The profession of ferryman: considerations on the analyst's internal attitude in consultation and in referral

Psychoanalytic consultation is an interview with a patient who will not be taken in treatment by the consultant analyst, but who will be sent to another, perhaps specifically chosen, colleague after one or more assessment sessions. This practice is becoming increasingly important since, besides traditional private relationships between consultant and patient, it is now common in many specialized centres affiliated to official psychoanalytical institutions. The author explores some fundamental aspects of the analyst's internal attitude in consultation: motivation to know; a 'concave' attitude to listening; responsibility in proposing suitable technical choices and referral to a further specialist; empathy and partial identification; the balance between authentic experience in the consultation and risks of seduction; internal links within the community of colleagues; the technique for sending patients on. He presents a clinical example, specifically aimed at reproducing the internal attitude of the analyst, together with the necessary work that allows a difficult patient to initiate psychoanalytic treatment.