casement - some pressures on the analyst

8/10/2019 Casement - Some Pressures on the Analyst

http://slidepdf.com/reader/full/casement-some-pressures-on-the-analyst 1/9

NUMAI PENTRU UZ INTERN ACPPB NU SE DIFUZEAZA IN AFARA ACPPB

Casement, P.J. (1982). Some Pressures on the Analyst for Physical Contact During the e!"i#...$nt. . Psycho!Anal., 9%2&9!28'.

(1982). $nternational e#ie of Psycho!Analysis, 9: 2&9!28'Some Pressures on the Analyst for Physical Contact During the Re-Living of an EarlyTrauma

Patrick J. Casement

$s hysical contact ith the atient, e#en of a to*en *in+, al ays to e reclu+e+ ithout-uestion un+er the classical rule of a stinence /r are there some occasions hen this might ea ro riate, e#en necessary, as 0argaret "ittle has suggeste+ in relation to e iso+es of +elusionaltransference ( 9!"#( 9!$# or as alint an+ innicott ha#e illustrate+ in relation to erio+s of +eeregression (e%g% &alint' 9! # (19'8) ()innicott' 9!*a# , ( 9+,a# .

$ shall resent a clinical se-uence +uring hich the ossi ility of hysical contact as

a roache+ as an o en issue. 3here seeme+ to e a case for allo ing a atient the ossi ility of hol+ing my han+. 3he +ecision to reconsi+er this as arri#e+ at from listening to the atient an+from follo ing closely the a#aila le cues from the countertransference. 3he clinical materialclearly illustrates some of the issues in#ol#e+ in this +ecision.

3he atient, hom $ shall call 0rs , is in her 45s. She ha+ een in analysis a out 26 years. Ason ha+ een orn +uring the secon+ year of the analysis.

hen she as 11 months ol+ 0rs ha+ een se#erely scal+e+, ha#ing ulle+ oiling ater onto herself hile her mother as out of the room. She coul+ ha#e +ie+ from the urns. hen sheas 1& months ol+ she ha+ to e o erate+ on to release gro ing s*in from the +ea+ scar tissue.3he o eration as +one un+er a local anaesthetic. During this the mother ha+ fainte+. ($t isrele#ant to the chil+hoo+history that the father as largely a sent +uring the first fi#e years.)

Soon after the summer holi+ay 0rs resente+ the follo ing +ream.She ha+ een trying to fee+ a +es airing chil+. 3he chil+ as stan+ing an+ as a out 15 monthsol+. $t asn7t clear hether the chil+ as a oy or a girl.

0rs on+ere+ a out the age of the chil+. er son as soon to e 15 months ol+. e asno a le to stan+. She too oul+ ha#e een stan+ing at 15 months. (3hat oul+ ha#e een eforethe acci+ent.) hy as the chil+ in her +ream so +es airing, she as*e+. er son is a li#ely chil+an+ she assume+ that she too ha+ een a normal ha y chil+ until the acci+ent. 3his rom te+ meto recall ho 0rs ha+ clung to an i+eali e+ #ie of her re!acci+ent chil+hoo+. $ thought sheas no +aring to -uestion this. $ therefore commente+ that may e she as eginning to on+er a out the time efore the acci+ent. Perha s not e#erything ha+ een -uite so ha y as she ha+

al ays nee+e+ to assume. She imme+iately hel+ u her han+ to signal me to sto .During the follo ing silence $ on+ere+ hy there as this resent an:iety. as it the

atient7s nee+ still not to loo* at anything from efore the acci+ent unless it as seen as erfectas the acci+ent itself eing use+ as a screen memory $ thought this ro a le. After a hile $sai+ that she seeme+ to e afrai+ of fin+ing any element of a+ e: erience +uring the time eforethe acci+ent, as if she still felt that the goo+ that ha+ een there efore must e *e t entirelyse arate from the a+ that ha+ follo e+. She listene+ in silence, ma*ing no erce ti le res onse+uring the rest of the session.

http://www.pep-web.org/search.php?volume=9&journal=irp


http://www.pep-web.org/toc.php?journal=irp&volume=9#p0279


http://www.pep-web.org/search.php?author=%22Casement%2C+P.J.%22




http://www.pep-web.org/search.php?author=%22Casement%2C+P.J.%22




3he ne:t +ay 0rs came to her session ith a loo* of terror on her face. ;or this session, an+the fi#e sessions follo ing, she coul+ not lie on the

<<<<<<<<<<<<<

Presente+ at the 42n+ $nternational Psychoanalytical Congress, elsin*i, July 1981(0.S. recei#e+ A ril 1981)Co yright = Patric* J. Casement

couch. She e: laine+ that hen $ ha+ gone on tal*ing, after she ha+ signalle+ me to sto , thecouch ha+ 7 ecome7 the o erating ta le ith me as the surgeon, ho ha+ gone on o eratingregar+less, after her mother ha+ fainte+. She no coul+n7t lie +o n 7 ecause the e: erience illgo on7. >othing coul+ sto it then, she felt sure.

