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PubMed1995

Concern: spurious or real.

This paper is about a group of patients who appear to show excessive concern for their objects, reflecting a combination of a real wish for reparation alongside an attitude of hostility and superiority towards the object. Detailed clinical examples from two patients are used to illustrate a certain combination of characterological defences in these patients who have been severely deprived, and overcompensate for this experienced deprivation by the expression of excessive concern for an object that is simultaneously experienced as hostile and frustrating. Side by side with the partial achievement of the depressive position there is an early 'take over' of the breast, in which the infant 'becomes' the breast and shows behaviour which is in part a fake of a very concerned mother. The paper includes a discussion of some of the technical problems in dealing with such patients, and stresses the need for distinguishing between what is real and what is false; it suggests that what is required is a balanced or 'two handed' approach, in which there is firm handling of the manic or pretentious 'take over' together with a sympathetic understanding of the underlying vulnerability of these patients.

Adult↗

PubMed1985

Working through in the countertransference.

This paper is intended as a development of Strachey's classic paper 'The nature of the therapeutic action of psycho-analysis'. Strachey states that the full or deep transference experience is disturbing to the analyst; that which the analyst most fears and most wishes to avoid. He also stresses that conveying an interpretation in a calm way is necessary. The area addressed is the task of coping with these strong countertransference experiences and maintaining the analytic technique of interpretation. The clinical illustrations attempt to show something of the process of transformation or working through in the analyst, as well as showing that the patient is consciously or unconsciously mindful as to whether the analyst evades or meets the issues. The contention that the analyst is not affected by these experiences is both false and would convey to the patient that his plight, pain and behaviour are emotionally ignored by the analyst. It is suggested that if we keep emotions out, we are in danger of keeping out the love which mitigates the hatred, allowing the so-called pursuit of truth to be governed by hatred. What appears as dispassionate may contain the murder of love and concern. How the analyst allows himself to have the experiences, work through and transform them into a useful interpretation is the issue studied in this paper.

Child Development↗