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Although there are increasing numbers of disciplined observations and studies about the dying patient, the question remains as to whether they have been read and put into practice. This paper reports on a current study aimed at exploring how physicians actually work with patients suffering from fatal illnesses. Responding to a questionnaire on their methods of managing dying patients were 59 internists, 76 surgeons, 25 gynecologists, 13 general practitioners and 5 psychiatrists. Sixty-six percent of the physicians said they sometimes inform patients of a malignancy, 25 percent said they always tell the patient, and only 9 percent said they never tell the patient. The fact that very few physicians apparently feel justified in saying they never inform a patient about a fatal diagnosis is in itself a modification of previous practice. However, judging from answers to other questions, it is the author's impression that in actual practice many physicians tend to resist informing their patients of the diagnosis in a direct manner and are inclined to be quite selective in informing only those patients described as self-reliant, independent and able to face reality.

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The subtitle of Donnel Stern ' s new book includes the essential concepts that constitute his view of what he calls the " relational-dissociative " school of psychoanalysis. Unformulated experience, dissociation and enactment are his terms of engagement that substitute for the classical analytic terminology of unconscious, defense and resistance.Going beyond terminology what he offers the psychoanalytic reader in this complex and challenging volume is nothing less than a new and different version of psychoanalysis in terms that encompass both theory and technique. While it is hardly unusual to fi nd a relational school analyst like Stern moving away from the spirit, terminology and technique of classical psychoanalysis the elaborated content of his approach contains elements that are both surprising and controversial even for those analysts who are either partially or completely relational in their approach to clinical work.As is the case with relational psychoanalysts, Stern, advocates for a less authoritarian stance on the analyst ' s part. It is important to him that an analyst accept that she (Stern refers to the analyst as " she throughout the book " ) is uncertain, even confused about both what she is looking for in the patient, hence, the process must be spontaneous to allow for a creative process to occur in which the analyst and patient together are able to fi nd new understanding. This is his message that is expressed as " partners in thought " a phrase meant to indicate that the content of an analysis is co-constructed by both the analyst and patient. He adds to this the awareness that the context for determining content is always the analytic dyad. The ideal dyad, in Stern ' s view, is one that depends heavily upon negotiation. In order to support his concept of negotiation, Stern turns fi rst to the philosopher Gadamer and his rules of conversation. Gadamer ' s philosophy of conversation in Stern ' s synopsis of it includes an insistence that the listener must submerge his own perspective or self in order to understand that of the other.Stern ignores or at least underplays the signifi cance of turning to Gadamer to justify the shift in analytic perspective that negotiating to truth or reality in analysis involves. Unlike Kohut who made a similar shift to a position of empathic listening and immersion on the basis of his clinical experience, Stern appears to be appealing to the authority of a philosopher who is refl ecting on the nature of communication in a more general setting than that involved in analysis. The ability to hear the other person ' s communication over one ' s own thoughts, opinions and feelings may be more applicable in diplomatic negotiations than in the consulting room. While the stance, frequently found in classical analysis, that elevates the analyst ' s assertion of what the patient is really experiencing is obviously unpleasant and often defeating