$n one of these sitting!u sessions 0rs sho e+ me a hotogra h of her holi+ay house, uiltinto the si+e of a mountain ith high retaining alls. She stresse+ ho essential these alls are tohol+ the house from falling. She as afrai+ of falling for e#er. She felt this ha+ ha ene+ to her after her mother ha+ fainte+.

( ere $ shoul+ mention that 0rs ha+ re#iously recalle+ thin*ing that her mother ha+ +ie+,hen she ha+ fallen out of her sight +uring the o eration, an+ ho she ha+ felt that she as leftalone ith no one to rotect her from the surgeon ho seeme+ to e a out to *ill her ith his*nife.) >o , in this session, 0rs tol+ me a +etail of that e: erience hich she ha+ ne#er mentione+ efore. At the start of the o eration her mother ha+ een hol+ing her han+s in hers, an+0rs remem ere+ her terror u on fin+ing her mother7s han+s sli ing out of hers as she fainte+an+ +isa eare+. She no thought she ha+ een trying to re!fin+ her mother7s han+s e#er since,an+ she egan to stress the im ortance of hysical contact for her. She sai+ she coul+n7t lie +o non the couch again unless she *ne she coul+, if necessary, hol+ my han+ in or+er to get throughthe re!li#ing of the o eration e: erience. oul+ $ allo this or oul+ $ refuse $f $ refuse+ sheasn7t sure that she coul+ continue ith her analysis.

0y initial res onse as to ac*no le+ge to her that she nee+e+ me to e 7in touch7 ith theintensity of her an:iety. o e#er, she insiste+ that she ha+ to *no hether or not $ oul+actually allo her to hol+ her han+. $ felt un+er increase+ ressure +ue to this eing near the en+of a ;ri+ay session, an+ $ as eginning to fear that the atient might in+ee+ lea#e the analysis.0y ne:t comment as +efensi#ely e-ui#ocal. $ sai+ that some analysts oul+ not contem lateallo ing this, ut $ reali e+ that she might nee+ to ha#e the ossi ility of hol+ing my han+ if itseeme+ to e the only ay for her to get through this e: erience. She sho e+ some relief u on

my saying this./#er the ee*!en+ $ re#ie e+ the im lications of this ossi ility of the atient hol+ing myhan+. hile reflecting u on my countertransference aroun+ this issue $ came to recogni e thefollo ing *ey oints% (1) $ as in effect offering to e the 7 etter mother7 ho oul+ remainhol+ing her han+, in contrast to the actual mother ho ha+ not een a le to ear hat asha ening. (2) 0y offer ha+ een artly moti#ate+ y my fear of losing this atient, hich ases ecially threatening to me ?ust then as $ as a out to resent a a er on this atient to our Society. (4) $f $ ere to hol+ this atient7s han+ it oul+ almost certainly not, as she assume+, hel




her to get through a re!e: eriencing of the original trauma. (A central factor of this ha+ een theabsence of her mother7s han+s.) $t oul+ instea+ amount to a y! assing of this as ect of thetrauma, an+ coul+ reinforce the atient7s erce tion of this as something too terri le e#er fully to

e remem ere+ or to e e: erience+. $ therefore +eci+e+ that $ must re#ie ith the atient theim lications of this offer as soon as $ ha+ an o ortunity to +o so.

/n the Sun+ay $ recei#e+ a han+!+eli#ere+ letter in hich the atient sai+ she ha+ ha+ another +ream of the +es airing chil+, ut this time there ere signs of ho e.3he chil+ as cra ling to ar+s a motionless figure ith the e:cite+ e: ectation of reaching thisfigure.

