Some Dilemmas of Enactment in Clinical Decision-Making

Three clinical hours illustrate a few of the dilemmas that may arise as clinical decisions become shaped by the process of enactment. These dilemmas include: the experience of thinking and speaking from within the enactment; the role of the analyst's discomfort at being the recipient of the patient's transference; the effort to relieve that discomfort through interpretation; the fact that what the analyst chooses not to say is as much a part of the enactment as what is said and may have as much influence on the process of the analysis; the feeling of disingenuousness that can arise when our experience of ourselves matches the patient's negative experience of us; the question of whether psychic change can emerge from analyzing the ongoing process of enactment, despite its recursive nature.