Academic journal article Contemporary Psychoanalytic Studies

One: Understanding Psychic Shifts

Academic journal article Contemporary Psychoanalytic Studies

One: Understanding Psychic Shifts

Article excerpt

In trying to understand a patient's progress, stagnation, or decline over time, many factors come into play from a psychoanalytic perspective. The nature of the patient's interaction with external objects is important and the impact of projection and identification is critical. How the patient uses or misuses his or her objects is helpful to explore as well in terms of whether phantasy objects are seen as helpful, loving, and forgiving, or unpredictable, unavailable, or simply a source of gratification. The nature of the patient's primary defensive systems, pathological organizations (Rosenfeld, 1987; Steiner, 1990), and psychic retreats (Steiner, 1993, 201 1) are important to examine as the findings help explain how viable change can be embraced or to what degree change will be avoided and resisted.

All these factors can be investigated through an analysis of the genetic, historical experiences the patient has had and how the patient has organized and filtered these experiences. The clinically vital parallel to this is the psychological patterns that emerge within the transference situation. The analyst observes and interprets how patients own and present their past, how they play out that past experience with the analyst, and how they react to establishing analytic contact (Waska, 2007, 2010, 2011) and working through their conflicts. As patients emerge from their psychological conflicts and depart from the therapeutic relationship, first by an emotional separation and then a literal separation, they must be self-sustaining yet dependent on others as well. They must be able to function and relate in a healthy and reciprocal manner with others, internally and externally. How patients are able or unable to successfully claim their lives as their own, separate from the desperate object relational phantasy struggles they have been a prisoner to, defines when termination is near.

CASE MATERIAL: MY TIME WITH C

After two years of seeing me in once-a-week psychoanalytic treatment with occasional twice-a-week sessions, C came in and told me, "I have been doing a lot of thinking about our work together and I think this will be my last day. At least for a while. Today is the day I want to stop. I feel we have really accomplished a great deal. There have been many changes and I feel I have improved in so many important ways. I have grown and you have really helped me get there. I listen to what you say and it has really made a difference."

During the rest of the session, C summarized how he felt he had changed. I wasn't completely surprised by his announcement because there were indications over the previous few months of his wanting to try out his "own new wings" and "no longer feeling like [he was] living in a crisis state."

However, it was still somewhat sudden, and C looked somewhat nervous telling me about it, "hoping I agree with it." When I asked him about this aspect of it, he told me he "still worried about what I thought but also was able to have his own mindset and not give it up or hide it if he thought I was not in agreement." This was indeed a major change in Cs internal experience of himself and his objects. He could trust in his own mind and risk expressing himself while trusting that his objects would not be hurt or retaliate if they felt differently.

C came to see me two years prior at the insistence of his third wife. She was convinced he was cheating on her and at the very least was sure he was "on the verge of straying" due to what she said was his "constant flirting with every woman who comes into our restaurant." C had left his first wife for his secretary, and after several years of marriage to her, he had an affair with his current wife. During the course ofthat now nine-year marriage, C had been caught by his wife downloading nude pictures of someone he met online. As a result, she demanded he "take his sick mind and find help or else." C came in and told me, "I need help with what my wife calls my perversions and my sexual addictions. …

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