/n the 0on+ay, although she as some hat reassure+ y her +ream, 0rs remaine+ sittingon the couch. She sa the central figure as me re resenting her missing mother. She also stresse+that she ha+n7t ante+ me to ha#e to ait to *no a out the +ream. $ inter rete+ her fear that $might not ha#e een a le to ait to e reassure+, an+ she agree+. She ha+ een afrai+ that $ mightha#e colla se+ o#er the ee*!en+, un+er the

<<<<<<<<<<<<<

17;alling for e#er7 is referre+ to y innicott as one of the 7unthin*a le an:ieties7 along ith7going to ieces7, 7ha#ing no relationshi to the o+y7 an+ 7ha#ing no orientation7 ( 9+ , . @8).2At the time $ as thin*ing that this offer of the ossi ility of hol+ing my han+ might, in issler7s( 9!,# terms, e a ermissi le 7 arameter7.eight of the ;ri+ay session, if $ ha+ een left until 0on+ay ithout *no ing that she as

eginning to feel more ho eful.As this session continue+, hat emerge+ as a clear im ression that 0rs as seeing the

ossi ility of hol+ing my han+ as a 7short!cut7 to feeling safer. She ante+ me to e the motionlessfigure, controlle+ y her an+ not allo e+ to mo#e, to ar+s hom she coul+ cra l ith the e:cite+e: ectation that she oul+ e#entually e allo e+ to touch me. 0rs then re orte+ an image,hich as a continuation in the session of the ritten +ream. She sa the +ream!chil+ reachingthe central figure, ut as she touche+ this it ha+ crum le+ an+ colla se+. ith this cue as my lea+$ tol+ her that $ ha+ thought #ery carefully a out this, an+ $ ha+ come to the conclusion that thistentati#e offer of my han+ might ha#e a eare+ to ro#i+e a ay of getting through the e: erienceshe as so terrifie+ of, ut $ no reali e+ that it oul+ instea+ ecome a si+e!ste ing of thate: erience as it ha+ een rather than a li#ing through it. $ *ne that if $ seeme+ to e in#iting ana#oi+ance of this central as ect of the original e: erience $ oul+ e failing her as her analyst. $therefore +i+ not thin* that $ shoul+ lea#e the ossi ility of hol+ing my han+ still o en to her. 0rs loo*e+ stunne+. She as*e+ me if $ reali e+ hat $ ha+ ?ust +one. $ ha+ ta*en my han+ a ay fromher ?ust as her mother ha+, an+ she imme+iately assume+ that this must e ecause $ too coul+n7t

ear to remain in touch ith hat she as going through. >othing $ sai+ coul+ alter her assum tion that $ as afrai+ to let her touch me.

3he follo ing +ay the atient7s res onse to hat $ ha+ sai+ as +e#astating. Still sitting on thecouch she tol+ me that her left arm (the one nearest to me) as 7steaming7. $ ha+ urne+ her. Shecoul+n7t acce t any inter retation from me. /nly a real hysical res onse from me coul+ +oanything a out it. She ante+ to sto her analysis to get a ay from hat as ha ening to her inher sessions. She coul+ ne#er trust me again. $ trie+ to inter ret that her trust in her mother, hich




ha+ in a fragile ay een restore+ after the acci+ent, seeme+ to ha#e een finally ro*en after her mother ha+ fainte+. $t as this ultimate reach of her trust in her mother that ha+ got in the ay of her su se-uent relationshi to her. $ felt it as this that she as no in the rocess of re!enactingith me in or+er to fin+ that this unresol#e+ reach of trust coul+ e re aire+. She listene+ to this,an+ as no++ing un+erstan+ing, ut she re eate+ that it as im ossi le to re air.

3he follo ing +ay 0rs rage+ at me still for hat she sa as my ith+ra ing from her. 3he ossi ility of hol+ing my han+ ha+ een the same to her as actual hol+ing. She felt sure she oul+not ha#e a use+ the offer. $t ha+ een #itally im ortant to her that $ ha+ een re are+ to allothis, ut my change of min+ ha+ ecome to her a real +ro ing a ay of the han+ she nee+e+ tohol+ on to. 3o her $ as no her mother ho ha+ ecome afrai+. er arm seeme+ to e on fire. 3oher $ as afrai+ of eing urne+ too.

