Academic journal article International Journal of Psychoanalysis

Truth as a Way of Developing and Preserving the Space for Thinking in the Minds of the Patient and the Analyst

Academic journal article International Journal of Psychoanalysis

Truth as a Way of Developing and Preserving the Space for Thinking in the Minds of the Patient and the Analyst

Article excerpt

Clinical material from the analysis of a young patient diagnosed with borderline personality disorder and heavily dependent on drugs was examined to identify changes in setting that may be necessary to enable the psychoanalytical treatment of this type of patient. The article describes a lack of truth in the patient's life and the absence of a good enough space for thinking in her mind. In order to enhance the development of the capacity for symbolization in the patient's mind, the analyst had to become an object the patient needed. In order to do this the analyst had to manage setting alteration. Theoretical frameworks proposed by Ferenczi, Winnicott and Bion were used to guide the psychoanalyst's approach to this patient. The survival of the capacity for thinking psychoanalytically inside the analyst's mind when the setting has been significantly distorted by the disruptive behavior of the patient is guaranteed by the trueness of their link. It is suggested that maybe this is decisive for a successful psychoanalytical treatment of this type of patient.

Keywords: abstinence, borderline personality disorder, borderline transference, changes in setting, neutrality, substance-related disorder / drug addiction, truth in the analytic pair

There is a group of patients whose significance derives not only from their numbers in today's psychoanalytical consulting rooms, but also and chiefly from the difficulties and technical issues they raise for the psychoanalyst who is willing to treat them. They are often adolescents or young adults. Their pathological characteristics do not always allow them to be placed within standard frameworks of psychoanalysis, but they seek help and have a deep desire to find relief from their suffering. Many have an intuitive understanding of the analytical process, even if they have never been in analysis. The analytical function of their personalities (Bion, 1975, p. 89; Chuster, 2001) is capable of good development, and for this reason analytical treatment is worthwhile, even if it is long and troubled. These individuals are satisfying for the analyst because they improve under appropriate treatment. This group probably includes patients with a range of borderline characteristics such as those who are drug-addicted, young anorexic women, and young individuals with antisocial, psychosomatic, narcissistic and severely neurotic behavior.

One of the main features of these patients is the absence of a welldeveloped symbolic capacity. Since the patient's space for thinking does not exist in a consistent form, that of the analyst must remain intact - particularly when the obstacles to the maintenance of the analytical setting threaten the survival of the process. These people present a significant intolerance to frustration. This intolerance "extends to an intolerance of reality; since modification of reality is precluded by the state of mind itself, the hate is directed against the mental apparatus on which awareness of reality depends" (Bion, 1992, p. 246). The analyst's mental apparatus and in consequence his / her capacity for thought are intensively attacked. Many adaptations on the setting can be required to contain the destructiveness that these people present. But inside the psychoanalyst's mind, the setting has to be preserved as a way of keeping his / her capacity for thinking intact.

Such patients have never been absent from analyst consulting rooms, but they seem to be more common now. Since Freud's time, it has been possible to identify limitations in the approach used with these patients; Ferenczi can be cited as one of the pioneers in dealing with the technical aspects involved in their treatment. The elastic technique for patients who are very resistant to the habitual approach, proposed by Ferenczi (1928), shows his concern with being able to deal with the communications of these patients, who are so difficult to treat using conventional techniques. For Ferenczi, the hereand- now relationship of the patient with the analyst was as important as the memories relived within the transferential relationship, and the cure would take place on the basis of this new emotional contact. …

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