Incorporation of an invasive object

On Reverie and Independence

The author presents a detailed clinical discussion of his work with a forty-year-old man and a ten-year-old boy in which he focuses on loss of self-object differentiation in the transference-countertransference experiences while he and these two patients were working with tyrannical internal objects (arising from in-tergenerationally transmitted trauma). In both of the analytic psychotherapies, the author experiences reveries in which a benevolent paternal figure lovingly supports a child's quest for independence. These reveries are of help to the therapist in recognizing, acknowledging, and accepting the need on the part of both patients to emancipate themselves from unconscious tyrannizing internal objects. The patients had previously experienced their need for emancipation as destructive to their parents and themselves, and consequently too dangerous to attempt.

Residues in the analyst of the patient's symbiotic connection at a somatic level: unrepresented states in the patient and analyst

This paper discusses the residues of a somatic countertransference that revealed its meaning several years after apparently successful analytic work had ended. Psychoanalytic and Jungian analytic ideas on primitive communication, dissociation and enactment are explored in the working through of a shared respiratory symptom between patient and analyst. Growth in the analyst was necessary so that the patient's communication at a somatic level could be understood. Bleger's concept that both the patient's and analyst's body are part of the setting was central in the working through.

Some Paths Towards Psychotic Alienation

In this paper I use the term alienation to describe the mind's detachment from psychic reality and its withdrawal into an alien world that leads to progressive dehumanization. In spite of this phenomenon having a psychodynamic nosography and descriptive models that effectively reveal it in detail, mental alienation is still mysterious and unsettling, especially when it manifests all of a sudden in clinical work. Alienating withdrawal into sensory fantasizing, which causes increasing loss of contact with human reality, is often preceded by a long period of time spent in a dissociated world that has gradually replaced psychic reality. However, prior to the human world being completely replaced by the alien world, both worlds coexisted for a considerable length of time in the patient's mind. My hypothesis is that the dissociation from psychic reality that underlies the future state of psychotic alienation occurs in psychic withdrawal that begins in infancy. This mental state is particularly obvious in small children who constantly live in a fantasy world.

On the Psychoanalytic Treatment of a Psychotic Breakdown

The author discusses the four-session-a-week psychoanalysis of a patient in psychotic breakdown with outbursts of violence. The analyst's first appearance in the transference was as a "rattle" (the noise made by his shifting in his chair), which constituted undeniable evidence of corporality--first the analyst's and then the patient's--leading eventually to the awareness of there being two separate persons in the psychoanalytic relationship. This case highlights the analyst's need to function in a particular way, and to allow him- or herself to be used in a particular way, in working with very disturbed patients, where issues of the body-mind relationship and of separation from the other are often central to the analytic work.

Orientations of psychotic activity in defensive pathological organizations

The author reviews some clinical experiences of the treatment of personality disordered patients suffering from internal domination of ego functioning by a defensive pathological organization. In particular, the function and purpose of perverse, sadistic attacks by the organization on the ego are considered and questions pertaining to technique are raised. It is suggested that different forms of sadistic, subjugating activity by pathological organizations may denote differences in intent borne of the type and severity of the psychopathology of the individual. Patients with severe narcissistic psychopathology for whom object contact has become associated with the arousal of intense psychotic anxieties seem more likely to be subjected to an invasive, annihilatory imperative by the pathological organization, the purpose of which appears to be to obliterate the experience of contact with any differentiated object, to avoid emotion and to use coercion to enforce a primitive identification by the ego with the psychotic organization in the mind. Certain patients with less severe narcissistic psychopathology, yet for whom object contact can also be associated with the arousal of psychotic anxieties due to intense or persistent conflict with the object, sometimes expressed as organized sadomasochistic clinging to a punishing and punished object (for example, in certain borderline or depressed patients) exhibit sadistic attacks that serve less to annihilate object contact and more to intrusively control and punish the object. Observations of these phenomena have been made by a number of psychoanalysts in recent decades and these contributions are discussed. This paper is addressed primarily to the implications for technique with such patients, particularly a need for triangulation of their experiences of oppression in order to loosen the controls over the ego by the pathological organization.