0rs tol+ me that the re#ious +ay, imme+iately after her session ith me, she ha+ ecome7fully suici+al7. She ha+ only got out of this y as*ing a frien+ if she coul+ go roun+ to see her, atany time, if she felt that she coul+n7t carry on. She ha+n7t ultimately nee+e+ to see her frien+. $tha+ een her frien+7s a#aila ility hich ha+ re#ente+ her from *illing herself. She then re u*e+me ith the fact that her frien+ coul+ get it right. hy coul+n7t $ $ tol+ her that she +i+ not nee+from me hat she coul+ get from others. She nee+e+ something +ifferent from me. She nee+e+ menot to uy off her anger y offering to e the 7 etter mother7. $t as im ortant that $ shoul+ not eafrai+ of her anger, or of her +es air, in or+er that $ stay ith her throughout the re!li#e+e: erience of no longer ha#ing her mother7s han+s to hol+ on to. She nee+e+ me to remain analystrather than ha#e me as a 7 reten+7 mother. $t as also crucial that $ +o nothing that coul+ suggestthat $ nee+e+ to rotect myself from hat she as e: eriencing or as feeling to ar+s me. Shelistene+ an+ ecame calmer. 3hen, momentarily efore lea#ing the session, she lay +o n on thecouch. She thus resume+ the lying osition.

$ shall no summari e the ne:t t o ee*s. 0rs +reame+ of

eing lost an+ unsafe amongst a strange eo le ith hom she coul+ not fin+ a commonlanguage.$ inter rete+ her an:iety as to hether $ coul+ fin+ a common language ith her. $n one

session she ha+ a #isual image of a chil+ crying stone tears, hich $ inter rete+ as the tears of a etrifie+ chil+ (herself). She +reame+ of a a y eing +ro e+ an+ left to +ie.

She +reame+ of eing #ery small an+ eing +enie+ the only foo+ she ante+. $t as there ut a tall erson oul+not let her ha#e it.

$n another +ream she was in terror anticipating some kind of explosion.

3hroughout this she ersiste+ in her con#iction that she coul+ ne#er trust me again, an+ shee: erience+ me as afrai+ of her. Alongsi+e this she tol+ me that her hus an+ ha+ ecome #erysu orting of her continuing her analysis, e#en though he as getting a lot of 7*ic*! ac*7 from it.3his as -uite ne . $ inter rete+ that at some le#el she as ecoming more a are of me as a le tota*e the *ic*! ac* from her, in her analysis.

Shortly after this 0rs re orte+ the follo ing t o +reams in the same session. $n the firstshe as ta*ing a chil+ e#ery +ay to meet her mother to get some or+er into the chaos,




hich $ inter rete+ as her ringing her chil+!self to me in or+er to or* through the chaos of her feelings to ar+s me as the mother she still coul+n7t trust. She agree+ ith this ut a++e+ thatshe +i+n7t ring the chil+ to me y the han+. She ha+ to +rag her chil+!self y the hair. $n thesecon+ +reamshe as falling through the air, con#ince+ that she as going to +ie +es ite the fact that she ashel+ y a arachute ith a helico ter atching o#er her.

She coul+ see the contra+ictions (sure of +ying hilst actually eing safe) ut this +i+ not stoher feeling terrifie+ in the +ream, an+ still terrifie+ of me in the session. She stresse+ that she+i+n7t *no if $ reali e+ that she as still feeling sure that she as +ying insi+e.

/n the follo ing 0on+ay 0rs tol+ me that she ha+ +reame+ thatshe ha+ come for her last session as she coul+n7t go on. She ha+ egun falling for e#er, the couchan+ the room falling ith her. 3here as no ottom an+ no en+ to it.

3he ne:t +ay the atient felt that she as going insane. She ha+ +reame+there as a sheet of glass et een herself an+ me so that she coul+n7t touch me or see me clearly.$t as li*e a car in+!screen ith no i ers in a storm.

$ inter rete+ her ina ility to feel that $ coul+ get in touch ith hat she as feeling, ecause of the arrier et een her an+ me create+ y the storm of her feelings insi+e her. 3his re#ente+ her seeing me clearly, ?ust as it ha+ ith her mother. She agree+ an+ colla se+ into uncontrolle+crying, t isting on the couch, torture+ ith ain. At the en+ of this session she ecame anic*e+that $ oul+n7t e a le to tolerate ha#ing e: erience+ this +egree of her +istress.

/n the ;ri+ay she s o*e of a ne or*er in her office. She ha+ as*e+ him ho long he ha+ een traine+. She then reali e+ that she as as*ing him for his cre+entials. $ inter rete+ her an:iety a out my cre+entials an+ hether $ ha+ the necessary e: erience to e a le to see her through. $ a++e+ that may e she use+ the or+ 7cre+entials7 ecause of the allusion to 7 elie#e7.

