with" the child's material as it relates to his internal world. As Ms. Todd's brave and honest paper illustrates, trying to stay with the "not knowing" when faced with a world that demands answers and quick fixes is a challenging and at times disheartening reality faced by the contemporary child analyst.My commentary will follow the process of the analysis from a developmental psychoanalytic perspective. I will reflect on moments of transition as well as on the impact of the objective anxiety experienced by Joey, which this paper beautifully describes. I will use Yorke and Wiseberg's 1976 paper on the elaboration of a developmental view of anxiety to guide my understanding of this case. Their paper describes a trajectory from the early somatic experiences to early psychic concomitant to psychic anxiety and finally to signal anxiety as the final outcome of this pathway, in summary, the child's forward developmental progression from the somatic to the psychic.Joey's mother's struggle with her own affects following the birth of her son, and mother and son's ongoing sleeping difficulties, both bring to mind Ms. Todd's comment about sleeping twelve hours per night and still feeling tired while working on this case. Her comment may reflect not only the overall level of affect intolerance in the system, specifically frustration tolerance, but also the high levels of uncontained anxiety and aggression projected onto both Joey and his analyst. Joey's progressive developmental strives and his willingness to explore difficult affects and conflicts in the context of his analytic relationship with Ms. Todd highlight both Joey's innate capacity to make use of a containing and helpful object and his therapist's capacity to survive and contain Joey's difficult affects.Anna Freud's (1963) concept of developmental lines was concerned with the interaction between ego and ego-superego development and their reaction to environmental influences. Joey's analysis is an excellent example of the "backwards and forwards" dynamic described by Anna Freud in the context of object relations and the influence of the environmental attributions and understanding of the child in this process. Ms. Todd's initial description of Joey's mother evokes the image of a highly anxious preoedipal caregiver who struggles to respond to her baby's needs in an attuned fashion. In the midst of external intrusion, Joey found in his relationship with his analyst an opportunity for repair. He was able to experience Ms. Todd as a new developmental object, one that was able to provide him with the experience of being kept in mind, and it served at first as the much-needed ego auxiliary for a little boy who seemingly struggled to move forward in the developmental line of anxiety. …