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The following response to discussions by Benjamin and by Fonagy and Target focuses on several issues raised, including linearity versus multiplicity in the assessment of developmental capacities, the complex interplay of shame and subjectivity in an intersubjective field, the notion of surrender in resolving therapeutic impasse, and some thoughts on the concept of the third, as they are exemplified in this case material.
What allows us to explain the repetitive cycles of self-destructive, self-defeating behavior that we all struggle to help patients overcome? What explains the malignancy that can infuse certain transference – countertransference relationships, often suddenly and without warning? Why do some patients come to hate us despite our best efforts? Why do we come to hate some of them? Perhaps more to the point of this paper, why do we come to hate that version of ourselves that emerges when we are with them? This paper explores these questions, examining the issues of repetition and repair with regard to our most toxic introjects – the patients' and our own. Whereas Melanie Klein helped us to understand why we come to hate that which is good in others, this author explores the complementary question of how loving that which is bad in others keeps the self innocent, good, and sane. A fundamental dissociative split in two necessary but incompatible self–other organizations is posed. With reference to a detailed clinical example, the author investigates how the evocation of intensely shame-riddled bad self representations in both the patient and the analyst can perpetuate a need to provoke, find, and sustain that badness clearly in the psychic domain of the other, blocking entry into certain necessary therapeutic enactments that may therefore fail to occur. Both self – other organizations must occur, first in oscillating moments and ultimately in simultaneous awareness, in order for the analytic work to proceed.
The silent patient
(2004)
This commentary is a response to questions and discussion points raised by Peter Fonagy and Mary Target in >Playing with the Reality of Analytic Love.< It includes a discussion of the relationship between attachment and sexuality, in addition to issues concerning seductiveness, sadomasochism and therapeutic change.