She re lie+ 7/f course, cre+o7. She sai+ that she ante+ to elie#e that $ coul+ see her through, an+to trust me, ut she still coul+n7t.3he ne:t ee* 0rs continue+ to say that she +i+n7t thin* she coul+ go on. She ha+ ha+

many terri le +reams o#er the ee*!en+. 3he follo ing +ay she again sat u for the session. ;or much of this session she seeme+ to e -uite +elu+e+. Aareness of reality as fleeting an+tenuous. ;or the greater art of the session she as a chil+. She egan y saying she +i+n7t ?usttal* to her a y, she ic*s him u an+ hol+s him. 3hen, loo*ing straight at me she sai+ 7$ am a

a y an+ you are the erson $ nee+ to e my mother. $ nee+ you to reali e this, ecause unless youare re are+ to hol+ me $ cannot go on. Bou ha#e got to un+erstan+ this7. She as utting meun+er immense ressure. ;inally she stare+ accusingly at me an+ sai+ 7Bou are my mother an+ youare not hol+ing me7.

3hroughout this $ as a are of the +elusional -uality of her erce tion of me. , $n this sessionthere as little 7as if7 sense left in her e: erience of me, an+ at times there seeme+ to e none. $tas meaningless to her hen $ attem te+ to inter ret this as transference, as a re!li#ing of her chil+hoo+ e: erience. >ot only as $ the mother ho as not hol+ing her, in her terror of me $ha+ also ecome the surgeon ith a *nife in his han+ ho seeme+ to e a out to *ill her. At this

oint there seeme+ to e no remaining contact ith me as analyst.$ reflecte+ u on my +ilemma. $f $ +i+ not gi#e in to her +eman+s $ might lose the atient, or

she might really go sychotic an+ nee+ to e hos itali e+. $f $ did gi#e in to her $ oul+ e




collu+ing ith her +elusional erce tion of me, an+ the a#oi+e+ elements of the trauma coul+ ecome enca sulate+ as too terri le e#er to

<<<<<<<<<<<<<

4$ no un+erstan+ this in terms of the sychic imme+iacy of the transference e: erience.

confront. $ felt lace+ in an im ossi le osition. o e#er, once $ came to recogni e the ro?ecti#ei+entification rocess o erating here $ egan to surface from this feeling of com lete hel lessness.3his ena le+ me e#entually to inter ret from my countertransference feelings. ery slo ly, an+ith auses to chec* that the atient as follo ing me, $ sai+ to her 7Bou are ma*ing mee: erience in myself the sense of +es air, an+ the im ossi ility of going on, that you are feeling. $am a are of eing in hat feels to me li*e a total ara+o:. $n one sense $ am feeling that it isim ossi le to reach you ?ust no , an+ yet in another sense $ feel that my telling you this may ethe only ay $ can reach you7. She follo e+ hat $ as saying #ery carefully, an+ slightly no++e+

her hea+. $ continue+, 7Similarly $ feel as if it coul+ e im ossi le to go on, an+ yet $ feel that theonly ay $ can hel you through this is y my eing re are+ to tolerate hat you are ma*ing mefeel, an+ going on7. After a long silence 0rs egan to s ea* to me again as analyst. She sai+ 7;or the first time $ can elie#e you, that you are in touch ith hat $ ha#e een feeling, an+ hat is soama ing is that you can ear it7. $ as then a le to inter ret to her that her +es erate ish for me tolet her touch me ha+ een her ay of letting me *no that she nee+e+ me to e really in touchith hat she as going through. 3his time she coul+ agree. She remaine+ in silence for the last15 minutes of this session, an+ $ sense+ that it as im ortant that $ shoul+ +o nothing to interru tthis in any ay.

3he follo ing +ay 0rs tol+ me hat ha+ een ha ening +uring that silence. She ha+ eena le to smell her mother7s resence, an+ she ha+ felt her mother7s han+s again hol+ing hers. Shefelt that it as her mother from efore the fainting that she ha+ got in touch ith, as she ha+ ne#er felt hel+ li*e that since then. $ commente+ that she ha+ een a le to fin+ the internal mother thatshe ha+ lost touch ith, as +istinct from the 7 reten+7 mother she ha+ een anting me to ecome.e coul+ no see that if $ ha+ agree+ to hol+ her hysically it oul+ ha#e een a ay of shuttingoff hat she as e: eriencing, not only for her ut also for me, as if $ really coul+n7t ear toremain ith her through this. She imme+iately recogni e+ the im lications of hat $ as sayingan+ re lie+, 7Bes. Bou oul+ ha#e ecome a colla se+ analyst. $ coul+ not reali e it at the time ut$ can no see that you oul+ then ha#e ecome the same as my mother ho fainte+. $ am so gla+you +i+n7t let that ha en7.

3o conclu+e $ ill summari e art of the last session in this ee*. 0rs ha+ o*en feeling

ha y an+ ha+ later foun+ herself singing e:tracts from the / era 'Der Freischütz' , the lot of hich (she e: laine+) inclu+es the trium h of light o#er +ar*ness. She ha+ also +reame+ thatshe as in a car hich ha+ got out of control ha#ing ta*en on a life of its o n. 3he car crashe+into a arrier hich ha+ re#ente+ her from running into the on!coming traffic. 3he arrier ha+sa#e+ her ecause it ha+ remaine+ firm. $f it ha+ colla se+ she oul+ ha#e een *ille+.

She sho e+ great relief that $ ha+ ithstoo+ her angry +eman+s. 0y remaining firm ha+ eena le to sto the rocess hich ha+ ta*en on a life of its o n, +uring hich she ha+ felt com letelyout of control. 3he same +ream en+e+ ith




the atient reaching out to safety through the car in+screen hich ha+ o ene+ to her li*e t oglass +oors.

D SC.SS /0

3his case illustrates the inter lay et een the #arious +ynamics o erating. 0y initial offer of ossi le hysical contact as, ara+o:ically, tantamount to the countertransference ith+ra alhich the atient later attri ute+ to me in my +ecision not to lea#e this offer of that easier o tiono en to her. $n terms of ion7s ( 9+ # conce t of 7a ro?ecti#e!i+entification!re?ecting!o ?ect7 thecountertransference here ecame the container's ear o the contained! A further com licating

ressure came from the fact that $ as shortly to resent a a er on this atient to our Society, an+$ as genuinely afrai+ of eing e: ose+ there as ha#ing faile+ ha+ my atient left the analysis, or ha+ she nee+e+ to e hos itali e+, ?ust rior to my resenting that a er concerning her. yoffering the ossi ility of the atient hol+ing my han+ $ as in effect see*ing to lessen these ris*sto myself, an+ this is an e:am le of ac*er7s ( 9+$# conce t of indirect co"ntertrans erence , inthat my res onse to the atient here as eing influence+ y some +egree of ersecutory

su erego eing ro?ecte+ y me on to my rofessional colleagues.3he resulting se-uence can e un+erstoo+ in the interactional terms of San+ler7s ( 9"+#

conce t of ro#e$res%onsi&eness or in terms of innicott7s +escri tion of the atient7s nee+ to ea le to e: erience in the resent, in relation to a real situation et een atient an+ analyst, thee:tremes of feeling hich elonge+ to an early traumatic e: erience ut hich ha+ een 7fro en7

ecause of eing too intense for the rimiti#e ego to encom ass at that ti e ()innicott' 9!*1# ,( 9+,1# . (See also )innicott' 9"2# . 3here ha+ come to e a real issue et een this atient an+me, in the ith+ra al of my earlier offer of the ossi ility of hol+ing my han+. $n using this tore resent the central element of the original trauma the atient entere+ into an intensely reale: erience of the ast as she ha+ ercei#e+ it. $n so +oing she as a le, as it ere, to 7?oin u ith7her o n feelings, no unfro en an+ a#aila le to her. 3he re resse+ ast ecame, in the resent, aconscious sychic reality from hich (this time) she +i+ not ha#e +efensi#ely to e sychicallya sent. During this $ ha+ to continue to e the sur#i#ing analyst, an+ not ecome a colla se+analyst, in or+er that she coul+ +efuse the earlier fantasy that it ha+ een the intensity of her nee+for her mother that ha+ cause+ her mother to faint.

3he e#entual inter reti#e resolution ithin this session gre out of my a areness of the %ro(ecti&e identi ication %rocess then o erating. $ am un+erstan+ing this here as the ro+uct of interactional ressures u on the analyst, from the atient, hich are unconsciously aiming toe#o*e in him the un eara le feeling state hich the atient coul+ not on her o n yet containithin herself (cf% /g3en' 9"9# . $t is a matter for s eculation hether $ oul+ ha#e een so fullysu ?ecte+ to the necessary im act of this atient7s e: erience ha+ $ not first a roache+ the-uestion of ossi le hysical contact as an o en issue. a+ $ gone y the oo*, follo ing theclassical rule of no hysical contact un+er any circumstance, $ oul+ certainly ha#e een ta*ingthe safer course for me ut $ oul+ ro a ly then ha#e een accurately ercei#e+ y the atient asactually afrai+ e#en to consi+er such contact. $ am not sure that the re!li#ing of this early traumaoul+ ha#e een as real as it as to the atient, or in the en+ so thera eutically effecti#e, if $ ha+

een reser#ing myself throughout at that safer +istance of classical 7correctness7. $nstea+ $ acte+u on my intuition of the moment, an+ it is uncanny ho recisely an+ un ittingly this le+ me tore!enact ith the atient this +etail of the original trauma, hich she nee+e+ to e a le toe: erience ithin the analytic relationshi an+ to e genuinely angry a out. $t is this unconscious




res onsi#eness to communicati#e cues from the atient to hich San+ler refers in his ( 9"+# a er 7Countertransference an+ role!res onsi#eness7. innicott also s ea*s of this hen he says% 7$n theen+ the atient uses the analyst7s failures, often -uite small ones, erha s manoeu#re+ y the

atient an+ e ha#e to ut u ith eing in a limite+ conte:t misun+erstoo+. 3he o erati#efactor is that the atient no hates the analyst for the failure that originally came as anen#ironmental factor, outsi+e the infant7s area of omni otent control, ut that is no) stage+ in thetransference. So in the en+ e succee+ y failing<failing the atient7s ay. 3his is a long +istancefrom the sim le theory of cure y correcti#e e: erience7 ( 9+,1 , . 2@8).

ith regar+ to the reco#ere+ analytic hol+ing $ ish to a++ one further oint. ecause this asarri#e+ at e: erientially ith the atient, rather than y rule of thum , it ecame more than ?ust a

roof of the rightness of the classical osition concerning no hysical contact. 7 n route7 this ha+instea+ ac-uire+ a s ecificity to this atient hich, in my o inion, allo e+ a fuller re!li#ing of thisearly trauma than might other ise ha#e een ossi le.

$ shall conclu+e ith a -uotation from ion7s ( 9+ # a er 7A theory of thin*ing7. e says 7$f the infant ee#s Emy italicsF it is +ying it can arouse fears that it is +ying in the mother. A ell!

alance+ mother can acce t these an+ res on+ thera eutically% that is to say in a manner thatma*es the infant feel it is recei#ing its frightene+ ersonality ac* again ut in a form that it cantolerate<the fears are managea le y the infant ersonality. $f the mother cannot tolerate these

ro?ections the infant is re+uce+ to continue+ ro?ecti#e i+entification carrie+ out ith increasingforce an+ fre-uence7 ( . 11Gf). ion continues 7>ormal +e#elo ment follo s if the relationshi

et een infant an+ reast ermits the infant to ro?ect a feeling, say, that it is +ying into themother an+ to reintro?ect it after its so?ourn in the reast has ma+e it tolera le to theinfant syche. $f the ro?ection is not acce te+ y the mother the infant feels that its feeling that itis +ying is stri e+ of such meaning as it has. $t therefore reintro?ects, not a fear of +ying ma+etolera le, ut a nameless +rea+7 ( . 11').

$ *no that ion is here +escri ing an infant7s relationshi to the reast. >e#ertheless $ elie#ethat a similar rocess, at a later +e#elo mental stage, is illustrate+ in the clinical se-uence $ ha#e+escri e+. $ consi+er that it as my rea+iness to reser#e the restore+ sychoanalytical hol+ing, inthe face of consi+era le ressures u on me to relin-uish it, hich e#entually ena le+ my atientto recei#e her o n frightene+ ersonality ac* again in a form that she coul+ tolerate. a+ $resorte+ to the hysical hol+ing that she +eman+e+ the central trauma oul+ ha#e remaine+fro en, an+ coul+ ha#e een regar+e+ as erha s for e#er unmanagea le. 3he atient oul+ thenha#e reintro?ecte+, not a fear of +ying ma+e tolera le, ut instea+ a nameless +rea+.

S.44AR53he atient +escri e+ in this clinical resentation ha+ een seriously scal+e+ hen she as 15

months ol+. At the age of 1& months she ha+ een o erate+ on (un+er local anaesthetic) to releasescar tissue from the surroun+ing s*in. During this the atient7s mother ha+ fainte+. $n re!li#ing thise: erience, of eing left alone ith the surgeon ho continue+ to o erate on her regar+less of themother7s a sence, the atient as*e+ an+ later +eman+e+ to e allo e+ to hol+ the analyst7s han+ if the an:iety ere to ecome too intolera le to ear. ithout this ossi ility she felt she oul+ ha#eto terminate the analysis. $n consi+ering this +eman+ the analyst +eci+e+ that it oul+ amount to acollusi#e a#oi+ance of the central as ect of the original trauma, the a sence of the mother7s han+safter she ha+ fainte+. 3he restoration of the analytic 7hol+ing7, ithout any hysical contact, an+




the e#entual resolution of the near!+elusional transference at this time in the analysis is e:amine+in +etail. 3he inter retation hich e#entually ro#e+ effecti#e in restoring contact ith the

atient7s rea+iness to continue ith the analysis emerge+ from a close follo ing of thecountertransference res onses to the atient an+ the ro?ecti#e!i+entificatory ressures u on theanalyst +uring the clinical se-uence +escri e+.

RE6ERE0CESA"$>3, 0. 19@2 >e eginning an+ the aranoi+ an+ +e ressi#e syn+romes $n alint 19@2 .

245!2G978A"$>3, 0. 19@2 Primary "o#e an+ Psycho!analytic 3echni-ue "on+on% 3a#istoc* 19'@ 78A"$>3, 0. 19'8 3he asic ;ault "on+on% 3a#istoc*. 78$/>, . . 19'2 A theory of thin*ing $n ion 19'& . 115!119$/>, . . 19'& Secon+ 3houghts >e Bor*% Jason Aronson, 19&&$SS" , H. . 19@4 3he effect of the structure of the ego on sychoanalytic techni-ue J. Am.

Psychoanal. Assoc. 1%15G!1G478

"$33" , 0. 19@& 7 7<3he analyst7s total res onse to his atient7s nee+s Int! *! Ps+choana#! 48%2G5!2@G78"$33" , 0. 19@8 /n +elusional transference Int! *! Ps+choana#! 49%14G!14878/ID >, 3. 19&9 /n ro?ecti#e i+entification Int! *! Ps+choana#! '5%4@&!4&478ACH , . 19'8 3ransference an+ Countertransference "on+on% ogarth Press. 78SA>D" , J. 19&' Countertransference an+ role!res onsi#eness Int! *! Ps+choana#! . 4%G4!G&78$>>$C/33, D. . 19@Ga ith+ra al an+ regression $n innicott 19@8 . 2@@!2'1$>>$C/33, D. . 19@G 0eta sychological an+ clinical as ects of regression ithin the sycho!

analytical set!u $n innicott 19@8 . 2&8!29G$>>$C/33, D. . 19@8 Collecte+ Pa ers. 3hrough Pae+iatrics to Psycho!Analysis "on+on%

3a#istoc*. 78

$>>$C/33, D. . 19'2 go integration in chil+ +e#elo ment $n innicott 19'@ . @'!'4$>>$C/33, D. . 19'4a Psychiatric +isor+er in terms of infantile maturational rocesses $ninnicott 19'@ . 245!2G1

$>>$C/33, D. . 19'4 De en+ence in infant!care, in chil+!care, an+ in the sycho!analyticalsetting $n innicott 19'@ . 2G9!2@9

$>>$C/33, D. . 19'@ 3he 0aturational Processes an+ the ;acilitating n#ironment "on+on%ogarth Press. 78

$>>$C/33, D. . 19&5 ;ear of rea*+o n Int! *! Ps+choana#! . 1%154!15& 19&G78

Article Citation 7)ho Cite3 ThisCasement' P%;% (1982). Some Pressures on the Analyst for Physical Contact During the e!"i#ing of

an arly 3rauma. Int! Re&! Ps+cho$Ana#!, 9%2&9!28'

http://www.pep-web.org/document.php?id=zbk.033.0001a



http://www.pep-web.org/document.php?id=apa.001.0104a

http://www.pep-web.org/document.php?id=ijp.038.0240a



http://www.pep-web.org/document.php?id=ipl.073.0001a




http://www.pep-web.org/document.php?id=irp.001.0103a

http://www.pep-web.org/search.php?whocitedthis=irp.009.0279a




http://www.pep-web.org/document.php?id=apa.001.0104a








http://www.pep-web.org/document.php?id=irp.001.0103a

http://www.pep-web.org/search.php?whocitedthis=irp.009.0279a

casement - some pressures on the analyst

Documents